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Database: Ovid MEDLINE(R) <2006 to March Week 3 2010> Search Strategy: -------------------------------------------------------------------------------- 1 exp *intrauterine devices/ (542) 2 use$.tw. and 1 (269) 3 limit 2 to (english language and "review articles" and humans) (59) 4 limit 3 to full text (16) 5 use$.ti. and 3 (16) 6 4 or 5 (30) 7 from 6 keep 1-30 (30) *************************** <1> Unique Identifier 20019650 Status MEDLINE Authors Concin H. Bosch H. Hintermuller P. Hohlweg T. Mursch-Edlmayr G. Pinnisch B. Schmidl- Amann S. Schulz-Greinwald G. Unterlerchner D. Wagner T. Mattle V. Wildt L. Fiala C. Authors Full Name Concin, Hans. Bosch, Hubert. Hintermuller, Peter. Hohlweg, Thomas. Mursch-Edlmayr, Gerhard. Pinnisch, Bettina. Schmidl-Amann, Sigrid. Schulz-Greinwald, Gunda. Unterlerchner, Dagmar. Wagner, Teresa. Mattle, Verena. Wildt, Ludwig. Fiala, Christian. Institution Department of Obstetrics and Gynaecology, Landeskrankenhaus Bregenz, Bregenz, Austria. firstname.lastname@example.org Title Use of the levonorgestrel-releasing intrauterine system: an Austrian perspective. [Review] [48 refs] Source Current Opinion in Obstetrics & Gynecology. 21 Suppl 1:S1-9, 2009 Nov. Abstract Approximately 12 million women worldwide use the levonorgestrel-releasing intrauterine system (IUS), with approximately 180,000 users of this IUS currently reported in Austria. A patient satisfaction study of 591 women in Austria revealed a high number of 'very satisfied' (79%) and 'satisfied' (19%) patients. Reliability, comfort, excellent compatibility and less severe, shorter and less painful monthly periods were the most frequently named advantages of the levonorgestrel-releasing IUS. Medication-induced cervical priming before insertion can be carried out on a routine or selective basis (for example in nullipara, in women who have undergone cervical conisation or in women who have previously experienced painful insertion). There is, at present, no evidence of an increased rate of breast cancer through use of the levonorgestrel-releasing IUS. A directly comparative study with oral contraceptives in young nullipara showed excellent results for the levonorgestrel-releasing IUS, with no perforations, inflammation or pregnancies. [References: 48] Publication Type Journal Article. Research Support, Non-U.S. Gov't. Review. <2> Unique Identifier 19657812 Status MEDLINE Authors Ewies AA. Authors Full Name Ewies, Ayman A A. Institution Obstetrics and Gynaecology Department, The Ipswich Hospital NHS Trust, Maternity Block, Heath Road, Ipswich, Suffolk, IP4 5PD, UK. email@example.com Title Levonorgestrel-releasing intrauterine system--the discontinuing story. [Review] [42 refs] Source Gynecological Endocrinology. 25(10):668-73, 2009 Oct. Abstract Levonorgestrel-releasing Intrauterine System (LNG-IUS) is licensed for use as a contraceptive, for the treatment of heavy menstrual bleeding and during estrogen replacement therapy. It is publicized as a local source of progestogen with minimal systemic adverse effects. However, there is overwhelming evidence of elevated serum and tissue levels of levonorgestrel, and high discontinuation and dissatisfaction rates amongst users. The guidelines of The National Institute for Health and Clinical Excellence (NICE), United Kingdom recommended that the healthcare professionals should be aware that upto 60% of women discontinue using LNG-IUS within 5 years because of unscheduled bleeding, pain, and/or systemic progestogenic adverse effects. This article highlights these issues to healthcare professionals to ensure that the rates of adverse effects are not underestimated, and full information are made available to women to enable them making an informed choice. [References: 42] Publication Type Journal Article. Review. <3> Unique Identifier 19751859 Status MEDLINE Authors Gaffield ME. Kapp N. Curtis KM. Authors Full Name Gaffield, Mary E. Kapp, Nathalie. Curtis, Kathryn M. Institution Department of Reproductive Health and Research, World Health Organization, 1211 Geneva 27, Switzerland. firstname.lastname@example.org Title Combined oral contraceptive and intrauterine device use among women with gestational trophoblastic disease. [Review] [19 refs] Source Contraception. 80(4):363-71, 2009 Oct. Abstract BACKGROUND: Women diagnosed with gestational trophoblastic disease (GTD) need safe and effective contraception because they are advised to delay a subsequent pregnancy. STUDY DESIGN: We searched MEDLINE and The Cochrane Library for articles in any language on use of combined oral contraceptives (COC), copper-bearing or levonorgestrel-releasing IUDs among women with benign or malignant GTD, from database inception through November 2008. One review and nine articles were identified and evaluated. RESULTS: Incidence of postmolar trophoblastic disease was lower among COC users compared with nonusers in six studies, but higher among COC users in three studies. Five studies reported shorter human chorionic gonadotropin (hCG) regression duration among COC users compared with other methods. Development of postmolar trophoblastic disease did not differ significantly among IUD users compared with COC users or nonusers in three studies. CONCLUSIONS: Evidence shows that postmolar trophoblastic disease risk does not increase among women using COCs or an IUD following molar pregnancy evacuation compared with use of other contraceptive methods or no method. [References: 19] Publication Type Journal Article. Research Support, N.I.H., Extramural. Research Support, Non-U.S. Gov't. Research Support, U.S. Gov't, Non-P.H.S.. Research Support, U.S. Gov't, P.H.S.. Review. <4> Unique Identifier 19445984 Status MEDLINE Authors Rose S. Chaudhari A. Peterson CM. Authors Full Name Rose, Susan. Chaudhari, Angela. Peterson, C Matthew. Institution Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, 50 North Medical Drive, Suite 2B200, Salt Lake City, Utah 84132, USA. Susan.email@example.com Title Mirena (Levonorgestrel intrauterine system): a successful novel drug delivery option in contraception. [Review] [49 refs] Source Advanced Drug Delivery Reviews. 61(10):808-12, 2009 Aug 10. Abstract This manuscript serves as a review of Mirena, the levonorgestrel intrauterine system (LNG IUS) as a very successful drug delivery system. The LNG IUS has a very high contraceptive efficacy rate, and low rates of patient discontinuation. In addition to its contraceptive benefits, most users experience a decrease in menstrual bleeding over the 5 years of use. LNG IUS has also been used for management of menorrhagia, dysmenorrhea, adenomyosis, and endometrial hyperplasia in some cases. The LNG IUS provides long term efficacy, high rates of compliance, rapid return to fertility, and minimal adverse effects during use. [References: 49] Publication Type Journal Article. Review. <5> Unique Identifier 19172421 Status MEDLINE Authors Martinez F. Lopez-Arregui E. Authors Full Name Martinez, Francisca. Lopez-Arregui, Eduardo. Institution Servicio de Medicina de la Reproduccion, Department of Obstetrics & Gynecology, Institut Universitari Dexeus, Barcelona, Spain. firstname.lastname@example.org Title Infection risk and intrauterine devices. [Review] [14 refs] Source Acta Obstetricia et Gynecologica Scandinavica. 88(3):246-50, 2009. Abstract For most women, intrauterine contraceptive devices (IUCD) are a safe option. Upper genital tract infections (pelvic inflammatory disease, PID) occur when pathogenic microorganisms ascend from the cervix and invade the endometrium and the fallopian tubes, causing an inflammatory reaction. Evidence-based recommendations regarding intrauterine contraception and risk of infection were presented at the Congress of the European Society of Contraception, in Prague, 2008: A clinical history (including sexual history) should be taken as part of the routine assessment for intrauterine contraception to identify women at high risk of sexually transmitted infections (STI); if appropriate a test should be offered; if symptoms or signs are present, appropriate diagnostic tests should be done, results awaited, necessary treatment completed, and IUCD insertion postponed until resolution. Prophylactic antibiotics are not recommended (evidence level II-3). STI screening is not routinely recommended. PID among IUCD users is most strongly related to the insertion process and to the background risk of STI (evidence level II-2). Conditions which represent an unacceptable health risk if an IUCD is inserted (WHO Medical Eligibility Criteria, MEC, Categories 3-4) are current PID, current purulent cervicitis, chlamydial or gonorrheal infection. For continuation as well as initiation, WHO MEC categories 3-4 are allotted to women with known pelvic tuberculosis, puerperal sepsis and septic abortion. [References: 14] Publication Type Journal Article. Review. <6> Unique Identifier 18797269 Status MEDLINE Authors Gold MA. Johnson LM. Authors Full Name Gold, Melanie A. Johnson, Lisa M. Institution Division of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, PA 15213, USA. email@example.com Title Intrauterine devices and adolescents. [Review] [48 refs] Source Current Opinion in Obstetrics & Gynecology. 20(5):464-9, 2008 Oct. Abstract PURPOSE OF REVIEW: The purpose of this review is to inform the reader of new information published on intrauterine devices (IUDs) and adolescents. RECENT FINDINGS: There are few studies on the use of IUDs in adolescents. The article reviews topics related to IUD use such as adolescents' knowledge of and attitudes toward IUDs, mechanism of action of copper-releasing and levonorgestrel-releasing IUDs, benefits of using IUDs with adolescents, safety, side effects, as well as noncontraceptive benefits such as management of menstrual disorders and endometriosis using IUDs. SUMMARY: IUDs are a safe and effective long-term contraceptive method with no increase in risk of pelvic inflammatory disease, tubal infertility or ectopic pregnancies. IUDs are underutilized in the United States, especially by adolescents. Because adolescents contribute disproportionately to the epidemic of unintended pregnancy, IUDs should be considered as a first-line contraceptive choice regardless of parity. The levonorgestrel-releasing intrauterine system (LNG IUS) is a particularly good choice for adolescents because of associated noncontraceptive benefits such as decreased menstrual bleeding, dysmenorrhea and pain associated with endometriosis. There is a clear need for further studies in the use of the IUD among adolescents. [References: 48] Publication Type Journal Article. Review. <7> Unique Identifier 18757667 Status MEDLINE Authors Browne H. Manipalviratn S. Armstrong A. Authors Full Name Browne, Hyacinth. Manipalviratn, Somjate. Armstrong, Alicia. Institution Program in Reproductive and Adult Endocrinology, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA. firstname.lastname@example.org Title Using an intrauterine device in immunocompromised women. [Review] [13 refs] Source Obstetrics & Gynecology. 112(3):667-9, 2008 Sep. Other ID Source: NLM. NIHMS82591 Source: NLM. PMC2607525 Abstract Intrauterine devices (IUDs) are a viable treatment option for immunocompromised women who need contraception or menses suppression. They may also be an alternative treatment for women who have a contraindication to estrogen use. A review of the literature on IUD use in this population is sparse, but currently available data suggest that immunocompromised women are not at greater risk of developing pelvic infections. [References: 13] Publication Type Journal Article. Research Support, N.I.H., Extramural. Review. <8> Unique Identifier 18573044 Status MEDLINE Authors Bahamondes L. Bahamondes MV. Monteiro I. Authors Full Name Bahamondes, Luis. Bahamondes, M Valeria. Monteiro, Ilza. Institution Department of Obstetrics and Gynecology, School of Medicine, University of Campinas, Caixa Postal 6181, Campinas, SP, Brazil. email@example.com Title Levonorgestrel-releasing intrauterine system: uses and controversies. [Review] [99 refs] Source Expert Review of Medical Devices. 5(4):437-45, 2008 Jul. Abstract This article provides a perspective on the use of the levonorgestrel-releasing intrauterine system as a contraceptive method and as therapy in different situations, as well as presenting the corresponding controversies and unresolved issues. All studies have reported high contraceptive efficacy, an improvement in menstrual blood loss in women with idiopathic menorrhagia, menorrhagia due to thrombophilic diseases and fibroids, and excellent endometrial protection during postmenopausal estrogen therapy. Moreover, the device is able to reduce pelvic pain and dysmenorrhea as well as improve the staging of endometriosis and adenomyosis, and to control, albeit partially, endometrial hyperplasia. The expectation is that in years to come the number of hysterectomies and female sterilizations will fall due to increased use of the device, including use by patients with endometriosis and HIV-positive women. It would also be desirable to develop a smaller device for postmenopausal women and nulligravidas. [References: 99] Publication Type Journal Article. Review. <9> Unique Identifier 18261926 Status MEDLINE Authors Beining RM. Dennis LK. Smith EM. Dokras A. Authors Full Name Beining, Robin M. Dennis, Leslie K. Smith, Elaine M. Dokras, Anuja. Institution Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, USA. Title Meta-analysis of intrauterine device use and risk of endometrial cancer. [Review] [28 refs] Source Annals of Epidemiology. 18(6):492-9, 2008 Jun. Abstract PURPOSE: We sought to study the association between intrauterine device (IUD) use and endometrial cancer. METHODS: A comprehensive search of literature published through April 2007 was conducted, studies reviewed, and data abstracted. Data from ten studies were pooled and analyzed using both fixed- and random-effects models to examine the association of ever use of an IUD and endometrial cancer. RESULTS: Based on the random effects model, a protective crude association between IUD use and endometrial cancer was observed (odds ratio [OR] = 0.39; 95% confidence interval [CI] = 0.29-0.51; heterogeneity p < 0.001) with a pooled adjusted risk of OR = 0.54 (95% CI, 0.47-0.63; heterogeneity p = 0.40). A decreased risk of endometrial cancer also was seen for increased years of IUD use (OR for 5 years of use 0.88; 95% CI = 0.84- 0.92; n = 5; heterogeneity p = 0.14), increased years since last IUD use (OR for 5 years of use 0.91; 95% CI, 0.86-0.95; n = 4; heterogeneity p = 0.02), and increased years since first IUD use (OR for 5 years of use 0.89; 95% CI, 0.83-0.95; n = 4; heterogeneity p = 0.04). CONCLUSIONS: Our results suggest that nonhormonal IUD use may be associated with a decreased risk for endometrial cancer; however, the exact mechanism for this association is unclear. Future investigations should address the difference in the proposed association by specific type of IUDs. [References: 28] Publication Type Journal Article. Meta-Analysis. Review. <10> Unique Identifier 18507610 Status MEDLINE Authors Fontenot HB. Harris AL. Authors Full Name Fontenot, Holly B. Harris, Allyssa L. Institution Maternal Child Health Department, Boston College, William F. Connell School of Nursing, Chestnut Hill, MA 02467, USA. firstname.lastname@example.org Title The latest advances in hormonal contraception. [Review] [31 refs] Source JOGNN - Journal of Obstetric, Gynecologic, & Neonatal Nursing. 37(3):369-74, 2008 May-Jun. Abstract Millions of women each year start or continue to use some type of hormonal contraceptive method. Choosing a method may be anxiety provoking. In this article, we review some of the latest advances in and options for hormonal contraception, including extended-dose oral contraceptives, the vaginal ring, injectable methods, and emergency contraception. Nurses can facilitate women's decision making for healthy reproductive options. [References: 31] Publication Type Journal Article. Review. <11> Unique Identifier 18283598 Status MEDLINE Authors Bastianelli C. Farris M. Benagiano G. Authors Full Name Bastianelli, Carlo. Farris, Manuela. Benagiano, G. Institution Department of Gynaecologic Sciences, Perinatology and Child Care, University la Sapienza, Rome, Italy. email@example.com Title Emergency contraception: a review. [Review] [67 refs] Source European Journal of Contraception & Reproductive Health Care. 13(1):9-16, 2008 Mar. Abstract Emergency contraception (EC), also known as 'the morning after pill', or post-coital contraception, is a modality of preventing the establishment of a pregnancy after unprotected intercourse. Both a hormonal and an intrauterine form are available. Modern hormonal EC, with low side effects, was first proposed by Yuzpe in 1974. More recently, a new regimen, consisting of levonorgestrel administered alone, was introduced and found in clinical trials to be more effective (if taken as early as possible), and associated with less side effects than the Yuzpe regimen, which it has gradually replaced. The WHO developed another regimen based on the use of the selective progesterone receptor modulator (antiprogestin) mifepristone and conducted trials with different dosages. Intrauterine EC was first proposed by Lippes in 1976. It has the advantage of being applicable for almost a week and the disadvantage of a greater complexity. In addition, this modality is solely interceptive, acting by preventing implantation. Pregnancy rates reported following EC using an intrauterine device with more than 300 mm2 of copper are consistently low (0.1-0.2%). [References: 67] Publication Type Journal Article. Review. <12> Unique Identifier 18460943 Status MEDLINE Authors Skjeldestad FE. Authors Full Name Skjeldestad, Finn E. Institution SINTEF Health Research and Institute of Laboratory Medicine, Children's and Women's Health, Norwegian University of Technology and Science, Trondheim, Norway. firstname.lastname@example.org Title The impact of intrauterine devices on subsequent fertility. [Review] [41 refs] Source Current Opinion in Obstetrics & Gynecology. 20(3):275-80, 2008 Jun. Abstract PURPOSE OF REVIEW: To investigate the impact of intrauterine devices on subsequent fertility. RECENT FINDINGS: Intrauterine devices are safe, well tolerated and used by millions of women worldwide. Subsequent fertility is studied among women who remove the intrauterine contraceptive device for planning pregnancy or among women who have removed the intrauterine contraceptive device because of intrauterine contraceptive device-related complications and later on have become pregnant. Study participants are recruited from randomized clinical trials on intrauterine contraceptive device performance or in case series among women who remove the intrauterine contraceptive device. Pregnancy rates after removal are high and are similar to time-to-pregnancy rates in the general population. The birth rates are high with a normal distribution of preterm deliveries, normal birth weight and sex ratio of newborns. The ratio of extra-intrauterine pregnancies and the need for infertility work up are low, and the distribution of infertility causes among fully investigated couples is as seen in the general population. SUMMARY: Despite small sample size of studies investigating impact of intrauterine contraceptive devices on subsequent fertility, the results are consistent and reassuring on high pregnancy rates, and a normal distribution of pregnancy outcomes. There are limited data on return of fertility after usage of medicated intrauterine contraceptive devices-- more studies are warranted among women who have used hormone-releasing intrauterine contraceptive devices. [References: 41] Publication Type Journal Article. Review. <13> Unique Identifier 18400840 Status MEDLINE Authors ESHRE Capri Workshop Group. Authors Full Name ESHRE Capri Workshop Group. Institution Department of Obstetrics and Gynecology, University of Milano, Via Commenda 12, 20122Milano, Italy. Title Intrauterine devices and intrauterine systems. [Review] [93 refs] Source Human Reproduction Update. 14(3):197-208, 2008 May-Jun. Abstract From a public health viewpoint, the intrauterine device (IUD) is the most widely used contraceptive method in the world. Prevalence rates range among countries from 2 to 80% of contraceptive users. During 5 years of IUD use, pregnancy occurs in less than 2 per 100 insertions. Bleeding and pain are the most common reasons for removal rates of 10% in the first year and up to 50% within 5 years. The contraceptive effects of IUDs may be due to a sterile inflammatory reaction in the endometrial cavity which interferes with sperm function, so that fertilization is less likely to occur. IUDs also interfere with implantation but the extent to which this contributes to their contraceptive action is unknown. In nulliparous women rates of expulsion and removal for bleeding and/or pain are higher than in parous women. Effective use of IUDs for up to 10 years has the same pregnancy rate as tubal interruption. Thus, the IUD may be an alternative to female sterilization, especially in younger women who are more likely to experience regret after sterilization. The levonorgestrel intrauterine system (LNG-IUS) reduces bleeding and dysmenorrhoea, provides superior effectiveness to copper IUDs, and may be a useful treatment for endometriosis or an alternative to hysterectomy for menorrhagia. [References: 93] Publication Type Journal Article. Research Support, Non-U.S. Gov't. Review. <14> Unique Identifier 18221924 Status MEDLINE Authors Thonneau PF. Almont T. Authors Full Name Thonneau, Patrick F. Almont, Thierry. Institution Human Fertility Research Group, Toulouse University Hospital, France. thonneau.p@chu- toulouse.fr Title Contraceptive efficacy of intrauterine devices. [Review] [55 refs][Erratum appears in Am J Obstet Gynecol. 2008 Apr;198(4):485 Note: Almont, Thierry E [corrected to Almont, Thierry]] Source American Journal of Obstetrics & Gynecology. 198(3):248-53, 2008 Mar. Abstract To compare the contraceptive efficacy of various types of intrauterine devices (IUD; copper devices, Nova-T, intrauterine contraceptive systems, levonorgestrel-releasing devices), we reviewed all relevant publications on this subject that have been published over the last 2 decades. The first point to be highlighted by this review is the excellent effectiveness of IUDs, with a global cumulative pregnancy rate <2% at 5 years, whatever the type of device used. We observed a large variation in efficacy rate according to the type of IUD and also according to study design. Nevertheless, of all the types of IUDs, the levonorgestrel-releasing IUD and to a lesser extent the TCu380A IUD seem to be the most effective, with a cumulative pregnancy rate at 5 years of <0.5% for the levonorgestrel-releasing IUD and between 0.3% and 0.6% for the TCu380A IUD. [References: 55] Publication Type Comparative Study. Journal Article. Review. <15> Unique Identifier 17544330 Status MEDLINE Authors Mansour D. Authors Full Name Mansour, Diana. Institution Graingerville Clinic, Newcastle General Hospital, Newcastle upon Tyne, UK. email@example.com Title Modern management of abnormal uterine bleeding: the levonorgestrel intra-uterine system. [Review] [61 refs] Source Best Practice & Research in Clinical Obstetrics & Gynaecology. 21(6):1007-21, 2007 Dec. Abstract Since its launch, more than 9 million women worldwide have used the levonorgestrel intra- uterine system (IUS) for contraception, as a treatment for heavy menstrual bleeding and as the progestogen component of hormone-replacement therapy. For women in their reproductive years, the IUS has become one of the most acceptable medical treatments for menorrhagia, reducing referrals to specialists and decreasing the need for operative gynaecological surgery. This article will outline the development of the IUS, highlighting the most important recent areas of research covering its use to control menstrual blood loss and pain. [References: 61] Publication Type Journal Article. Review. <16> Unique Identifier 17982331 Status MEDLINE Authors Chrisman C. Ribeiro P. Dalton VK. Authors Full Name Chrisman, Camaryn. Ribeiro, Pricilla. Dalton, Vanessa K. Institution Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA. Title The levonorgestrel-releasing intrauterine system: an updated review of the contraceptive and noncontraceptive uses. [Review] [98 refs] Source Clinical Obstetrics & Gynecology. 50(4):886-97, 2007 Dec. Abstract The levonorgestrel containing intrauterine system is an effective and safe form of long-term yet reversible birth control. Intrauterine contraception use in the United States fell dramatically after early studies reported an association between intrauterine contraception use and later tubal infertility. Subsequent evaluation suggests that these early studies were biased. Users often experience menstrual disturbances. Informing patients of these common side effects is important to improve compliance. In addition to its contraceptive effect, the levonorgestrel intrauterine system offers potential therapeutic benefits in other clinical contexts, including menorrhagia, symptomatic fibroids, endometriosis, and endometrial suppression. [References: 98] Publication Type Journal Article. Review. <17> Unique Identifier 17531622 Status MEDLINE Authors Hubacher D. Authors Full Name Hubacher, David. Institution Family Health International, PO Box 13950, Research Triangle Park, NC 27709, USA. firstname.lastname@example.org Title Copper intrauterine device use by nulliparous women: review of side effects. [Review] [25 refs] Source Contraception. 75(6 Suppl):S8-11, 2007 Jun. Abstract BACKGROUND: Nulliparity was once a relative contraindication to using the copper IUD. However, new research and changes in product labeling have eased safety concerns. Side effects remain a major problem with copper IUD use in this population. METHODS: A review of published articles was undertaken to find information on expulsion rates and removals for bleeding and pain among nulliparous women using a copper IUD; approximately 500 articles and abstracts were found. RESULTS: In 15 studies comparing IUD performance in parous vs. nulliparous women, nulliparous women had higher rates of expulsion and removals due to bleeding and pain. Among 8 studies examining different types of copper IUDs in nulliparous women, some evidence suggests IUD size and shape play a role in performance. CONCLUSION: All existing copper IUDs are suitable for use by nulliparous women. However, more research is needed to determine whether expulsions and removals due to bleeding and pain can be reduced with improved copper devices. [References: 25] Publication Type Journal Article. Research Support, Non-U.S. Gov't. Research Support, U.S. Gov't, Non-P.H.S.. Review. <18> Unique Identifier 17531621 Status MEDLINE Authors Nelson AL. Authors Full Name Nelson, Anita L. Institution Harbor-UCLA Medical Center, Box 474, Torrance, CA 90509-2910, USA. email@example.com Title Contraindications to IUD and IUS use. [Review] [42 refs] Source Contraception. 75(6 Suppl):S76-81, 2007 Jun. Abstract Contraindications to IUD or IUS use can be found on product labeling, in the guidelines of various specialty groups and in recommendations from peer-reviewed articles. Overly restrictive contraindications block access to this top-tier method for many women who would be candidates based on current scientific evidence. Assuming that a condition should be listed as a contraindication only if the risk of IUD/IUS use by a woman with that condition exceeds her risk with pregnancy, the list of contraindications is reduced to pregnancy, active uterine infection, malignancy in the uterus or cervix, an inability to place or retain the device, unexplained abnormal bleeding and adverse reaction to product ingredients. [References: 42] Publication Type Journal Article. Review. <19> Unique Identifier 17531620 Status MEDLINE Authors Sivin I. Authors Full Name Sivin, Irving. Institution Center for Biomedical Research, Population Council, New York, NY 10021, USA. firstname.lastname@example.org Title Utility and drawbacks of continuous use of a copper T IUD for 20 years. [Review] [18 refs] Source Contraception. 75(6 Suppl):S70-5, 2007 Jun. Abstract This article examines interrelated questions concerning the extent of need for contraception in women 40 years and older and the degree to which that need can be served when use of collared T IUDs is initiated in women aged 25-35 years. Differentials in the impacts of intrauterine device (IUD) use on health issues in the second decade of contraception are also addressed. Although fertility of all women aged 40-44 years is below 100 per 1000 in all regions of the world today, the risk of pregnancy among married or cohabiting women who do not use contraception is estimated at 270-300 per 1000 or 27-30% per year. At ages 45-49 years, the annual risk of pregnancy to women in union who do not use contraception lies at or above 10% per year. Data from three studies show that users of collared copper IUDs who continued using the same device beyond the completion of 10 years experienced no pregnancies through the end of 15 years. A small number of women continued with the same IUD through 20 years and still experienced no pregnancies. Use of collared copper T IUDs beyond 10 years was not associated with intensification of side effects nor with an increase in the relative frequency of those effects, with the exception of the experience of perimenopausal symptoms and problems. Neither increased bleeding nor increased severity of pelvic disease was manifest in the second decade of continuous use of the same IUD, as compared with the first decade of such use. Under our current understanding of the duration of IUD effectiveness, only a small percentage of women complete 10 years of use. Even with revised understanding of the duration of effectiveness of long-acting copper devices, average annual continuation rates must be quite high in order that 20% of women aged 25-35 years initiate a second decade of continuous IUD use. Those who do so would find considerable protection against pregnancy and reasonable economic benefits in continuing to use the same device. [References: 18] Publication Type Journal Article. Review. <20> Unique Identifier 17531619 Status MEDLINE Authors Curtis KM. Marchbanks PA. Peterson HB. Authors Full Name Curtis, Kathryn M. Marchbanks, Polly A. Peterson, Herbert B. Institution Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. email@example.com Title Neoplasia with use of intrauterine devices. [Review] [48 refs][Erratum appears in Contraception. 2008 Feb;77(2):138] Source Contraception. 75(6 Suppl):S60-9, 2007 Jun. Abstract BACKGROUND: One of the mechanisms by which intrauterine devices (IUDs) prevent pregnancy is the creation of a sterile inflammatory response in the endometrium. Additionally, hormone-releasing IUDs or intrauterine systems (IUSs) release progestins or progesterone into the uterus. Both of these mechanisms may affect users' risk for neoplasia. STUDY DESIGN: We searched the PubMed database for studies on IUD use and risk for neoplasia conducted between 1960 and September 2006 and published in all languages. We excluded case reports and case series. For the association between ever using an IUD and risk for endometrial cancer, we conducted a meta-analysis using a Bayesian random-effects model to account for between-study heterogeneity. RESULTS: We found no evidence of increased risk for neoplasia with IUD use. Nine case-control studies and one cohort study found reduced risks for endometrial cancer with having ever used an IUD (pooled adjusted odds ratio=0.6, 95% confidence interval=0.4-0.7). No trend in associations was observed with characteristics of IUD use, type of IUD and histologic type of cancer. Four case-control studies found no association between IUD use and risk for cervical cancer. One study found no increased incidence of breast cancer among levonorgestrel- releasing IUS users as compared with the general population in Finland. Finally, three studies found no association between IUD use and occurrence of hydatidiform moles or malignant sequelae. CONCLUSIONS: Use of an IUD does not appear to increase the risk for neoplasia. While nearly all studies found that IUD use was associated with a decreased risk for endometrial cancer, it remains unclear whether this association is causal. [References: 48] Publication Type Journal Article. Review. <21> Unique Identifier 17531617 Status MEDLINE Authors Castano PM. Authors Full Name Castano, Paula M. Institution Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032, USA. firstname.lastname@example.org Title Use of intrauterine devices and systems by HIV-infected women. [Review] [25 refs] Source Contraception. 75(6 Suppl):S51-4, 2007 Jun. Abstract Human immunodeficiency virus (HIV)-infected women have unique contraceptive needs. HIV infection is now considered a chronic disease and contraceptive options have widened for HIV- infected women. However, there are safety concerns regarding the use of intrauterine devices and systems in HIV-infected women. Although studies are limited, intrauterine devices appear to be safe for use by most HIV-infected women. This is a review of the available data and international recommendations. [References: 25] Publication Type Journal Article. Review. <22> Unique Identifier 17531612 Status MEDLINE Authors d'Arcangues C. Authors Full Name d'Arcangues, Catherine. Institution UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, CH-1211 Geneva, Switzerland. email@example.com Title Worldwide use of intrauterine devices for contraception. [Review] [28 refs] Source Contraception. 75(6 Suppl):S2-7, 2007 Jun. Abstract The intrauterine device is the most widely used reversible method of contraception in the world today, particularly in developing countries where it is used by 14.5% of women of reproductive age. In the developed world, this percentage is only 7.6%. There are marked regional differences with the highest use in Eastern Asia and the lowest in North America. Such differences between regions and countries can be explained by a number of factors at the individual, service delivery, program and policy levels. The situation in seven countries is briefly described to illustrate this and to conclude that this method of contraception is largely underutilized in many parts of the world, where it could play a significant role in improving women's health. [References: 28] Publication Type Journal Article. Review. <23> Unique Identifier 17531611 Status MEDLINE Authors Inki P. Authors Full Name Inki, Pirjo. Institution Bayer Schering Pharma AG, D-13342 Berlin, Germany. firstname.lastname@example.org Title Long-term use of the levonorgestrel-releasing intrauterine system. [Review] [42 refs] Source Contraception. 75(6 Suppl):S161-6, 2007 Jun. Abstract Since its launch in Finland in 1990, the levonorgestrel-releasing intrauterine system (LNG IUS) has become available in more than 100 countries throughout the world, with most countries also having the approval for the treatment of idiopathic menorrhagia and protection from endometrial hyperplasia during estrogen replacement therapy. After its introduction in Finland and Scandinavian countries, the LNG IUS has been available in most European countries since the mid to late 1990s and in the United States since 2001. Studies on the repeat use of the LNG IUS with second and third consecutive IUSs have shown high continuation rates and low rates of adverse effects. During repeat use of the LNG IUS, the bleeding pattern changes toward an increasing amenorrhea rate. With regard to the menorrhagia indication, the 5-year follow-up results of a randomized comparative trial of the LNG IUS and hysterectomy have shown equal satisfaction and improvement in health-related quality of life with both treatments. Although a proportion of women assigned to the LNG IUS group eventually underwent hysterectomy, the continuation rate of the LNG IUS for menorrhagia is clearly superior to that of conventional medical therapy (e.g., oral progestins). Use of the LNG IUS in combination with estrogen therapy in women undergoing menopausal transition seems to be well tolerated and associated with a favorable bleeding pattern. [References: 42] Publication Type Journal Article. Review. <24> Unique Identifier 17531609 Status MEDLINE Authors Sitruk-Ware R. Authors Full Name Sitruk-Ware, Regine. Institution Center for Biomedical Research Population Council, Rockefeller University, New York, NY 10021, USA. email@example.com Title The levonorgestrel intrauterine system for use in peri- and postmenopausal women. [Review] [37 refs] Source Contraception. 75(6 Suppl):S155-60, 2007 Jun. Abstract The intrauterine system (IUS) delivering levonorgestrel (LNG; Mirena), initially developed as a long-acting method of contraception, has demonstrated its efficacy and safety in a large number of users all over the world. The local delivery of a small dose of a highly effective progestin in the uterine cavity maintains the endometrium in a nonproliferative state and reduces the number of bleeding days, thus preventing anemia, an important medical benefit, especially in developing countries. In addition, the intrauterine delivery of a progestin allows the treatment of other medical conditions and prevention of endometrial hyperplasia, in postmenopausal women receiving estrogen therapy. During the perimenopausal years, the IUS provides an effective contraception as occasional ovulations occur. In addition, by its direct effect on the endometrium, it prevents the occurrence of menorrhagia, a frequent condition in the premenopause. After cessation of the ovarian function, when estrogen therapy may be initiated, the IUS would ensure endometrial protection as a transition to the menopause and as long as hormone therapy is needed. Although the circulating levels of LNG are very low, minor side effects related to the androgenic properties of LNG have been reported. In addition, the insertion of the system needs a skilled health provider and may be difficult or painful when the uterus is small or atrophic. The development of smaller devices is warranted for these specific situations. [References: 37] Publication Type Journal Article. Review. <25> Unique Identifier 17531605 Status MEDLINE Authors Bahamondes L. Petta CA. Fernandes A. Monteiro I. Authors Full Name Bahamondes, Luis. Petta, Carlos A. Fernandes, Arlete. Monteiro, Ilza. Institution Human Reproduction Unit, Department of Obstetrics and Gynecology, School of Medicine, Universidade Estadual de Campinas (UNICAMP), 13084-971, Campinas, SP, Brazil. firstname.lastname@example.org Title Use of the levonorgestrel-releasing intrauterine system in women with endometriosis, chronic pelvic pain and dysmenorrhea. [Review] [39 refs] Source Contraception. 75(6 Suppl):S134-9, 2007 Jun. Abstract OBJECTIVES: This report is a review of the medical literature on the use of the levonorgestrel- releasing intrauterine system (LNG-IUS) in women with endometriosis, adenomyosis, cyclic pelvic pain and dysmenorrhea. MATERIAL AND METHODS: A review was carried out using the MEDLINE and EMBASE databases to evaluate the use of LNG-IUS in women with endometriosis and adenomyosis. RESULTS: Nine studies were identified, only two of which were randomized clinical trials. One compared the insertion of LNG-IUS after surgery with expectant conduct and the other compared the use of the device with a GnRH analogue (GnRH-a). All studies reported an improvement in pelvic pain and dysmenorrhea, and a reduction in menstrual bleeding. One study found an improvement in the staging of the disease at 6 months of use, and the studies that evaluated the use of LNG-IUS in women with adenomyosis reported a reduction in uterine volume. Furthermore, the only study in which women were followed up for 3 years after insertion found improvement in pelvic pain at 12 months of use. However, there was no improvement after that period. CONCLUSIONS: The use of LNG-IUS is an alternative for the medical treatment of women suffering from endometriosis, adenomyosis, chronic pelvic pain or dysmenorrhea, but experience is limited and long-term studies are necessary to reach definitive conclusions. However, for women who do not wish to become pregnant, this device offers the possibility of at least 5 years of treatment following one single intervention. [References: 39] Publication Type Journal Article. Research Support, Non-U.S. Gov't. Review. <26> Unique Identifier 17081937 Status MEDLINE Authors Morgan KW. Authors Full Name Morgan, Katherine W. Institution University of Utah College of Nursing, 10 South 2000 East, Salt lake City, UT 84112, USA. Katie.email@example.com <Katie.firstname.lastname@example.org> Title The intrauterine device: rethinking old paradigms. [Review] [39 refs] Source Journal of Midwifery & Women's Health. 51(6):464-70, 2006 Nov-Dec. Abstract The United States continues to have one of the highest rates of unintended pregnancy and elective abortion in developed countries. Intrauterine devices (IUDs) available today offer women safe and highly effective contraception along with noncontraceptive benefits, yet IUDs remain underutilized in part because of outdated and biased information about the risks associated with this method of fertility control. New research demonstrates that IUD use does not increase the risk of pelvic infections or subsequent infertility. IUD use decreases the absolute risk of ectopic pregnancies. In light of this data, the IUD should be made available to women at low-risk for sexually-transmitted infections and should not be denied to women on the basis of parity or marital status. [References: 39] Publication Type Journal Article. Review. <27> Unique Identifier 17054271 Status MEDLINE Authors Grimes DA. Hubacher D. Lopez LM. Schulz KF. Authors Full Name Grimes, D A. Hubacher, D. Lopez, L M. Schulz, K F. Institution Family Health International, Clinical Research Department, PO Box 13950, Research Triangle Park, Durham, NC 27709, USA. email@example.com Title Non-steroidal anti-inflammatory drugs for heavy bleeding or pain associated with intrauterine- device use. [Review] [47 refs] Comments Comment in: Evid Based Nurs. 2007 Apr;10(2):48; PMID: 17384100] Source Cochrane Database of Systematic Reviews. (4):CD006034, 2006. Abstract BACKGROUND: Heavy bleeding and pain are the most common reasons why women discontinue IUDs. Non-steroidal anti-inflammatory drugs, which inhibit prostaglandin synthesis, have been shown to be effective in reducing menstrual bleeding and pain in women without IUDs. OBJECTIVES: This review summarizes all randomized controlled trials studying use of nonsteroidal anti-inflammatory drugs for treatment of bleeding or pain associated with IUD use. Trials of prophylactic use of these drugs around the time of IUD insertion were also included. SEARCH STRATEGY: We performed searches of PubMed, CENTRAL, POPLINE, EMBASE, LILACS, and CINAHL for relevant trials. We also wrote to the authors of all trials identified to seek other published or unpublished trials. SELECTION CRITERIA: We included all randomized controlled trials in any language that tested one or more nonsteroidal anti- inflammatory drugs for treatment or prevention of bleeding or pain associated with IUD insertion or use. DATA COLLECTION AND ANALYSIS: Two authors independently abstracted data from relevant trials, and we entered data into RevMan for analysis. MAIN RESULTS: We found 15 trials from 10 countries; the total number of participants was 2702. Nonsteroidal anti-inflammatory drugs (naproxen, suprofen, mefenamic acid, ibuprofen, indomethacin, flufenamic acid, alclofenac, and diclofenac) were effective in reducing menstrual blood loss associated with IUD use. This held true for women with and without complaints of heavy bleeding. Similarly, these drugs were effective in reducing pain associated with IUD use. In contrast, prophylactic use of nonsteroidal anti-inflammatory drugs had mixed results; studies with ibuprofen found no effect on pain after insertion on IUD discontinuation. No important differences emerged in the one trial comparing the effect of different NSAIDs on bleeding. AUTHORS' CONCLUSIONS: Nonsteroidal anti-inflammatory drugs reduce bleeding and pain associated with IUD use. NSAIDs should be considered first-line therapy; if NSAIDs are ineffective, tranexamic acid may be considered as second-line therapy. Prophylactic ibuprofen administration with the first six menses after insertion appears unwarranted. [References: 47] Publication Type Journal Article. Meta-Analysis. Research Support, N.I.H., Extramural. Research Support, U.S. Gov't, Non-P.H.S.. Review. <28> Unique Identifier 16563872 Status MEDLINE Authors Farquhar C. Brosens I. Authors Full Name Farquhar, Cynthia. Brosens, Ivo. Institution Department of Obstetrics and Gynaecology, National Womens' Health at Auckland, City Hospital, University of Auckland, Private Bag 92019, Auckland, New Zealand. firstname.lastname@example.org Title Medical and surgical management of adenomyosis. [Review] [57 refs] Source Best Practice & Research in Clinical Obstetrics & Gynaecology. 20(4):603-16, 2006 Aug. Abstract Adenomyosis of the uterus is a common condition amongst women in their reproductive years. It is defined as the presence of heterotopic endometrial glands and stroma in the myometrium with adjacent smooth muscle hyperplasia. The common presenting symptoms are painful and heavy periods and infertility, although many women are asymptomatic. Adenomyosis is thought to affect 1% of women and is typically diagnosed in the 4th and 5th decades of life. The aetiology is unclear, and until recently a diagnosis was made only after invasive and destructive surgery. With the advent of improved imaging of the pelvic organs, and in particular magnetic resonance imaging, the diagnosis of adenomyosis is being made more frequently. Unfortunately, because the disease has been infrequently diagnosed prior to hysterectomy, there are few well-designed studies of medical or surgical management. Management with hormonal treatment that aims to reduce the proliferation of endometrial cells is promising, but there is a paucity of well-designed studies to guide treatment. Hysterectomy or use of the levonorgestrel intrauterine system (LNG- IUS) remains the mainstay of treatment. [References: 57] Publication Type Journal Article. Review. <29> Unique Identifier 16882450 Status MEDLINE Authors Paladine HL. Blenning CE. Judkins DZ. Mittal S. Authors Full Name Paladine, Heather L. Blenning, Carol E. Judkins, Dolores Zegar. Mittal, Shashi. Institution University of Southern California/Keck School of Medicine, Los Angeles, CA, USA. Title Clinical inquiries. What are contraindications to IUDs?. [Review] [11 refs] Source Journal of Family Practice. 55(8):726-9, 2006 Aug. Abstract Based on limited evidence, use of intrauterine devices (IUDs) is not contraindicated for women with HIV/AIDS (strength of recommendation [SOR]: C), multiple sexual partners (SOR: C), previous actinomyces colonization (SOR: C), most types of fibroids (SOR: C), or previous ectopic pregnancy (SOR: C). The risk to IUD users of pelvic inflammatory disease (PID) is similar to women using no contraception (SOR: B). Nulliparous women may experience increased insertion discomfort and higher rates of expulsion (SOR: B). IUD use of <3.5 years is not associated with decreased fertility (SOR: B). [References: 11] Publication Type Journal Article. Review. <30> Unique Identifier 16413845 Status MEDLINE Authors Mohllajee AP. Curtis KM. Peterson HB. Authors Full Name Mohllajee, Anshu P. Curtis, Kathryn M. Peterson, Herbert B. Institution Division of Reproductive Health, WHO Collaborating Center in Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. Title Does insertion and use of an intrauterine device increase the risk of pelvic inflammatory disease among women with sexually transmitted infection? A systematic review. [Review] [20 refs] Source Contraception. 73(2):145-53, 2006 Feb. Abstract Concerns exist as to whether the insertion of copper and levonorgestrel-releasing intrauterine devices (IUDs) increases the risk of pelvic inflammatory disease (PID) among women with sexually transmitted infection (STI). We searched the MEDLINE database for all articles published between January 1966 and March 2005 that included evidence relevant to IUDs and STIs and PID. None of the studies that examined women with STIs compared the risk of PID between those with insertion or use of an IUD and those who had not received an IUD. We reviewed indirect evidence from six prospective studies that examined women with insertion of a copper IUD and compared risk of PID between those with STIs at the time of insertion with those with no STIs. These studies suggested that women with chlamydial infection or gonorrhea at the time of IUD insertion were at an increased risk of PID relative to women without infection. The absolute risk of PID was low for both groups (0-5% for those with STIs and 0-2% for those without). [References: 20] Publication Type Journal Article. Research Support, N.I.H., Extramural. Research Support, Non-U.S. Gov't. Research Support, U.S. Gov't, Non-P.H.S.. Research Support, U.S. Gov't, P.H.S.. Review.
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