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The presence of mast cells in the human endometrium pre- and post-insertion of intrauterine devices.
A study of the density of mast cells in the human endometrium was carried out on biopsy specimens prepared for light microscopy in 87 cases with three types of IUDs (stainless steel ring SS-type, copper Cu-T 220 and LNG-IUD levonorgestrel-releasing device) pre- and post-insertion. The results revealed that, in general, there was an increase of mast cells after 3 to 24 months' use of IUD, independent of type (p < 0.01 when compared with the pre-insertion value). The increase in number of mast cells was most prominent in women having used the Cu-T220 IUD for 24 months (p < 0.05 when compared with the SS-IUD and p < 0.01 when compared with the LNG-IUD). The difference between the SS-IUD and the LNG-IUD as to the number of mast cells was not significant. No significant difference was found between the "bleeders" and "non-bleeders" in any of the three types of IUDs. It is noteworthy that patients using the Cu-T220-IUD had the highest percentage of patients with abnormal bleeding (> 50%) and that this group also had the highest density of mast cells per mm2 after 24 months' use. Although no significant difference with regard to the density of mast cells could be found between the "bleeders" and the "non-bleeders" in the present study, the number of "bleeders" of the three study groups is usually small and sometimes this number does not allow an adequate statistical analysis for comparison. Further investigations, involving larger number of IUD users, may yield a better understanding with regard to the potential relationship between the number of bleeding episodes and the density of mast cells in the human endometrium.
Microflora of cervical and vaginal secretion in women using copper- and norgestrel-releasing IUCDs.
In 90 women with a norgestrel-releasing IUCD inserted and 50 women having a copper releasing IUCD, culturing of cervical and vaginal secretion was performed prior to, and 3 and 12 months after insertion of the IUCD. There were no significant changes in the cervical or vaginal microflora, and no significant differences between the groups. According to these findings, locally released progestogens from an IUCD do not affect the microflora of the vagina or of the cervix.
Modern trends in contraception.
Substantial improvements have been made in oral contraceptives, a new injectable contraceptive (Norplant), and the intrauterine device (IUD). Major risks with oral contraceptives have declined substantially, and a number of noncontraceptive health benefits have been discovered. Norplant is probably the first new contraceptive in recent years, and offers long-term contraception with high efficacy and modest risks. The IUD, by carefully selecting users, is a safe and efficacious contraceptive method. The major risk, pelvic inflammatory disease (PID), is far less common if one avoids use in the presence of risk factors for PID.
No increase of the fibrinolytic activity of the human endometrium by progesterone-releasing IUD (ProgestasertR).
An increase in menstrual blood loss is one of the most common side effects of plastic IUDs and, though less often, also of copper IUDs. This has been explained by the observation that IUD enhances the fibrinolytic activity of the endometrium. A progesterone-releasing IUD (ProgestasertR) does not increase menstrual bleeding. The fibrinolytic activity of the endometrium was studied in 17 women before and after insertion of a progesterone-releasing IUD. It did not enhance the histochemically determined fibrinolytic activity in the endometrium.
The intrauterine device and ectopic pregnancy.
Based on data given by case-control and cohort studies the relationships between current and past IUD use, duration of IUD use and the type of IUD were evaluated to determine the risk of ectopic pregnancy among IUD users. The results of this review indicate that current and past IUD users do not have an increased risk of ectopic pregnancy. No relationship was found between the duration of IUD use, for either current or past IUD users, and the risk of ectopic pregnancy. Pooled data from clinical studies of different types of IUD showed that the lowest risk of ectopic pregnancy was for users of copper-bearing IUDs, and the highest risk was for users of progesterone-releasing IUDs. Further research is needed to evaluate the ectopic pregnancy risks to past IUD users, especially in view of recent studies which have shown that these women may be at a higher risk of infertility.
Studies of carbohydrate and lipid metabolism in women using the progesterone-T intrauterine device for six months: blood glucose, insulin, cholesterol, and triglyceride levels.
A prospective, detailed study of both lipid and carbohydrate metabolism was carried out in 35 women who used a progesterone-T type intrauterine device (IUD). A 3-hour oral glucose tolerance test was performed in each woman before the IUD was inserted and again after 6 months of use. There was no change in the patients' weight or in the fasting glucose, cholesterol, or triglyceride levels. There were significant increases in the 3-hour glucose and the fasting, 0.5-, and 3-hour plasma insulin values in the 6-month tests. These values were less than those found after 6 months of systemic progestogen use, but do suggest some systemic effect of the released progesterone.
Progestin-releasing intrauterine devices.
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Initial clinical studies of intravaginal rings containing norethindrone and norgestrel.
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The effect of intrauterine progesterone on the DNA-content in isolated human endometrial cells.
The effect of an intrauterine progesterone-releasing device on the DNA-content in human endometrial cells has been studied by means of a microfluorometric method. Following six of seven months' use of the progesterone-releasing device a significant decrease in the mean DNA-content per cell nucleus was found in the epithelial cells indicating a suppression of the proliferative activity of the endometrium. The mean DNA-values of the endometrial cells remained at a low level throughout the cycles in spite of circulating levels of steroids indicating a normal ovarian function. It is suggested that the progesterone released in utero interferes with the DNA-synthesis of the epithelial cells, which may result in a disturbed metabolic function of the endometrium at the time of implantation.
Selected events following insertion of the Progestasert system.
The incidences of selected events were analyzed following insertion of the PROGESTASERT intrauterine progesterone contraceptive system (IPCS) and following its reinsertion after one year of use. Reinsertion did not interrupt the stabilizing or declining trends in incidences of P.I.D., removals for bleeding/pain, removals for other medical reasons, unplanned pregnancies, moderate/severe menstrual cramps and bleeding, and premenstrual/intermenstrual cramps. Comparison of the incidence of P.I.D. in the U.S. population with postinsertion incidence of P.I.D. in IPCS users indicates that the IPCS does not increase the likelihood that a woman will have P.I.D. over the likelihood that she would have it without use of the IPCS. The incidences of expulsions and intermenstrual spotting and bleeding rose temporarily after reinsertion to about half their previous peaks and then diminished markedly within two months, reverting to the levels and favorable patterns of change established during the first year.
Effect of T-shaped progesterone-releasing system on contraceptive efficacy and menstrual cycle regularity in Japanese monkeys.
Twenty-seven sexually mature Japanese monkeys (Macaca fuscata fuscata) weighing 6 to 8 kg were used to evaluate and characterize the local and systemic effects of a T-shaped progesterone-releasing system (UTS) following transabdominal insertion into the uterus. None of five experimental animals conceived, while four of five sham-operated control animals and all intact animals conceived. The general physical appearance, behavior, and clinical blood chemical titer of animals receiving the UTS were comparable with those of the sham-operated group. The UTS also had no significant effect on the cyclic vaginal smear pattern and serum luteinizing hormone (LH) surge during the ovulatory interval. The time course of radioactivity, determined in serum obtained serially following intrauterine insertion of a tritiated UTS, revealed the immediated appearance of 3H in serum, and the levels increased rapidly and remained high for 1 to 1.5 months. The LH release pattern in peripheral blood induced by the intravenous injection of 100 mug of LH-releasing hormone was not affected by the device in utero. The UTS did not appear to interfere with systemic function; when placed in the uterine cavity, the UTS appears to release steroid locally and to exert its antifertility effect without affecting the hypothalamic-pituitary-ovarian axis. A characteristic of the UTS is its effectiveness, since it has both mechanical and hormonal contraceptive properties.
Clinical experience with the uterine progesterone system (Progestasert R).
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The effect of the copper-T 200 IUD on the luteal phase plasma progesterone concentration in the normal menstrual cycle.
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Progesterone and estradiol patterns in women using an intrauterine contraceptive device.
Levels of progesterone, estradiol, LH, and FSH were measured in daily serum samples obtained from 4 subjects during a control cycle and during the first and fourth menstrual cycles after insertion of an intrauterine device (IUD). In addition, progesterone and estradiol were measured in serum samples obtained from 6 women 3, 4, or 5 months after IUD insertion, and from 6 women more than 1 year after IUD insertion. These measurements were compared to the data obtained from study of a large group of normal cycles. The results indicated that the IUD does not influence follicular maturation, time of ovulation, or corpus luteum function. The IUD did exert a local effect on the endometrium, causing the onset of menses to take place when steroid levels were higher than in control cycles.
Serum and endometrial sodium and potassium levels with inert and copper-containing IUCDs and relation to serum steroid levels.
Serum and endometrial sodium (Na) and potassium (K) levels and serum estradiol, progesterone, testosterone and cortisol were measured in the mid-follicular and mid-luteal phases of the menstrual cycle in 20 Lippes loop and 20 CuT-200 IUCD users and 20 matched controls. Na and K were measured by atomic absorption spectrophotometry, while serum steroids were measured by RIA. Regarding steroids, the only significant difference between the three groups was a significantly lower mean mid-luteal serum estradiol in CuT-200 IUCD users compared to Lippes loop users (p less than 0.05). Regarding sodium in the control group, there was significantly lower mean mid-luteal serum and endometrial Na (p less than 0.01) that was not found in both groups of IUCD users. In the mid-follicular phase, there was significantly higher mean serum Na in both Lippes loop and CuT-200 groups compared to controls (p less than 0.05). Mean endometrial Na showed no significant difference between the three groups in both phases of the menstrual cycle. Regarding potassium in the control group, there was significantly lower mean levels in the mid-luteal-phase of the cycle (p less than 0.01) that was not seen with both groups of IUCD users. Serum K showed no significant difference in the three groups in both phases of the menstrual cycle. Endometrial K showed a significantly higher mean level in both Lippes loop and CuT-200 IUCD users compared to controls in the mid-luteal (p less than 0.01), but not in the mid-follicular phases of the cycle.