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Relationship between copper IUD complications and ultrasonographic findings

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

Intrauterine device (IUD) is a widely used long-acting contraceptive method; however, the side-effects related to IUD may lead to method discontinuation. The aim of this study is to evaluate the relation between the most common side-effects of IUD use; mainly dysmenorrhea, menorrhaghia, pelvic cramping and the relation of these complications with the position of the IUD device within the cavity and uterine dimensions evaluated by transvaginal ultrasonography.

Material and method

Two hundred and eighty-four patients who had Cu-T380A IUD insertion at the Family Planning Clinic of a tertiary health center were evaluated at insertion and 6 and 12 weeks after the insertion. Demographic characteristics, medical history, symptoms and findings of the gynecological examination were recorded. Transvaginal ultrasonographic measurement of the uterine dimensions, the distance between the tip of the Cu-IUD and the fundus, myometrium and endometrium were measured to evaluate the displacement of the IUD. The relationship between the symptoms and IUD displacement diagnosed by ultrasonographic examination were investigated.

Results

Two hundred and sixty-seven patients were followed-up for 12 weeks as the remaining 16 had partial or complete IUD expulsion. A statistically significantly shorter uterine length was measured in patients who complained of menorrhagia in comparison to the ones without this complaint (54.27 ± 6.11 vs 60.25 ± 10.52 mm, p = 0.02) while uterine length was similar in patients with or without dysmenorrhea at 12 weeks (59.60 ± 10.25 vs 60.33 ± 10.68 mm, p = 0.71). The distances between the tip of the IUD and the endometrium, myometrium and the uterine fundus, were statistically and significantly longer in patients who experienced pelvic cramping at 3rd month, showing a downward movement of the IUD. (Endometrium; 0.29 ± 0.72 vs 0.45 ± 0.35 mm, p = 0.02, Myometrium; 1.25 ± 1.39 vs 2.38 ± 2.26 mm p < 0.05, Fundus; 1.68 ± 2.39 vs 2.92 ± 1.78 mm, p < 0.05).

Conclusion

A shorter uterine cavity length seems to be a predictor of menorrhagia in patients with Cu-T 380A IUD. Patients experiencing pelvic cramping with IUD are more susceptible for IUD expulsion as the downward movement of IUD is more prominent in these patients.

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References

  1. Darney LS, Philip D (2010) A clinical guide for contraception, 5th edn. Lippincott Williams & Wilkins, Philadelphia, pp 242–243

    Google Scholar 

  2. Winner B, Peipert JF, Zhao Q, Buckel C, Madden T, Allsworth JE, Secura GM (2012) Effectiveness of long acting reversible contraception. N Engl J Med 366(21):1998–2007

    Article  CAS  PubMed  Google Scholar 

  3. O’Brien PA, Kulier R, Helmerhorst FM, Usher-Patel M, d’Arcangues C (2008) Copper-containing, framed intrauterine devices for contraception: a systematic review of randomized controlled trials. Contraception 77(5):318–327

    Article  PubMed  Google Scholar 

  4. WHO (2015) “Intrauterine devices (IUDs)”. Medical eligibility criteria for contraceptive use, 5th edn. http://www.who.int/reproductivehealth/publications/family_planning/MEC-5/en/. Available at 15 Jan 2016

  5. Peri N, Graham D, Levine D (2007) Imaging of intrauterine contraceptive devices. J Ultrasound Med 26(10):1389–1401

    Article  PubMed  Google Scholar 

  6. Coskun E, Cakiroglu Y, Aygun BK, Muezzinoglu B, Caliskan E (2011) Effect of copper intrauterine device on the cyclooxygenase and inducible nitric oxide synthase expression in the luteal phase endometrium. Contraception 84(6):637–641

    Article  CAS  PubMed  Google Scholar 

  7. Mutlu I, Demir A, Mutlu MF (2014) Can uterine artery Doppler parameters predict copper intrauterine device-induced side effects? Eur J Contracept Reprod Health Care 19(1):51–56

    Article  CAS  PubMed  Google Scholar 

  8. Faundes D, Perdigao A, Faundes A, Bahamondes L, Petta CA (2000) T-shaped IUDs accommodate in their position during the first 3 months after insertion. Contraception. 62(4):165–168

    Article  CAS  PubMed  Google Scholar 

  9. Warner PE, Critchley HO, Lumsden MA, Campbell-Brown M, Douglas A, Murray GD (2004) Menorrhagia I: measured blood loss, clinical features, and outcome in women with heavy periods: a survey with follow-up data. Am J Obstet Gynecol 190:1216–1223

    Article  PubMed  Google Scholar 

  10. Faundes D, Bahamondes L, Faundes A, Marchi N (1997) No relation between the intrauterine contraceptive device position evaluated by ultrasound and complaints of bleeding and pain. Contraception 56:43–47

    Article  CAS  PubMed  Google Scholar 

  11. Sivin I, Batár I (2010) State-of-the-art of non-hormonal methods of contraception: III. Intrauterine devices. Eur J Contracept Reprod Health Care 15:96–112

    Article  PubMed  Google Scholar 

  12. Petta CA, Faúndes D, Pimentel E, Diaz J, Bahamondes L (1996) The use of vaginal ultrasound to identify copper T IUDs at high risk of expulsion. Contraception 54(5):287–289

    Article  CAS  PubMed  Google Scholar 

  13. Liang H, Li L, Yuan W, Zou Y, Gao ES, Duffy JM, Wu SC (2014) Dimensions of the endometrial cavity and intrauterine device expulsion or removal for displacement: a nested case-control study. BJOG 121(8):997–1004

    Article  CAS  PubMed  Google Scholar 

  14. Shimoni N, Davis A, Westhoff C (2014) Can ultrasound predict IUD expulsion after medical abortion? Contraception 89(5):434–439

    Article  PubMed  Google Scholar 

  15. Yigit N, Kacar M, Yigit H et al (2009) The effects of copper contraceptive intrauterine device on the uterine blood flow: a prospective transvaginal Doppler study. J Clin Ultrasound 37:380–384

    Article  PubMed  Google Scholar 

  16. El-Mazny, Abou-Salem N, Elshenoufy H (2013) Three-dimensional power Doppler study of endometrial and subendometrial microvascularization in women with intrauterine device-induced menorrhagia. Fertil Steril 99(7):1912–1957

    Article  PubMed  Google Scholar 

  17. Shen O, Ben Chetrit A, Margalioth EJ, Lavie O, Rabinowitz RR (2008) Effects of a copper-medicated intrauterine device on ovarian artery, uterine artery, and intrauterine blood flow. Gynecol Obstet Invest 66(4):253–256

    Article  CAS  PubMed  Google Scholar 

  18. de Souza MA, Geber S (2006) Doppler color flow analysis of the uterine arteries before and after intrauterine device insertion: a prospective study. J Ultrasound Med 25(2):153–157

    Article  PubMed  Google Scholar 

  19. Pirhonen J, Pulkkinen M (1995) The effect of nimesulide and naproxen on the uterine and ovary arterial blood flow velocity. A Doppler study. Acta Obstet Gynecol Scand 74:549–553

    Article  CAS  PubMed  Google Scholar 

  20. Wildemeersch D (2011) Intrauterine contraceptives that do not fit well contribute to early discontinuation. Eur J Contracept Reprod Health Care 16(2):135–141

    Article  PubMed  Google Scholar 

  21. Bajka M, Badir S (2017) Fundus thickness assessment by 3D transvaginal ultrasound allows metrics-based diagnosis and treatment of congenital uterine anomalies. Ultraschall Med 38(2):183–189

    PubMed  Google Scholar 

  22. Benacerraf BR, Shipp TD, Bromley B (2009) Three-dimensional ultrasound detection of abnormally located intrauterine contraceptive devices which are a source of pelvic pain and abnormal bleeding. Ultrasound Obstet Gynecol 34(1):110–115

    Article  CAS  PubMed  Google Scholar 

  23. Wildemeersch D, Jandi S, Pett A, Nolte K, Hasskamp T, Vrijens M (2014) Use of frameless intrauterine devices and systems in young nulliparous and adolescent women: results of a multicenter study. Int J Womens Health 6(6):727–734

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kaislasuo J, Heikinheimo O, Lähteenmäki P, Suhonen S (2014) Predicting painful or difficult intrauterine device insertion in nulligravid women. Obstet Gynecol 124(2 Pt 1):345–353

    Article  PubMed  Google Scholar 

  25. Kaislasuo J, Heikinheimo O, Lähteenmäki P, Suhonen S (2015) Menstrual characteristics and ultrasonographic uterine cavity measurements predict bleeding and pain in nulligravid women using intrauterine contraception. Hum Reprod 30(7):1580–1588

    Article  CAS  PubMed  Google Scholar 

  26. Jiménez MF, Vetori D, Fagundes PA, de Freitas FM, Cunha-Filho JS (2008) Subendometrial microvascularization and uterine artery blood flow in IUD-induced side effects (levonorgestrel intrauterine system and copper intrauterine device). Contraception 78(4):324–327

    Article  PubMed  Google Scholar 

  27. Sahmay S, Kaleli S, Oral E, Alper T, Unal O, Karacan I, Atasu T (1999) Effect of different types of intrauterine devices on intrauterine activity. Int J Fertil Womens Med 44(3):150–155

    CAS  PubMed  Google Scholar 

  28. Goldstuck ND, Wildemeersch D (2014) Role of uterine forces in intrauterine device embedment, perforation, and expulsion. Int J Womens Health 7(6):735–744

    Article  Google Scholar 

  29. Morales-Rosello J (2005) Spontaneous upward movement of lowly placed T-shaped IUDs. Contraception 72:430–431

    Article  PubMed  Google Scholar 

  30. Eggebroten JL, Sanders JN, Turok DK (2017) Immediate postpartum intrauterine device and implant program outcomes: a prospective analysis. Am J Obstet Gynecol 217(1):51.e1–51.e7

    Article  Google Scholar 

  31. Eroğlu K, Akkuzu G, Vural G, Dilbaz B, Akin A, Taşkin L, Haberal A (2006) Comparison of efficacy and complications of IUD insertion in immediate postplacental/early postpartum period with interval period: 1 year follow-up. Contraception 74(5):376–381

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

Authors

Contributions

SF: Corresponding author, data curation, data collection; BD: lead supervisor, project development; EF: writing, data analysis; SD: supporting supervisor

Corresponding author

Correspondence to Seyma Fadiloglu.

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Funding

This study was not funded by any company.

Conflict of interest

Conflict of interest is declared by none of the authors.

Human and animal rights statement

This article does not contain any studies with human participants or animals performed by any of the authors.

Ethical approval

Study is approved by Ankara Etlik Zübeyde Hanım Education and Training Hospital Institutional Review Board.

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Cite this article

Fadiloglu, S., Dilbaz, B., Fadiloglu, E. et al. Relationship between copper IUD complications and ultrasonographic findings. Arch Gynecol Obstet 297, 989–996 (2018). https://doi.org/10.1007/s00404-018-4711-y

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  • DOI: https://doi.org/10.1007/s00404-018-4711-y

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