Subendometrial microvascularization and uterine artery blood flow in IUD-induced side effects (levonorgestrel intrauterine system and copper intrauterine device)

Programa de Pós-graduação em Medicina: Ciências Médicas, Faculdade de Medicina, 90035-003 UFRGS, Brazil.
Contraception (Impact Factor: 2.34). 11/2008; 78(4):324-7. DOI: 10.1016/j.contraception.2008.06.013
Source: PubMed


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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    • "A study of endometrial biopsies from LNG-IUS users explored the local effect on the endometrium and documented significant modifications in endometrial vascularization, with a decrease in mean vascular density and an increase in mean vessel area [16]. An increase in subendometrial vascularization has also been documented in women complaining of major side effects (dysmenorrhea and/or irregular bleeding) following insertion of copper-releasing intrauterine devices (Cu-IUDs) [17, 18]. "
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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: Objective: To test the hypothesis that copper intrauterine device (CIUD) induced abnormal uterine bleeding is secondary to an increase in the uterine artery blood flow and to determine whether transvaginal color Doppler can be used to identify women at risk of developing abnormal uterine bleeding after CIUD insertion. Design: Prospective clinical study. Setting: University teaching hospital. Methods: Ninety three women were examined by transvaginal color Doppler to detect the pulsa- tility index (PI) and resistance index (RI) in the uterine artery. Women were divided into three groups. Group I; included 32 women using CIUD (TCu-380A) and complaining of menorrhagia or menometrorrhagia, group II; included 30 women using CIUD with normal menstrual flow and group III which was a control group that included 31 women with normal menstrual flow and not using any contraceptive methods. Mean outcome measures: PI and RI of the uterine artery. Results: PI and RI were significantly lower in women with CIUD-induced abnormal uterine bleeding compared to women using CIUD with normal menstrual flow or women in the control group. The ROC curves for PI and RI revealed that PI 6 2.07 had sensitivity 84.4% and specificity 83.3% and RI 6 0.7 had sensitivity 78.1% and specificity 80% in detecting women with CIUD-induced abnormal uterine bleeding. Conclusion: The results of our study confirm the hypothesis that there is increase in the uterine blood flow (as indicated by decreased PI and RI in uterine artery) in women with CIUD-induced abnormal uterine bleeding. © 2010 Middle East Fertility Society. Production and Hosting by Elsevier B.V. All rights reserved.
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