Uterine Artery and Arcuate Vessels Doppler in Patients with Abnormal Uterine Bleeding Using Copper Intrauterine Contraceptive Device (IUCDs) and Combined Oral Contraceptive Pills (COCPs)

Abstract

Objectives: The aim of our study was to perform a comparative evaluation of the uterine and arcuate vessels Doppler indices in four groups of women: Intrauterine contraceptive device (IUCD) users with and without abnormal uterine bleeding (AUB), combined oral contraceptive users and women not using any contraceptive. Materials and Methods: This prospective longitudinal analytic study was conducted in a tertiary university hospital during the period between September 2018 and March 2019. The study included 160 women with ages ranging from 20-35 years enrolled in 4 groups. Group 1: patient on IUCDs with AUB (n=40) Group 2: Patients on IUCD without AUB (n=40) Group 3: Patients on COCPs and without AUB (n=40) Group 4: Women not using aby contraceptive (n=40). The uterine artery and arcuate vessels were identified by transvaginal (TVUS) at the level of the internal os of the cervix. Real-time imaging and pulsed wave transvaginal Doppler assessment of the blood flow was performed to measure the blood flow indices. Results: There was a statistically significant difference between the three patients’ groups and the control group in endometrial thickness ( p=0.004 ), uterine artery PI ( p<0.001 ) , arcuate vessel PI ( p<0.001 ) and arcuate vessel RI ( p<0.001 ). However there was no significant difference regarding uterine artery RI ( p=0.112 ). Additionally, there was statistically significant difference between endometrial thickness ( p<0.001 ), uterine artery PI ( p=0.036 ), arcuate vessel PI ( p<0.001 ) and arcuate vessel RI ( p<0.001 ) when comparing the groups IUCD with and without AUB. Yet, there was no statically significant difference regarding uterine artery RI. Finally, ROC curve analysis showed the optimal cutoff values for the uterine artery PI (1.9), the arcuate vessels PI (0.9) and the arcuate vessels RI (0.49) to predict AUB in patients with IUCD. Conclusion : We identified a correlation between increased bleeding and Doppler indices. Most of the uterine artery and arcuate vessels Doppler indices were lower in the group with IUCD and AUB than in non-bleeding group. Thus the blood flow is increased during bleeding in women with IUCD-induced AUB than in those with normal menstruation. This indicates that there is an increase in uterine blood flow occurs in cases of IUCD - induced abnormal uterine bleeding.