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The Endometrium and the IUD

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Female Contraception


In mammals, the primary effect of intrauterine foreign bodies is to prevent pregnancy. How? The mechanisms of action are as yet uncertain and vary depending on the type of device [1]. In the case of inert and copper IUDs, the endometrium is the site of the essential contraceptive effect. This is an antiimplantation effect that is secondary to the changes in the endometrium and its functioning [2]. The IUD first causes injury to the endometrium, the extent of which depends on the shape and, especially, the size of the IUD. When in contact with the IUD, the mucosa becomes flattened, crushed, atrophic, and eroded. The second important change is a nonspecific inflammatory response (that of an endometrium reacting to a foreign body). This response consists of a focal inflammatory infiltrate containing polymorphonuclear cells, lymphocytes, plasma cells, macrophages, and, infrequently, giant cells. The inflammatory reaction is especially marked where the endometrium is in contact with the IUD. The IUD also causes vascular changes: altered permeability and diffuse microthrombosis of the capillaries in the endometrial stroma in contact with the IUD. These vascular changes, together with the presence of inflammatory cells, induce the release of numerous substances such as histamine, prostaglandins (PGE2 and PGE) — the levels of which are increased in the uterus with an IUD (which explains some cases of uterine pain) — and plasminogen activators, especially a proteolytic enzyme responsible for enhancing the fibrinolytic activity of the endometrium (this may be the cause of certain cases of uterine bleeding and may damage the blastocyst and/or prevent its implantation).

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© 1988 Springer-Verlag Berlin Heidelberg

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Serfaty, D., Yaneva, H. (1988). The Endometrium and the IUD. In: Runnebaum, B., Rabe, T., Kiesel, L. (eds) Female Contraception. Springer, Berlin, Heidelberg.

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-73792-3

  • Online ISBN: 978-3-642-73790-9

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