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Query: UMLS:C0745411 (irregular bleeding)
 386 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The menstrual patterns of women using subdermal implants of levonorgestrel and norgestrienone included in a double-blind clinical trial was evaluated by the method developed by the International Committee on Contraception Research. Women using Copper T200 randomly selected in the same clinics were used as controls. Both implant regimens were associated with a high frequency of reduced bleeding and norgestrel patients had also a high proportion of increased and irregular bleeding. Termination of use was associated to increased bleeding but not so much to reduced bleeding.
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PMID:Long acting contraceptive implants. An analysis of menstrual bleeding patterns. 36 47

Clinical experiences with the copper-7-IUD (Gravigard) in 258 women aged 16-42 years are reported. 45% of the patients were nulliparous women. Follow-up was possible in 236 cases, a total of 2717 women-months ( average of 11.5 woman-months per patient). 5 unwanted pregnancies (Pear l-Index of 2.3) were seen. Partial or total expulsion occurred in 27 cases (11%). 14 of 27 expulsions were noticed within the first 2 months after insertion. Removals for medical reasons were requested in 36 cases; in the majority (26 cases) because of bleeding and pain. 13 women desired removal of the IUD in order to get either pregnant or sterilized. The continuation rate after 2 years was 73%. The highest number of dropouts occurred within the 1st year after insertion (60 cases=23%) whereas only 4% dropouts occurred in the 2nd year. The low continuation rate might be partially due to the high number of physicians (19) participating in this study. The most important side effects of the copper-7-IUD in situ were irregular bleeding, intermenstr ual pain, and discharge. Irregular bleeding and pain decreased markedly after the 1st year, while slightly prolonged periods persisted in 30-50% of all patients. Compared with oral contraceptives, copper IUDs have less severe side effects but also less safety - especially for the younger fertile age group. Therefore they should be offered to young nulliparous women only for a limited period of time.
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PMID:[Copper-7 intrauterine device (Gravigard). Report of experience]. 96 14

This literature review compares the merits and disadvantages of the levonorgestrel-releasing IUD made by Leiras Pharmaceuticals, Turkey, Finland (LNG-IUD-20), with the Nova-T, Copper-T (TCu) and 220C, and Copper-T-38-Ag (TCu-380Ag). This IUD releases 20 mcg levonorgestrel daily from a Silastic sleeve on the vertical shaft containing 52 mg. The plasma level stabilized after a month at about 0.2 ng/ml, about half as high as that seen with Norplant implants. It is identical in size to the Nova-T. The Cu-T IUDs differ with respect to copper wire or sleeves, or silver-cored wire. The chief studies reviewed here were 2 multi-center trails primarily in European countries, and a 2 large multi-center trials in India. Cumulative pregnancy rates were 0.0 to 0.6 per 100 users for the LNG IUD, compared to slightly higher failures for inert or copper IUDs. While removal rates for bleeding, pain and pelvic inflammatory disease were lower for the LNG-IUD-20, removals for oligomenorrhea, amenorrhea and hormonal side effects were higher than for the other IUDS. In the Indian trials, removals for amenorrhea and irregular bleeding were much higher than rates reported in the European studies, resulting in significantly lower continuation rates overall. The results pointed to district benefits for the LNG-IUD-20, such as lower blood loss and anemia, relief of dysmenorrhea and menorrhagia, as well as possible lower risks of ectopic pregnancy in case of failure, less PID (pelvic inflammatory disease), and the claim by the maker that strictly correct placement is not necessary. Disadvantages of the LNG-IUD-20 are more difficult insertion due to the wider diameter; oligomenorrhea, amenorrhea and irregular bleeding; hormonal side effects such as acne, weight gain, nausea, headache and breast tension; and potential risk of functional ovarian cysts. The LNG-IUD-20 is considered comparable to copper IUDs in effectiveness, safety, longevity, and return to fertility after removal. Users should be counseled that the oligomenorrhea or amenorrhea is neither a medical problem or indicative of infertility, is common for the 1st 2 months, is reversible on removal, may signal an improved hemoglobin profile, relief of dysmenorrhea, and may be preferred to heavy bleeding from other IUDS. The program implications of this IUD are potential lower incidence of ectopic pregnancy and PID. The effect of its use on breast feeding, cost-effectiveness compared to Norplant, in-country manufacture, and cultural acceptance need to be determined in specific locales.
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PMID:An evaluation of the levonorgestrel-releasing IUD: its advantages and disadvantages when compared to the copper-releasing IUDs. 177 15

A total of 1905 subjects were randomly allocated to four types of intrauterine devices (IUDs) and were observed for 45,683 woman-months of use. While no method failure was observed with levonorgestrel (LNG) IUD, 11 women became pregnant with other devices; 4 with Copper T 380Ag, 1 with Copper T 220C, and 6 while using Copper T 200B, indicating method failure rates of 1.0, 0.3 and 1.6, respectively, at 36 months of use. These rates were within acceptable range. Continuation rates were significantly lower with LNG IUD (74.5, 58.7, 38.8 at 1 year, 2 years and 3 years, respectively) as compared to other copper devices, which ranged between 82.4 to 84.4 at 1 year, 66.6 to 69.9 at 2 years and 45.4 to 50.4 at 3 years. The difference in continuation rates was mainly due to menstrual disturbances (e.g. amenorrhoea, irregular bleeding) which were higher with LNG IUD (27.9 per 100 users) as compared to the copper devices (13.4-15.4 per 100 users) at 36 months of use. The risk of expulsion ranged between 8.3 to 10.6 per 100 users and was comparable for all the devices. The observations from the present study based on 36 months of experience with different intrauterine devices do not indicate the need to replace CuT 200, the device currently in use in the National Programme.
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PMID:Randomized clinical trial with intrauterine devices (levonorgestrel intrauterine device (LNG), CuT 380Ag, CuT 220C and CuT 200B). A 36-month study. Indian Council of Medical Research Task Force on IUD. 249 81

A table lists the commonly used methods of reversible contraception, their mechanism of action, and some adverse effects -- oral contraceptives (OCs), combined and progestin only; IUDs; the condom; diaphragm with spermicide; cervical cap with spermicide; sponge with spermicide; spermicide; periodic abstinence; and medroxyprogesterone acetate. The progestin-only OCs have a higher failure rate than the combined OCs and may cause irregular bleeding. Their principal indication is for nursing mothers who want to use an OC. To minimize the risk of cardiovascular adverse effects, OCs containing 35 mcg of estrogen or less and a low dose of a progestin are preferred. Most studies have found no overall increase in the incidence of breast cancer in women using OCs, but the possibility remains that the incidence may be increased in some subgroups. The 2 IUDs now marketed in the US -- the Progestasert and the Copper T380A both have a T shape and are medicated. The increased risk of pelvic inflammatory disease associated with IUDs was limited to the 1st few months after insertion in 1 study of 472 women using IUDs other than the Dalkon Shield. The increased risk of ectopic pregnancy appears to be lower with copper-containing devices than with the Progestasert. The advantages of condom use include safety and protection against sexually transmitted diseases, including Acquired Immune Deficiency Syndrome (AIDS). Diaphragms, which also offer some increased protection against sexually transmitted diseases, have been associated with an increased risk of urinary tract infection. The cervical cap, a smaller device than the diaphragm, can be left in place for 48 hours without adding more spermicide and is less messy to use than the diaphragm. The vaginal contraceptive sponge can protect during multiple acts of coitus over a 24-hour period. Nonoxynol-9, the most common spermicide used in the US, is a chemical surfactant that destroys the cell walls of sperm and offers some protection against sexually transmitted diseases. Women with irregular menstrual periods have the greatest risk of failure with periodic abstinence. Medroxyprogesterone acetate is not approved by the US Food and Drug Administration for contraceptive use.
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PMID:Choice of contraceptives. 297 98

The mechanism of action of intrauterine devices varies from one type of device to another, although the principle of action is the same, namely, to interfere with the physiology of reproduction at the endometrial level. The biochemical changes of the endometrial tissue and the composition of the uterine fluid have been reviewed in relation to the use of inert, copper-medicated and steroid-releasing IUDs. All IUDs, whether inert or medicated, provoke a significant increase in the number of neutrophils, mononuclear cells and plasma cells, the presence of which is unrelated to the tissue infiltration of inflammatory cells occurring pre-menstrually of the normal menstrual cycle. The increase of leucocytes in IUD-users is compatible with a foreign body reaction which may be related to the antifertility effect. The addition of copper to an inert IUD has been shown to significantly alter the metabolism of the endometrial cells, e.g. the enzymatic activity and the DOVA-synthesis. The steroid-medicated IUDs represent a new approach to intrauterine contraception where the morphology of the endometrium is considerably altered, showing massive decidual changes, atrophic glands and sometimes atrophy of the whole functional layer. In addition, there is an important foreign body reaction, similar to that of the inert IUDs. The enzymatic activity, as well as the proliferative activity was significantly altered in the endometrium of these IUD-users. Changes in the endometrial fibrinolytic activity in IUD-users have been demonstrated to be related to the presence of irregular bleeding. Micro-traumata of the endometrium and the increased fibrinolytic activity may also interfere with the protective processes present in the physiologically normal endometrium. Further studies on the factors influencing the fertilizing ability of the spermatozoa in the female genital tract, as well as on the conditions of the human endometrium required for the implantation of a blastocyst, may yield important information for the improvement of intrauterine contraception.
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PMID:Mechanism of action of intrauterine devices: biochemical changes. 331 20

The bacterial flora of the cervix and vagina were examined in 108 patients who had copper IUDs removed and in 66 controls at the Maternity Hospital and Maternal Welfare Clinics in Kuwait. The IUDs removed were the Nova-T, Copper 7, and Cu 250. 15 of the women having IUDs removed had pelvic inflammatory disease; 21 had irregular bleeding; 11 had suprapubic pain, vaginal discharge, or uterine perforation; and 51 were asymptomatic. Actinomyces species, particularly Actinomyces israelii, and Arachnia propionica were isolated from 16 of the IUD wearers but only 2 of the controls. Lactobacillus species were isolated from 10 of the IUD wearers and 25 of the controls. Anaerobic cocci were isolated from 13 device wearers and 12 controls. Except for Actinomyces, anaerobic bacteria were isolated from controls more often than from the IUD wearers. Copper is known to have an antibacterial effect on gram-positive anaerobes, and even Actinomyces was absent from IUD wearers who had worn the device less than a year, i.e., during the period of maximum copper release. Moreover, no significant difference was found in the patients in the different clinical groups. The presence of an IUD does promote colonization of the genital tract by Actinomyces. However, other factors must be considered in the development of pelvic inflammatory disease. The creation of an acidic environment by some bacteria, such as Lactobacillus, may promote the growth of some pathogens, while inhibiting the growth of others. Furthermore, the insertion of an IUD breaches the protective barrier of the cervical mucus, and the IUD tail creates a transmission link into the uterus.
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PMID:The effect of a copper intra-uterine contraceptive device on the microbial ecology of the female genital tract. 335 91

Among the advantages of IUDs are the device's high continuation rate, the lack of systemic side effects, and the absence of a need for continual motivation to practice contraception. The effectiveness of plastic IUDs is directly proportional to their surface area, but the degree of excessive bleeding experienced is inversely related to device size. Thus, devices represent a compromise between large size for effectiveness and small size for acceptability. The optimum time to fit an IUD is during the 1st hald of the menstrual cycle. Absolute contraindications to IUD use include the presence of active pelvic inflammatory disease, undiagnosed irregular bleeding, a history of ectopic pregnancy or tubal surgery, and a distorted uteine cavity. Failure rates associated with IUD use range from 2-3% in the 1st year and then decrease. Since the main mechanism of action appears to be production of a sterile inflammatory reaction in the uterine cavity, the IUD prevents intrauterine pregnancy more effectively than ectopic pregnancy. Nonetheless, there is little evidence to suggest that IUD use actually increases the incidence of ectopic pregnancy. Resumption of fertility after IUD removal is not delayed. There is not need to change inert plastic IUDs in women who remain symptom free. The copper devices should be changed every 3-4 years. A search is under way for antifertility agents that can be incorporated into the device to reduce side effects. In general, the IUD is most suitable for older, parous women.
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PMID:Intra-uterine contraceptive devices. 401 70

Postcoital contraceptives, the so-called "morning after pill," are agents used as emergency treatment to prevent pregnancy after unprotected intercourse or contraceptive accidents. In the 1960s and early 1970s high doses of estrogens were used in 5-day courses such as diethylstilbestrol 25-50 mg a day or ethinyl estradiol 0.5-5 mg a day begun within 72 hours after coitus. Although effective, a considerable drawback of the associated nausea and vomiting as well as an increased risk of menstrual disturbance during the treatment cycle. Norgestrel alone in various dosages has been used postcoitally. Quingestanol has been used as a continuing postcoital agent in Latin America but proved unacceptable owing to nausea and irregular bleeding. In China "visiting pills" have been devised containing anordrin. In the West regimens of this sort have been superseded by the Yuzpe treatment of 100 mcg ethinylestradiol and 0.5 mg levonorgestrel initially, repeated after precisely 12 hours. The treatment must be initiated within 72 hours of exposure. Postcoital contraceptives act by combinations of mechanisms--the function of the corpus luteum is disrupted, tubal motility may be affected, and changes in endometrial biochemistry prevent ovoimplantation. In a multicenter trial involving 602 women Yuzpe reported a pregnancy rate of 1.6%. Other workers show comparable figures of 0-3%. The primary side effects of the current hormonal method are nausea, which occurs in 61% of cases, and vomiting, 20% of cases. Both are mild and of short duration. All postcoital methods carry a risk of ectopic pregnancy should the treatment fail. 3 ectopic pregnancies were recorded with diethylstilbestrol and 1 recently with the Yuzpe regimen. There have been no reports of thromboembolic complications. If a hormonal form of postcoital treatment fails, the theoretical possibility of the pregnancy being harmed cannot be ruled out. The patient needs to be counseled about this, and careful records should be kept. Also important is the taking of an accurate menstrual and coital history to exclude exposures earlier in the menstrual cycle. Lippes and coworkers showed the efficacy of copper IUDs as postcoital agents. These can be used up to 5 days from intercourse. An IUD is preferred if hormones are contraindictated, if exposure was more than 72 hours beforehand, if the woman desires the most effective method, and if she wants the IUD for longterm contraception. Postcoital contraception, however defined, raises ethical questions. Postcoital methods could be classed as contraceptive rather than abortive within the maximum period (defined by medical scientific consensus) that may elapse between intercourse and nidation.
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PMID:Postcoital contraception. 613 82

A 43 year old woman, gravida 2, with a Lippes Loop IUD for 4 years presented herself at the family planning clinic of the New York Medical College in New York City complaining of intermittent spotting for 4 months. In her 2 previous clinic visits, clinic staff assured her that this bleeding was a result of the IUD. Upon examination during her 3rd visit for the same complaint, however, the physician noted an enlarged uterus with an irregular contour. The loop was removed and sent for a pathologic examination which showed a grade 1 adenocarcinoma of the endometrium. After confirming the diagnosis with a fractional curettage, the patient had a total abdominal hysterectomy with bilateral salpingo-oophorectomy. As of April 1980 there was no evidence of recurrence. Another woman, a 24 year old, gravida 4, had been followed by the same clinic for 3 months. On her 1st visit a health professional inserted a Copper 7 IUD, even though the health professional noted a cervical erosion. In addition, her Pap smear was not satisfactory. She missed her next appointment, but did attend the clinic 3 months later because of irregular bleeding. Staff removed the IUD and then reevaluated her. Due to the friability and abnormal appearance of her cervix, she had a colposcopy and the physician noted abnormal vessels in a large lesion, compatible with invasive cancer of the cervix. A biopsy and a laparotomy confirmed the physician's preliminary diagnosis. She was treated with radiotherapy, but her condition deteriorated quickly. Immunotherapy was unsuccessful, and she died 1 year after the initial diagnosis. Although abnormal bleeding in IUD users is common, health professionals must always consider the possibility of malignancy.
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PMID:Recognizing malignancy in intrauterine contraceptive device users. 736 45


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