Contraceptive delivery systems最新文献

320 medicated IUDs were removed from 292 women by means of the dynamometer. This instrument indicates the highest retention force (HRF) in newtons (N). Ages of the women ranged from 17-50 years. The IUDs were fitted in nulligravidae (56%), nulliparous with 1 or more abortions (13%), primiparous (18%), and multiparous (13%) women. The IUDs used were the ML Cu 250-standard, 7 Cu 200, T Cu 200-adapted, with a shortened transversal arm of 15-30 mm and T Cu 200 standard. With the low expulsion rate, the ML Cu 250-standard IUD needed 5.8-5.4N and the 7 Cu 200 3.8-2.6N. The adapted T Cu 200 IUD needed 2.6-1.6N, i.e., about 1N more thant the T Cu 200-standard with an HRF of 1.7-1.0N. As the dynamomoeter only indicated the highest retention force, a retentiograph was devised to demonstrate the different retention forces and phases of the various IUDs by characteristic curves. The possible connections between retention and expulsion of IUDs are discussed. The retention forces of the different IUDs compared are congruent with the published expulsion rates. The retentiograph showed new patterns to test IUDs before they demonstrate side effects in vitro.

Menstrual blood loss (MBL) was estimated before and after insertion of the U-coil progesterone-releasing device in 37 patients. The same procedure was carried out in 39 cases fitted with an inert U-coil IUD of the same size and shape. Blood loss was estimated by the atomic abosorption technique during the preinsertion cycle and at the 1st, 3rd, 6th, 9th, and 12th postinsertion cycles. MBL was significantly reduced in patients fitted with a progesterone-releasing U-coil compared to those fitted with an inert U-coil who showed a significant increase in MBL. The cycle length was prolonged with the progesterone U-coil, and was reduced with inert U-coil devices. The duration of flow was significantly reduced with the progesterone U-coil and significantly prolonged with the inert device. The incidence of intermenstrual spotting was higher with the progesterone U-coil than with the inert U-coil. The hemoglobin level was significantly increased with the progesterone U-coil while it was significantly reduced with inert U-coil devices.

49 women using either Lippes Loop D or copper T220C IUDs who were complaining of increased menstrual bleeding, were treated with mefenamic acid at a dosage of 500 mg 3 times/day for 5 days during their menstrual periods. Menstrual bleeding of each patient was quantified before initiation of the treatment and figures so obtained were used as pretreatment control values; during their 2nd cycle they received 1 placebo tablet 3 times/day for 5 days, the next 2 cycles utilized treatment with mefenamic acid, followed by a 5th cycle on placebo, and a 6th one without treatment. Of the 49 women admitted to the trial, 20 had pretreatment menstrual bleeding of more than 80 ml and 29 had less than 80 ml; groups 1 and 2, respectively. For group 1, a significant decrease in menstrual bleeding of 49.5% and 37.4% was observed during the 2 treatment cycles. Group 2, subjects with menstrual bleeding within the normal range, showed no decrease in menstrual bleeding.

Amenorrhea is a common side effect of injectable contraceptive. Lippes loops were inserted in 22 amenorrheic women who continued injectable contraception, and in 6 cases with prolonged postinjectable amenorrhea. The occurrence and rhythm of subsequent bleeding was recorded. IUD insertion induced bleeding in most cases of continued injectable users but it was usually irregular and unpredictable. It was regular in 6 subjects only while the IUD was in situ. After the removal of the IUD, the majority regained the state of amenorrhea within 3 months. Temporary IUD insertion had a positive impact on continuation (a mean additional rate of 18 months of use) among subjects who had wished to terminate the method because of amenorrhea. This procedure of temporary IUD insertion may serve to provide these women with an alternative contractive approach. In the postinjectable amenorrhea group, temporary IUD insertion induced bleeding during IUD application as well as after its removal, which was more predictable than that in the continued users. IUD insertion may facilitate return of regular menses and resumption of fertility in amenorrheic women who stop injectable contraception.

Desogestrel (13-ethyl-11-methylene-18, 19-dinor-17alpha-pregn-4-en-20-yn-17-ol) is a new potent progestagen suitable for incorporation into combined oral contraceptives (OC)s. 2 products have thus far been developed, 1 containing 150 mcg desogestrel plus 30 mcg ethinyl estradiol (EE)/tablet (Marvelon) and the other a normophasic product containing 50 mcg EE (7 tablets) followed by 125 mcg desogestrel plus 50 mcg EE (15 tablets). No tablet failures were reported in large-scale multicenter trials. Clinical studies, confirmed by receptor studies, showed that desogestrel lacks androgenicity in the dosages used. Also, studies on lipid metabolism revealed that desogestrel does not abolish EE-induced rises in HDL cholesterol. Since low levels of HDL cholesterol have been associated with an increased risk of ischemic heart disease, this can be regarded as a favorable aspect of desogestrel. In view of increasing demands for safer OCs, it can be concluded that preference should be given to OCs containing this progestogen.

The increase in menstrual blood loss (MBL) caused by IUDs may result in iron deficiency anemia. 60 women completing 2 years of Cu-IUD use were investigated for this risk, using hemoglobin concentration serum iron indices. No significant differences were found compared to a control group of women requesting interval Cu-IUD insertion. A decrease in the MBL increment with time following insertion, self-selection of the study population, and increased dietary iron absorption are suggested explanations for these results. 15.4% of patients suffered from iron deficiency anemia. Measurement of serum ferritin is advocated to identify these women for treatment, in order to enhance maternal health.

A trial was carried out on 154 selected volunteers who underwent cesarean section and then received an ML Cu 250 IUD during the operation. 56% of the operations were planned while 44% were not. The IUD was inserted in 65, 80, and 9 cases in the 1st, 2nd, and 3rd cesarean section, respectively. The patients were followed-up after 1, 3, 6, 12, and 24 months. Hospitalization time and postoperative morbidity did not increase with device insertion. Maternal lactation was not altered. 8% of the patients had postpartum bleeding which lasted more than 40 days. At the 1 year examination, 52% of the patients were menstruating normally while at 2 years, the percentage had increased to 62.5%. The acceptability, continuity, and efficiency of the contraceptive procedure proved successful. There were only 4 cases (2.6%) in which the device had to be removed for medical reasons (due largely to endometritis) and 8 cases (5.2%) because of patient desire (menstrual abnormalities). Spontaneous expulsion of the IUD occurred in 4 cases (2.6%). As of the present time, no pregnancies have been detected. The cesarean section insertion of an ML Cu 250 IUD produced excellent results and further, more widespread use is suggested.