Subendometrial microvascularization and uterine artery blood flow in IUD-induced side effects (levonorgestrel intrauterine system and copper intrauterine device)
ABSTRACT A better understanding of the uterine and endometrial vascularization in intrauterine device (IUD)-induced side effects is clearly of paramount importance in terms of both physiological and pathophysiological changes and may permit assessment for future therapeutic treatments. The aim of the study was to quantify the subendometrial microvascularization and uterine artery blood flow in IUD-induced side effects using power Doppler analysis as well as pulsatility index (PI) and resistance index (RI) in the exact midluteal phase 3 months after IUD insertion. There were 27 patients using the levonorgestrel-releasing intrauterine system and 25 patients using TCu 380A.
This study has a prospective clinical trial design.
There is an increased subendometrial blood flow in patients with severe dysmenorrhea and/or bleeding, after controlling for IUD type, age and parity. Moreover, the PI and RI were not different in such women.
The results provide new data on the bleeding patterns related to these IUD types that may be relevant during contraception use. This method could be used as a prognostic factor to better evaluate women for the risk of developing dysmenorrhea and/or bleeding after IUD insertion.
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ABSTRACT: To assess the efficacy and adverse effects, and reveal the effective pathway of the levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of heavy menstrual bleeding. In a prospective single-center study in Istanbul, Turkey, the LNG-IUS was inserted in 60 patients diagnosed with heavy menstrual bleeding between January 2008 and June 2010. Menstrual bleeding pattern, coagulation parameters, uterine arterial blood flow, endometrial thickness, and uterine and ovarian volumes were assessed pre-insertion, and at 6 and 12months. Forty-nine women completed the study. When compared with pre-insertion values, the LNG-IUS led to improvements in hemoglobin and marked decreases in visual bleeding scores, endometrial thickness, and fibrinogen levels (P<0.001); platelet count, international normalized ratio, prothrombin time, activated partial thromboplastin time, and uterine volume also decreased (P<0.05). No significant change in ovarian volumes, or uterine artery resistive and pulsatility indices was observed at 6 or 12months compared with pre-insertion values. The decline in menstrual blood loss among LNG-IUS users was associated with local progestogenic effects and aggravation of intrinsic and extrinsic coagulation pathways. Although the LNG-IUS is a highly effective method for treating heavy menstrual bleeding, care must be taken when a patient has thromboembolic risk factors.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 07/2013; 123(2). DOI:10.1016/j.ijgo.2013.05.018 · 1.56 Impact Factor
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ABSTRACT: Objective. Evaluate if different bleeding patterns associated with the use of the levonorgestrel intrauterine system (LNG-IUS) are associated with different uterine and endometrial vascularization patterns, as evidenced by ultrasound power Doppler analysis. Methodology. A longitudinal study, with each subject acting as its own control was conducted between January 2010 and December 2012. Healthy volunteers with a history of heavy but cyclic and regular menstrual cycles were enrolled in the study. Ultrasonographic examination was performed before and after six months of LNG-IUS placement: uterine volume, endometrial thickness, and subendometrial and myometrial Doppler blood flow patterns have been evaluated. Results. A total of 32 women were enrolled out of 186 initially screened. At six months of follow-up, all subjects showed a reduction in menstrual blood loss; for analysis, they were retrospectively divided into 3 groups: normal cycling women (Group I), amenorrheic women (Group II), and women with prolonged bleedings (Group III). Intergroup analysis documented a statistically significant difference in endometrial thickness among the three groups; in addition, mean pulsatility index (PI) and resistance index (RI) in the spiral arteries were significantly lower in Group I and Group III compared to Group II. This difference persisted also when comparing-within subjects of Group III-mean PI and RI mean values before and after insertion. Conclusions. The LNG-IUS not only altered endometrial thickness, but-in women with prolonged bleedings-also significantly changed uterine artery blood flow. Further studies are needed to confirm these results and enable gynecologists to properly counsel women, improving initial continuation rates.BioMed Research International 04/2014; 2014:815127. DOI:10.1155/2014/815127 · 2.71 Impact Factor
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ABSTRACT: Objectives To evaluate the predictive value of uterine artery Doppler characteristics in predicting copper intrauterine device (IUD)-induced side effects such as dysmenorrhoea and menorrhagia, and worsening of dyspareunia. Methods One hundred and twenty regularly menstruating women were enrolled in the study. All underwent transvaginal uterine artery Doppler analysis in the early follicular phase, on two occasions: before insertion of the IUD, and six months after insertion. Pre- and post-insertion resistance (RI) and pulsatility (PI) indices of the uterine arteries were measured. Doppler parameters were compared between subjects experiencing an increase in IUD-mediated side effects and those reporting no change. Results RI and PI of all participants before and after IUD insertion were not significantly different (0.75 ± 0.06 vs. 0.74 ± 0.09, p = 0.49; 1.81 ± 0.55 vs. 1.83 ± 0.70, p = 0.7, respectively). No significant difference was found in the comparison of pre- and post-insertion PI and RI values of women who had increased- and those who experienced no change in dysmenorrhoea, dyspareunia and duration/amount of menstruation. Conclusions No major changes in uterine blood flow were observed in women experiencing increased menstrual bleeding, dyspareunia or dysmenorrhoea after insertion of a copper IUD. The occurrence of these effects cannot be predicted by prior Doppler flow analysis.The European Journal of Contraception and Reproductive Health Care 12/2013; DOI:10.3109/13625187.2013.856405 · 1.84 Impact Factor