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Intrauterine contraceptive devices (IUDs) removed from 50 Igbo women were subjected to bacteriologic studies. High vaginal swabs from the women were cultured simultaneously. In 49 of the 50 IUDs, the culture was negative. The author concludes that the African IUD wearer, like her Caucasian peer, can safely combat any bacterial nidus introduced during device insertion.
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Premature removal of contraceptive implants (Norplant [levonorgestrel implants], Wyeth-Ayerst Laboratories, Philadelphia, Pennsylvania) is a cause of a sizable national medical expenditure in the United States. Understanding the factors that influence the decision to remove the implants and being able to predict which users are likely to elect discontinuation prematurely could provide useful information for counseling patients as they are considering contraceptive implants so that potentially enormous long-term savings could be achieved. This study surveyed 98 women who had Norplant inserted and removed between January 1991 and December 1994. Data were collected from chart review, and when necessary, a questionnaire was used to extract information not found in the chart. The chi-squared statistic and t-test were used to compare demographic variables. All but one subject received comprehensive pre-implant counseling. The main reason given for electively removing the Norplant prematurely was irregular menstrual bleeding (60%). Pre-implant counseling did not influence the decision for removal. These results indicate the importance of clarifying patients' doubts regarding menstrual bleeding irregularities during follow-up visits rather than relying on the information patients received during preimplant counseling.
OBJECTIVE: To investigate the experience of the users of a levonorgestrel-releasing contraceptive implant (Nor-plant) and reasons for early removal. STUDY DESIGN: Two hundred fifty-one women who had Norplant placed through the Ohio State University Department of Obstetrics and Gynecology were sent a questionnaire that included general demographic questions and questions regarding preplacement education; reasons for choosing Norplant; problems experienced due to Norplant; reasons for removal, if applicable; and overall satisfaction. RESULTS: One hundred eleven questionnaires (44%) were completed and analyzed. Twenty-four (21.6%) of patients had Norplant removed, 32 (28.8%) planned on early removal, and 55 (49.5%) desired continued use. Ninety-eight percent of women who planned continued use of Norplant had received reading material as part of their preplacement counseling and 95% felt adequately counseled. This is significantly higher than women who had Norplant removed or planned on early removal. Convenience, problems with other contraceptive methods and effectiveness were the most important reasons why patients chose Norplant. Menstrual changes were the most common side effect, experienced by 80% of all women in the study. Weight gain, headache, mood changes, mastalgia and acne were also frequently reported. Women who had Norplant removed were significantly more likely to have experienced dizziness when compared to women desiring continued use. Women planning early removal were also more likely to have experienced dizziness in addition to acne, headache, hair loss and other side effects. Menstrual irregularities, followed by mood changes and headaches, were the most important side effects associated with early Norplant removal. Overall, 68% of users were at least somewhat satisfied with Norplant. CONCLUSION: Norplant contraception was a satisfactory form of birth control for the majority of patients in the study despite the frequent occurrence of side effects. Reading material regarding benefits and side effects of Norplant is an important aspect of patient counseling and may improve long-term use of Norplant.
Norplant implants can be removed easily, if inserted properly. When they are inserted deeply and can not be palpated, or if they are located close to the neurovascular structures of the upper arm, radiological guidance may be needed to locate and remove the implants without causing injury to the surrounding vital structures. Digital subtraction fluoroscopic guidance is helpful in removing deeply located contraceptive implants and those that are close to the neurovascular structures, where blind removal may result in injury to those structures. We describe a case in which an implant that was located close to a major nerve near the axilla was removed under digital subtraction fluoroscopic guidance.
The continuation rate at the end of this five-year clinical study was 60% with no accidental pregnancy occurring throughout the five years. The post-removal conception rate in women desiring pregnancy was 92% at the end of two years. The majority of acceptors described the overall experience with the implants as favourable. In fact, 75% of the women planning to use contraception after removal of the implants were going to use implants again.
The case of a 26-year-old women on oral contraceptives who developed a benign liver cell adenoma that was successfully resected is reported. She continued on her oral medication and developed a recurrence 3 years later. On her second laparotomy, the liver tumor was merely biopsied and not removed. Oral contraceptive use was continued for an additional 3 years and then stopped. The tumor has regressed and is no longer palpable or diagnosable. The patient continues to be well 9 years following her first surgical procedure.
All steroid hormones are structurally similar, but relatively minor differences cause profound alterations in biochemical activity. The 21-carbon series (pregnane nucleus) includes the corticoids and the true progestins (e.g., medroxyprogesterone acetate). The 19-carbon series (androstane nucleus) includes all the androgens, among them the progestins used in most oral and parenteral contraceptives. The removal of carbon 19 from testosterone changes the major hormonal effect from androgenic to progestogenic, but these "19-nor" steroids retain varying degrees of androgenic activity. (They can also have limited estrogenic activity, but this is insignificant at the low doses used for contraception.) Some of the 19-nortestosterone progestins are metabolized to other compounds (e.g., norethynodrel, ethynodiol diacetate, and lynestrenol to norethindrone), and some (levonorgestrel, desogestrel) are active unchanged. The lingering androgenic effects of 19-nor progestins are dose-related, opposed by estrogen, and are manifested metabolically (e.g., glucose tolerance, lipoprotein synthesis) and symptomatically (e.g., acne, weight gain). The effect of 19-nortestosterones on lipoproteins prompted the development of less androgenic compounds, but the obvious benefit of the new progestins (desogestrel, gestodene, norgestimate) is a reduction in the symptoms associated with the androgenicity of the older compounds. Mitigation of androgenic effects on lipoprotein and carbohydrate metabolism could have long-term benefits, especially for women who are at risk of arteriosclerotic vascular disease; however, these effects remain to be epidemiologically demonstrated.
The purpose of this study was to determine the efficacy of the TCu380A (GYNET 380 IUD) in long-term users for periods of > 5 years and to obtain the incidence of Actinomyces as related to length of use and reasons for removal. The report is a retrospective descriptive study of all the clinical cases (n = 370 patients) at the Municipal Family Planning Centre-SERGAS A Coruña, Spain, of women who had a TCu380A IUD inserted during the period 1988-1989 with a September 1997 cutoff date for data analysis. A total of 271 (73.5%) patients had been using the TCu380A IUD for > 5 years with 100% efficacy. The accumulated incidence of Actinomyces was 5.9% (CI 95%: 3.8-8.9). The highest incidence was found between the second and third year of use. There was no increase in the incidence of Actinomyces after 5 years of use. The most common reason for removal of the IUD was the duration of use of 8 years with the same device (32.3%).
The significance of the location of intrauterine contraceptive device in relation to the gestational sac on pregnancy outcome was studied in 13 pregnant women after extraction of the device. Of the seven women (group 1) who had the intrauterine contraceptive device removed after initial localization by sonography, two (28.5%) miscarried. In both cases the device was located cephalad or lateral to the gestational sac. In six women (group 2) continuous sonographic scanning was undertaken to visualize the extraction procedure. Traction on an intrauterine device located laterally (two cases) or cephalad (one case) to the gestational sac was followed by distortion of the sac configuration. Gentle intermittent traction on the contraceptive device resulted in successful extraction procedure. These preliminary observations suggest that pregnancies with an intrauterine contraceptive device located laterally or cephalad to the gestational sac are at greater risk during extraction of the device. Sonographic monitoring of the extraction procedure during pregnancy may minimize the hazards of intrauterine contraceptive device failure.
From 4%-14% of intrauterine device (IUD) users have their IUD removed due to bleeding or pelvic pain in the first year of use. Past studies have analyzed whether baseline patient information can help predict such removals, but no previous analysis has examined whether information provided at the recommended 1-month follow-up visit could improve such predictions. Using data from an international multicenter randomized controlled trial, 89 women with removals for bleeding and pain after the 1-month visit were compared with 2536 continuing users. Logistic regression indicated several significant predictors of removal. Women reporting intermenstrual bleeding since last menses were nearly three times more likely to have removals for bleeding or pain (odds ratio [OR] 2.9; 95% confidence interval [CI] 1.4-5.9). Similarly, those complaining of excessive menstrual flow were 3.5 times more likely to have removals within 12 months (95% CI 1.4-9.2). Women reporting these menstrual problems during scheduled revisits may benefit from counseling and treatment with nonsteroidal anti-inflammatory drugs (NSAID).
OBJECTIVE: To determine whether a profile can be developed to indicate which clients are the best candidates for Norplant by describing the characteristics of clients who use this contraceptive for 5 years and those who have it removed early. DESIGN: A descriptive study of data collected from a convenience sample. SELLING: A state-supported university hospital's obstetric and gynecology outpatient clinic serving primarily indigent clients in the southern United States. PARTICIPANTS: Women (N = 256), primarily with low incomes, being seen for removal of Norplant contraceptive capsules. Of these, 166 women had completed the recommended 5 years. MAIN OUTCOME MEASURES: Characteristics of the clients who retained the contraceptive for the recommended 5 years and characteristics of clients who came for early removal. RESULTS: Clients who retained the contraceptive for 5 years differed from those who did not on only three characteristics: race, age, and parity. No significant differences were found in education or marital status. CONCLUSIONS: No clear profile of successful Norplant users emerged. Instead, thorough counseling of each individual is essential to the client's completion of 5 years with Norplant. Advantages and disadvantages must be explained and the client's tolerance of possible side effects must be assessed, thereby helping the client to make an informed choice.
The surface deposits on stainless steel contraceptive devices removed from the uterus after various periods of insertion were examined and analyzed by means of scanning electron microscopy, X-ray energy dispersive analysis, Augar electron spectroscopy, X-ray photoelectron spectroscopy, transmission electron microscopy and atomic absorption spectrophotometer for microquantitative analysis. The data obtained were compared with those of copper-bearing IUDs (TCu 200) obtained by the same methods. The wire coils of stainless steel IUDs which had been in situ for 5 years showed on evident changes but the copper wire coils of the same duration showed varying degrees of erosion. The analysis clearly showed that the wire coils of both types of IUDs were encrusted with deposit. Deposition began on copper-bearing IUDs earlier than on stainless steel IUDs (27 days and 3 months after insertion, respectively). This process began earlier than was reported in other literature. The amount of deposits increased with the time of insertion, but there were great individual variations. Through the above mentioned microanalysis, it was found that the principal composition of the deposition both types of IUDs was calcium and existed in the crystal form of calcium carbonate. The substance attaching to the crystals were very likely nitrogenous organic compounds. Regarding the mechanism of the deposit formation, the authors suggest that it may be similar to that of calculus. The influence of the deposits on the complications of IUD insertion, such as uterine bleeding and unwanted pregnancy, is discussed briefly in this article should be studied for further details.
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Surface deposits on stainless steel contraceptive devices removed from the uterus after varying periods of insertion were examined and analyzed by means of scanning electron microscopy (SEM), X-ray energy dispersive analysis (XEDA), Augar electron spectroscopy (AES), X-ray photoelectron spectroscopy (XPS), transmission electron microscopy (TEM) and atomic absorption spectrophotometry for microquantitative analysis. The data obtained were compared with the data for copper-bearing IUDs (TCu200) obtained by the same method. The wire coils of stainless steel IUDs which had been in situ for 5 years showed no obvious changes, but copper wire coils showed varying degrees of erosion after the same period of time. Analysis clearly showed that the wire coils of both types of IUD were encrusted with deposits. Deposition began earlier on copper-bearing IUDs than on stainless steel IUDs (27 days and 3 months after insertion, respectively). This process began earlier than has previously been reported in the literature. The amount of deposit increased with duration of insertion, but there were large individual variations. The microanalysis showed that the principal component of the deposit on both types of IUD was calcium, which was present in the crystal form of calcium carbonate. The substances attaching to the crystals were similar to the nitrogenous organic compounds. We suggest that the mechanism regulating the deposited formation may be similar to that of calculus. The influence of these deposits on complications relating to IUD insertion, such as uterine bleeding and accidental pregnancy, is briefly discussed in this article. The subject should be studied in greater detail.
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Removal of an intrauterine contraceptive device (IUCD) in nonpregnant patients under ultrasonic guidance has previously been reported, but results of the method in pregnancy are controversial. In the present study removal of the IUCD was performed in 16 women who conceived with the device in place. Four women were scheduled for pregnancy termination and 12 women wished to continue their pregnancy. Removal was successful in all 16 patients with minimal complications. Fetal loss occurred in one case out of the 12 who wished to continue their pregnancy. The procedure was found to be feasible even in cases with the IUCD located behind the gestational sac. We suggest ultrasonic guided removal of the IUCD during pregnancy to be the method of choice.