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

ArticleinContraception 78(4):324-7 · November 2008with29 Reads
DOI: 10.1016/j.contraception.2008.06.013 · Source: PubMed
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.
    • 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].
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Apr 2014
  • [Show abstract] [Hide abstract] ABSTRACT: The Sarcheshmeh copper flotation circuit is producing 510 4 t copper concentrate per month with an averaging grade of 28% Cu in rougher, cleaner and recleaner stages. In recent years, with the increase in the open pit depth, the content of aluminosili-cate minerals increased in plant feed and subsequently in flotation concentrate. It can motivate some problems, such as unwanted consumption of reagents, decreasing of the copper concentrate grade, increasing of Al 2 O 3 and SiO 2 in the copper concentrate, and needing a higher temperature in the smelting process. The evaluation of the composite samples related to the most critical working period of the plant shows that quartz, illite, biotite, chlorite, orthoclase, albeit, muscovite, and kaolinite are the major Al 2 O 3 and SiO 2 bearing minerals that accompany chalcopyrite, chalcocite, and covellite minerals in the plant feed. The severe alteration to clay min-erals was a general rule in all thin sections that were prepared from the plant feed. Sieve analysis of the flotation concentrate shows that Al 2 O 3 and SiO 2 bearing minerals in the flotation concentrate can be decreased by promoting the size reduction from 53 to 38 m. Interlocking of the Al 2 O 3 and SiO 2 bearing minerals with chalcopyrite and chalcocite is the occurrence mechanism of silicate and aluminosilicate minerals in the flotation concentrate. The dispersed form of interlocking is predominant.
    Full-text · Article · Nov 2009
  • [Show abstract] [Hide abstract] 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.
    Full-text · Article · Jul 2010
  • [Show abstract] [Hide abstract] ABSTRACT: Background: The levonorgestrel-releasing IUD can help the treatment of dysmenorrhea by reducing the synthesis of endometrial prostaglandins as a conventional treatment. Objective: This study was performed to assess the frequency of dysmenorrhea, satisfaction and quality of life in women using Mirena IUDs as compared to those using copper IUDs. Materials and Methods: This double-blind randomized clinical trial was performed between 2006 and 2007 on 160 women aged between 20 to 35 years who attended Shahid Ayat Health Center of Tehran, and they were clients using IUDs for contraception. 80 individuals in group A received Mirena IUD and 80 individuals in group B received copper (380-A) IUD. Demographic data, assessment of dysmenorrhea, and follow-up 1, 3 and 6 months after IUD replacement were recorded in questionnaires designed for this purpose. To assess the quality of life, SF36 questionnaire was answered by the attending groups, and to assess satisfaction, a test with 3 questions was answered by clients. Results: Dysmenorrhea significantly was decreased in both groups six months after IUD insertion as compared to the first month (p<0.001). However, statistically, Mirena reduced dysmenorrhea faster and earlier compared to cupper IUD (p<0.003). There isn't any significant difference between these two groups in satisfaction and quality of life outcomes. Conclusion: There is no difference between these two groups in terms of the satisfaction and quality of life, therefor the usage of Mirena IUD is not a preferred contraception method.
    Data · Mar 2011
  • [Show abstract] [Hide abstract] ABSTRACT: Background: The levonorgestrel-releasing IUD can help the treatment of dysmenorrhea by reducing the synthesis of endometrial prostaglandins as a conventional treatment. Objective: This study was performed to assess the frequency of dysmenorrhea, satisfaction and quality of life in women using Mirena IUDs as compared to those using copper IUDs. Materials and Methods: This double-blind randomized clinical trial was performed between 2006 and 2007 on 160 women aged between 20 to 35 years who attended Shahid Ayat Health Center of Tehran, and they were clients using IUDs for contraception. 80 individuals in group A received Mirena IUD and 80 individuals in group B received copper (380-A) IUD. Demographic data, assessment of dysmenorrhea, and follow-up 1, 3 and 6 months after IUD replacement were recorded in questionnaires designed for this purpose. To assess the quality of life, SF36 questionnaire was answered by the attending groups, and to assess satisfaction, a test with 3 questions was answered by clients. Results: Dysmenorrhea significantly was decreased in both groups six months after IUD insertion as compared to the first month (p<0.001). However, statistically, Mirena reduced dysmenorrhea faster and earlier compared to cupper IUD (p<0.003). There isn't any significant difference between these two groups in satisfaction and quality of life outcomes. Conclusion: There is no difference between these two groups in terms of the satisfaction and quality of life, therefor the usage of Mirena IUD is not a preferred contraception method.
    File · Data · Mar 2011 · Contraception
  • [Show abstract] [Hide abstract] ABSTRACT: As a contraceptive method, we investigated whether the levonorgestrel-releasing intrauterine system (LNG-IUS) has any effect on uterine artery blood flow when compared with copper intrauterine device (IUD). Sixty women with copper IUD and 60 women with LNG-IUS were included in the study. The age, gravidity, parity, body mass index (BMI) and menstrual flow pattern using a pictorial chart were recorded. All women were assessed by ultrasonography at the preinsertion period and 1 year after insertion. The pulsatility and resistance indices (PI and RI, respectively) of the uterine artery and endometrial thickness were evaluated in the preinsertion and postinsertion periods. In copper IUD users, preinsertion and postinsertion ultrasonographic assessments were not significantly different. However, postinsertion RI was significantly higher compared with preinsertion RI in LNG-IUS users (p=.001). The PI was also increased 1 year after insertion, but it did not reach statistically significant levels (p=.08). Endometrial thickness was also significantly decreased in the postinsertion period in women with LNG-IUS (p=.04). The significant increase in uterine artery RI in LNG-IUS users 1 year after insertion might be due to its local progestational effects. It might also indicate the mechanism of the LNG-IUS in reducing menstrual blood flow.
    Article · Jun 2011
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