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PurposeThe aim of this study is to prospectively evaluate whether women with copper-containing intrauterine devices (Cu-IUD), currently listed as MR conditional, can safely undergo 3.0 Tesla (3 T) magnetic resonance imaging (MRI).Methods73 women, age 18-54 years old, with a Cu-IUD who were undergoing MRI for any reason were included consecutively. Pre- and post-MRI standard pelvic ultrasound examinations were completed to determine the appropriate pre- and post-MRI positioning of the Cu-IUD. Displaced IUDs were defined by IUD crossbars not in the fundal portion of the endometrial cavity, a visualized tip in the mid or lower uterus, any part of the device located in the cervical canal or outside of the endometrial canal, a fractured device, or a non-visualized IUD. Additionally, a questionnaire was completed by participants to determine the level of pre- and post-MRI pelvic pain.ResultsThere were zero observed displaced Cu-IUDs on post-MRI pelvic ultrasounds (p = 0/70, 95% CI 0, .043). Three participants were dropped from the study due to malpositioned IUDs on pre-MRI pelvic ultrasound. Six patients reported new or worsening pelvic pain/discomfort during or after their MRI examination.ConclusionOur results suggest that performing 3 T MRI using a low SAR setting does not cause displacement of Cu-IUDs, with zero out of 70 patients demonstrating IUD displacement.

The relative risk of pregnancy with the levonorgestrel 52 mg IUD is 3 times lower than with optimal combined oral contraceptive use.

ObjectiveTo evaluate differences based on intrauterine device (IUD) frame geometry in force, and stress, and strain at the stem/arms junction during simulated IUD removal.Study designWe manufactured injection-molded frame models for three Nova-T IUDs (Mirena [model M]; Liletta [model L]; Kyleena [model K]) and a Tatum-T IUD (Paragard [model P]) at two-times scaling. We created a custom fixture to simulate the uterus and used a screw-driven machine to pull models at various displacement rates through the 10 cm fixture cavity to measure force and strain and calculate stress at the IUD stem/arms junction. We tested models at 30 mm/min and higher displacement rates for exploratory analyses. We used Mann-Whitney U test for statistical testing.ResultsWe completed testing at 30 mm/min using five of each Nova-T model and nine model P samples. Resistance against the cavity walls created significantly more force on model P (11.83, interquartile range [IQR] 11.61-12.31) than any Nova-T model samples (p

Patients who undergo organ transplantation are advised to use contraception for health optimization, yet limited data exists on safe contraceptive options for this population. This study investigates the infection risk of intrauterine devices (IUDs) in patients who have received a solid organ transplant by evaluating the incidence of pelvic inflammatory disease (PID). We performed a retrospective chart review of subjects with a solid organ transplant who used an IUD between the years of January 2007 to February 2021. We included subjects ages 22–55 years at the time of IUD placement. We abstracted demographic information, transplant type, IUD type, immunosuppressive medications, screening for sexually transmitted infections, and diagnosis of PID. We identified 29 subjects that met the inclusion criteria. Six subjects had a copper IUD (21%) and 23 had a levonorgestrel IUD (79%). The most common organ transplanted was a kidney (n = 10) and liver (n = 10) while five subjects had multiple organs transplanted. Twenty‐five (86.2%) subjects took immunosuppressive medications at the time of IUD insertion. Twenty‐four (82.8%) patients had their IUD placed after transplantation. The average time of IUD use was 2.5 years.. In our study of IUD use in patients with solid organ transplantation, no patients developed PID. IUDs are a safe contraceptive option for immunosuppressed transplant patients. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions To assess the awareness, attitude, and acceptance of the Post Placental Intra Uterine Contraceptive Device (PPIUCD) as an immediate long‐acting contraceptive method among Jordanian women.A cross‐sectional observational study was conducted at King Abdulla University Hospital among women attending antenatal clinics after 20 weeks of gestation between January 2020 and May 2021. One thousand and 30 women had completed a structured questionnaire in Arabic.Only 41.4% of the sample was aware of the PPIUCD. The attitude toward PPIUCD after a brief introduction was 56.3%. Women who had used interval IUCD were 5.82 times more likely to express a positive attitude toward PPIUCD, while postgraduate women were 1.35 times more prone to show the same attitude. Only 34% accepted PPIUCD if offered, whereas the main barrier to acceptance was the false fear of extra complications in 34.5% of the sample. The rate of unintended current pregnancy was 35.8%, where 53.4% were using natural methods.The rate of awareness of PPIUCD is low among women in Jordan. Antenatal introduction encourages attitude toward PPIUCD. [ABSTRACT FROM AUTHOR]

AbstractObjectivesMaterials and methodsResultsConclusion\nSHORT CONDENSATIONTo evaluate improvements in laboratory markers of anaemia (haemoglobin, haematocrit, serum iron, and ferritin) in women with subjective heavy menstrual bleeding (HMB) treated with the levonorgestrel 19.5-mg intrauterine device.We conducted a pilot study at the Department of Obstetrics and Gynaecology, University of Campinas, Faculty of Medical Sciences, Campinas, SP, Brazil. We compared anaemia markers in 73 women aged 18–48 years suffering from HMB, one year after placement of the IUD.The mean age of participants was 30.0 years (range 24–38); more than half were white, and the mean body mass index (kg/m2) was 27.0. Twenty (27.4%) participants exited the study due to loss to follow-up (n = 12; 16.4%), expulsion (n = 7; 9.6%) and uterine perforation (n = 1; 1.4%). One-year post-IUD placement, amenorrhoea was reported by 10 (13.7%) women. According to intention-to-treat and per protocol analyses, the proportion of women with normal haemoglobin levels significantly improved (p = 0.014 in both analyses), as did haematocrit (p < 0.001 in both analyses) and serum iron (p = 0.003 in both analyses) compared to baseline evaluations. The proportion of women with normal ferritin levels also improved (p < 0.001) in both analyses using a cut-off of 15 ng/ml, though no significant difference was observed using a 30 ng/ml cut-off (p = 0.083 in both analyses).The levonorgestrel 19.5-mg IUD effectively improved laboratory markers of anaemia one year after placement in women with HMB.Our results show that the levonorgestrel 19.5-mg IUD significantly improved anaemia markers in subjects with subjective HMB one year after insertion. The occurrence of expulsions emerged as a notable concern in this treatment group. [ABSTRACT FROM AUTHOR]

Despite increasing use of long-acting reversible contraception (LARC) among U.S. adolescents, there is limited literature on factors affecting intrauterine device (IUD) or subdermal implant use. This study aimed to describe statewide rates, and associated patient and provider factors of adolescent IUD or implant initiation and continuation. This retrospective cohort study used N.C. Medicaid claims data. 10,408 adolescents were eligible (i.e., 13–19 years, female sex, continuous Medicaid enrollment, had an IUD or implant insertion or removal code from January 1, 2013, to October 1, 2015). Bivariate analyses assessed differences in adolescents using IUD versus implant. Kaplan-Meier curves were created to assess IUD or implant discontinuation through December 31, 2018. Adolescents initiated 8,592 implants and 3,369 IUDs (N = 11,961). There were significant differences in nearly all provider and patient factors for those who initiated implants versus IUDs. 16% of implants and 53% of IUDs were removed in the first year. Younger (i.e., age <18 years old), Hispanic, and Black adolescents had higher adjusted continuation of implants compared with older and White adolescents, respectively (both p <.001). Those whose IUD was inserted by an obstetrician/gynecologist provider had lower continuation of IUDs compared with non-obstetrician/gynecologist providers (p <.001). We found that age-related, racial, and ethnic disparities exist in both implant and IUD continuation. Practice changes to support positive adolescent experiences with implant and IUD insertion and removals are needed, including patient-centered health care provider training in contraception counseling, LARC initiation and removal training for adolescent-facing providers, and broader clinic capacity for LARC services. [ABSTRACT FROM AUTHOR]

Migration of intrauterine devices (IUD) is uncommon; however, it can lead to increasingly severe complications, ranging from simple pelvic pain to potentially lethal septic shock. Therefore, diagnostic and therapeutic approaches combining endoscopic paraclinical examinations with surgical intervention need further investigation by clinicians to ensure better management. This study presents 2 rare cases where a migrating intrauterine device at the rectal level was removed via hysteroscopic approach and a second one was removed via laparoscopy.

Introduction Intrauterine devices (IUDs) are widely used worldwide. One of the rare but serious complications is uterine perforation and the penetration of an IUD through the uterine wall into the bladder. In this report, we present two cases of IUD removal from the bladder wall.Clinical case. Two patients were referred for recurrent episodes of dysuria. Medical imaging and cystoscopy revealed a foreign body in the bladder wall, which was confirmed to be an IUD that had been inserted into the uterine cavity several years prior and partially migrated into the bladder lumen. Both patients underwent successful transurethral surgery, with complete removal of the IUD without fragmentation.Discussion. The removal of the IUD through the bladder did not cause any complications, and the patients were discharged from the hospital after five days. The translation of the IUD is possible if there is partial or complete damage to the wall of the cervix, isthmus or uteral body during the installation of the device.Conclusion. Patients with an IUD in place and frequent episodes of acute cystitis should have a cystoscopy to rule out bladder perforation caused by the IUD. The removal of the IUD through the urethra using an cystoscope and forceps is a relatively simple procedure that does not usually cause any intraoperative, immediate or delayed postoperative complications.

• Emergency contraception if correctly administered has a high safety profile, low risk of adverse effects and high efficacy. • Oral EC's mechanism is to inhibiting ovulation, with no influence after the implantation neither preventing implantation of a fertilized egg. • Ulipristal acetate has lowest rate of adverse effects, higher efficacy in preventing pregnancy and longer administration time slot. • Copper intrauterine device has the highest success rate in preventing pregnancy. • EC reduces the rate of induced abortions and their negative influence on physical and mental health. Emergency contraception includes several methods of contraception that can be used after unprotected sexual intercourse, after failure of any used method of contraception or in case of sexual abuse, to prevent pregnancy. The aim of the study was to analyze the available methods of emergency contraception, their mechanisms of action, efficacy, forms of administration, clinical applications and possible adverse effects. PubMed, Scopus and Cochrane datebases were searched for articles from 2010 to 2024 about emergency contraception. The analyzed types of emergency contraception included single oral dose of ulipristal acetate, single oral dose of levonorgestrel and intrauterine system releasing levonorgestrel or copper intrauterine device. Taking emergency contraception in the optimum time according to the drug characteristics allows for avoiding pregnancy in more than 90% of cases (depending on the type of emergency contraception and time from unprotected intercourse). The analyzed literature shows that intrauterine copper intrauterine device is the most effective method of emergency contraception, also together with intrauterine system releasing levonorgestrel leading to the lowest rate of adverse effects. Taking emergency contraception can result in various adverse effects, therefore it should be introduced after thorough analysis of woman's medical history, including gynecological and obstetric history and potential contraindications. Additionally, the patient should receive detailed information about the drug mechanism of efficacy and potential adverse effects. [ABSTRACT FROM AUTHOR]

The high status of midwifery within the Millennium Development Goals (MDGs) is closely tied to enhancing clinical education. The purpose of this study was to review the effect of education on the knowledge and practice of midwifery students about Intrauterine Device (IUD) and Pap smears. This quasi-experimental study was conducted over the course of four semesters, involving 128 bachelor of midwifery students. The sampling method was non-random, utilizing convenience sampling. Four consecutive 45 min weekly sessions were held, which included three theory sessions and one practical training session. Education was conducted in face-to-face training sessions using different methods such as lectures, question and answer, slide shows, educational films and brochures, and training participants with moulage. The data were gathered using a questionnaire covering demographic characteristics, various aspects of IUD and Pap smear knowledge, along with checklists for IUD insertion and Pap smear. Paired-samples T-test and multiple regression test were used to analyze the data. A significance level of p<0.05 was set for the analysis. The results of this study showed that there was a significant difference in the average knowledge across various aspects of IUD and Pap smear before and after the intervention (p<0.001). On multiple regression analysis, residence and income significantly influenced knowledge (β=0.313, p=0.001 and β=−0.384, p=0.001, respectively). Also, multiple regression analysis indicated that the use of IUD among family or friends and age significantly impacted practice (β=−0.450, p=0.005 and β=−0.206, p=0.030, respectively). The educational intervention yielded a noticeable enhancement in the knowledge and practical skills of midwifery students. These students tend to achieve higher levels of success and deliver superior services to both patients and clients. [ABSTRACT FROM AUTHOR]

The migration or translocation of an intrauterine device (IUD) in the urinary tract is a rare event. Here, we present the case of a 55-year-old woman who accidentally discovered the ectopic presence of an IUD following a radiological examination for pelvic pain caused by a lumbar discopathy. Over the years, the patient had several IUDs inserted without being able to specify which one had migrated. The removal of the IUD was performed laparoscopically with the minimum resection of the bladder wall and the subsequent cystorrhaphy. The evolution of the patient was favorable. To better analyze these events, we conducted an all-time extensive electronic search of the PubMed database and identified 94 eligible articles, with a total of 115 cases. The literature analysis on the IUD migrations shows either the simultaneous existence of the second IUD or of a maximum number of up to two IUD insertions during the life of patients. Thus, in the presented case, we identified five IUD insertions over time, which explained the chronic inflammatory process by forming an important mass of adherents that included the urinary bladder, uterus, omentum, sigmoid colon, and abdominal wall. Therapeutic management must be adapted to each case depending on the intra/extravesical location of the migrated IUD evaluated by imaging. [ABSTRACT FROM AUTHOR]

Background Aims Materials and Methods Results Conclusions Despite clinical and economic benefits, pain during outpatient hysteroscopy (OPH) remains a barrier to use. There is a lack of evidence to support routine use of one analgesic over another versus no analgesic.To study the efficacy and safety of methoxyflurane analgesia during OPH.A single‐centre, randomised, double‐blind, placebo‐controlled experiment was performed; 90 patients were randomly assigned (1:1). Participants allocated to the treatment group (cases) received 3 mL of methoxyflurane through an inhaler. The control group received a placebo. The primary outcome was a mean difference in pain, via a change in Visual Analog Scale (VAS) score from baseline at diagnostic hysteroscopy. Secondary outcomes were a mean difference in VAS score with any subsequent operative procedures; a mean difference in VAS score at 15 min post‐procedure; participant and clinician‐reported adverse effects and events; and participant‐reported procedure acceptability, adjuvant nitrous oxide (N2O2) use and a composite of ‘distress’.During diagnostic hysteroscopy, there was a mean difference of 11.5 mm/100 (95% confidence interval (CI) 0.08–22.95), P = 0.05, with the lower score in the cases, compared with controls. During subsequent operative procedures, there was a mean difference of 15 mm/100 (95% CI 2.71–28.22), P = 0.02, with the lower pain score in the cases, compared with controls. There was no significant difference in pain 15 min post‐procedure, participant‐ and clinician‐ reported adverse effects and events, procedure acceptability and the ‘distress’ composite.Methoxyflurane significantly reduced pain during OPH compared with placebo, for diagnostic as well as operative procedures. Furthermore, methoxyflurane was well tolerated, with no adverse events. [ABSTRACT FROM AUTHOR]

Intrauterine devices (IUDs) are highly effective contraception, with rates of failure of less than one percent in the first year of utilize. Intrauterine devices are frequently placed at postpartum visits, typically four to six weeks following delivery but increasingly are being placed immediately post-partum, within three days of delivery. IUDs prevent pregnancy by Preventing sperm from fertilizing the egg, killing or immobilizing sperm by creating an inflammatory reaction inside the uterus that is toxic to sperm. Intrauterine devices are accessible to the majority of females, involving those who have not had kids and adolescent females. An intrauterine device can be inserted at any time during the menstrual cycle if females have not had unprotected sex since their last period. Before an intrauterine device is put, a pregnancy test must be performed on females who have engaged in sexual activity without protection. When it comes to females, the most prevalent causes for having an intrauterine device removed are pain and hemorrhage, which accounts for more than half of all removals that occur before the typical replacement time. Copper intrauterine devices are known to cause cramping and raise the volume of monthly bleeding. A nonsteroidal anti-inflammatory drug can typically alleviate the cramping. Implantable urinary devices that release levonorgestrel are known to induce irregular bleeding in the first few months following installation. [ABSTRACT FROM AUTHOR]

Issue Addressed: The internet is an important source of health information, however, the quality of information about long‐acting reversible contraception (LARC, including intrauterine devices (IUDs) and contraceptive implants) found online is largely unknown. Methods: A scoping review of webpages returned in a Google search was conducted. The first three pages of results were included if they were written in English and contained information about LARC. Results were critically reviewed and assessed using the DISCERN quality of health information tool. Results: Of 778 results, 306 pages met the eligibility criteria. While most webpages provided key information about LARC, including location in the body, benefits, side effects and risks, the information provided varied considerably. Only half mentioned efficacy and many webpages did not provide information about the cost of insertion and removal, how and where to access the devices or how they work. Despite side effects being mentioned in more than three‐quarters of webpages, the depth and specificity of these varied considerably and were often contradictory across different webpages. Conclusions: Most webpages provided medically accurate information to consumers; however, many did not include key information such as cost or how they work. Descriptions of side effects varied between webpages, and this may inhibit informed decision‐making. So What?: Most people make decisions about what contraceptive method they might like to use before visiting a health care provider, and most will get this information from the internet. Providing comprehensive, medically accurate and consistent information about both IUDs and contraceptive implants is vital to support informed decision‐making. [ABSTRACT FROM AUTHOR]

There are a wide variety of gynecologic devices encountered on pelvic imaging which may not be the focus or primary reason for imaging. Such devices include pessaries, menstrual products, radiation therapy devices, tubal occlusion devices, and contraceptive devices, including intrauterine devices and intravaginal rings. This manuscript offers a comprehensive review of multimodality imaging appearances of gynecologic devices encountered on pelvic imaging and discusses device indications, positioning, and complications. [ABSTRACT FROM AUTHOR]

The effects of female sex hormones on optimal performance have been increasingly recognized as an important consideration in exercise and sport science research. This narrative review explores the findings of studies evaluating the effects of menstrual cycle phase in eumenorrheic women and the use of hormonal contraception (oral contraceptives and hormonal intrauterine devices) on metabolism, muscular strength, and recovery in active females. Ovarian hormones are known to influence metabolism because estrogen is a master regulator of bioenergetics. Importantly, the menstrual cycle may impact protein synthesis, impacting skeletal muscle quality and strength. Studies investigating muscular strength in eumenorrheic women report equivocal findings between the follicular phase and luteal phase with no differences compared to oral contraceptive users. Studies examining recovery measures (using biomarkers, blood lactate, and blood flow) do not report clear or consistent effects of the impact of the menstrual cycle or hormonal contraception use on recovery. Overall, the current literature may be limited by the evaluation of only one menstrual cycle and the use of group means for statistical significance. Hence, to optimize training and performance in females, regardless of hormonal contraception use, there is a need for future research to quantify the intra-individual impact of the menstrual cycle phases and hormonal contraceptive use in active females. [ABSTRACT FROM AUTHOR]

To examine the prevalence of infections with high-risk human papillomavirus (HPV) and cervical dysplasia, and the clearance rate of HPV infections, in users of different kinds of intrauterine devices (IUDs) and other contraceptive methods. A cross-sectional register-based study including 16,181 women aged 30–49 years participating in the screening programme for cervical cancer in a Swedish County in 2017–2018. Data on contraception from screening records was paired with the HPV test results, cytological and histological follow-up tests and subsequent HPV test. There was no difference in the risk of being HPV positive, or histological HSIL+, between users of copper-containing IUDs and women with no reported use of contraception. Use of levonorgestrel intrauterine system and hormonal contraception were associated with higher odds for HPV infection in age-adjusted models (aOR 1.21; 95% CI 1.04–1.41, and aOR 1.41; 95% CI 1.22–1.63, respectively) and for HSIL+ (aOR 1.45; 95% CI 1.02–2.06, and aOR 1.56; 95% CI 1.13–2.16, respectively). No significant differences were found in HPV clearance rates. Reported use of levonorgestrel intrauterine system and hormonal contraception, but not use of copper IUD, was associated with a higher prevalence of HPV infections and histological HSIL + compared to no reported use of contraception. Women using copper IUD showed no difference in prevalence of HPV or cervical dysplasia compared to women not using contraception in cross-sectional study [ABSTRACT FROM AUTHOR]

The wide array of polydimethylsiloxane (PDMS) variants available on the market, coupled with the intricate combination of additives in silicone polymers, and the incomplete understanding of drug release behavior make formulation development of levonorgestrel intrauterine systems (LNG-IUSs) formidable. Accordingly, the objectives of this work were to investigate the impact of excipients on formulation attributes and in vitro performance of LNG-IUSs, elucidate drug release mechanisms, and thereby improve product understanding. LNG-IUSs with a wide range of additives and fillers were prepared, and in vitro drug release testing was conducted for up to 12 months. Incorporating various additives and/or fillers (silica, silicone resins, silicone oil, PEG, etc.) altered the crystallization kinetics of the crosslinked polymer, the viscosity, and the microstructure. In addition, drug-excipient interactions can occur. Interestingly, additives which increased matrix hydrophobicity and hindered PDMS crystallization facilitated dissolution and permeation of the lipophilic LNG. The influence of additives and lubricants on the mechanical properties of LNG-IUSs were also evaluated. PDMS chemical substitution and molecular weight were deemed to be most critical polymer attributes to the in vitro performance of LNG-IUSs. Drugs with varying physicochemical characteristics were used to prepare IUSs, modeling of the release kinetics was performed, and correlations between release properties and the various physicochemical attributes of the model drugs were established. Strong correlations between first order release rate constants and both drug solubility and Log P underpin the partition and diffusion-based release mechanisms in LNG-IUSs. This is the first comprehensive report to provide a mechanistic understanding of material-property-performance relationships for IUSs. This work offers an evidence-based approach to rational excipient selection and tailoring of drug release to achieve target daily release rates in vivo. The novel insights gained through this research could be helpful for supporting development of brand and generic IUS products as well as their regulatory assessment. [Display omitted] • Silicone resins form a hydrophobic amorphous matrix leading to faster drug release. • Intermolecular interactions in silica/DE increase crystallinity and mechanical strength. • Drug release from phenyl-PDMS> dimethyl-PDMS> fluoro-PDMS (increasing polarity). • Drug release from IUSs is directly proportional to API solubility in polymer and Log P. • PDMS crystallinity and drug-polymer interactions may govern matrix drug diffusivity. [ABSTRACT FROM AUTHOR]

Objectives: We sought to determine the association between intrauterine device (IUD) malposition and previous cesarean delivery (CD) and related uterine anatomical changes. Methods: A retrospective cohort of all persons with an IUD presenting for two‐ and three‐dimensional pelvic ultrasonography over 2 years, for any gynecologic indication, was compiled. IUD malposition was defined as IUD partially or completely positioned outside the endometrial cavity. Uterine position, uterine flexion, and cesarean scar defect (CSD) size were assessed. Patient characteristics and sonographic findings were compared between those with normally positioned and malpositioned IUD. Primary outcome was the rate of IUD malposition in persons with and without a history of CD. Logistic regression analysis was used to control for potential confounders. Results: Two hundred ninety‐six persons with an IUD had a pelvic ultrasound, 240 (81.1%) had a normally positioned IUD, and 56 (18.9%) had a malpositioned IUD. The most common location of IUD malposition was low uterine segment and cervix (67.9%). Malpositioned IUD was associated with referral for evaluation of pelvic pain (P =.001). Prior CD was significantly associated with a malpositioned IUD, after adjusting for confounders (aOR 3.50, 95% CI 1.31–9.35, P =.01). Among persons with prior CD, uterine retroflexion and a large CSD were independent risk factors for IUD malposition (aOR 4.1, 95% CI 1.1–15.9, P =.04 and aOR 5.4, 95% CI 1.4–20.9, P =.01, respectively). Conclusions: Prior CD is associated with significantly increased risk of IUD malposition. Among persons with previous CD, those with a retroflexed uterus and a large CSD are more likely to have a malpositioned IUD. [ABSTRACT FROM AUTHOR]

Long-acting contraception (LARC) is the utmost effective form of reversible birth control methods and there are to main types which include the intrauterine device (IUD) and the birth control implant. The objectives of this paper was to investigate the knowledge ,attitude and age factors of long acting reversible contraceptives (LARC) among postgraduate students at a tertiary institution in greater machester, England, UK using an online participatory survey,opned to the general public through internal email and social media (Twitter, WhatsApp, Facebook). Targeting 322 female postgraduate students between 21-50 years. However, only 50 participants took part in the survey due to the limitations posed by COVID-19 pandemic. The results showed that there were more participants between 31-40 years (42.9%), more married women (49.0%), more Christians (59.2%), and an equal number of White and black Africans (44.9%). The percentages of women who have heard about LARC include; implants (87.8%), injectables (85.7%), Intrauterine devices (72.9%), and hormonal intrauterine system (58.3%). Some of the participants showed positive attitudes towards LARC, while majority of the participants would not use LARC because of the side effects. Most of those who have used implants and injectables were women between 21-30 years, and older women have used intrauterine devices more than the younger age group. Some barriers to the use of LARC include; Side effects of LARC (63.8%), Interference with the body’s processes(63%), and lack of knowledge about different methods available(54.3%),having a foreign object in their bodies (59.1% for injectables) and (53.2% for implants).

Actinomyces spp. has been shown to form biofilms when exposed to copper, possibly enhancing its degradation. Fragmentation and migration of the copper coil on an intrauterine device (IUD) is rare, but the concomitant presence of Actinomyces spp. may increase its incidence. We present the first case of a fragmented copper IUD within its lifespan of 10 years, with documented Actinomyces genitourinary tract colonization in a premenopausal woman. KEY POINTS: Actinomyces spp. are more prevalent in the urogenital tract of women with IUDs due to the local tissue injury from the device inside the uterus, which creates an anaerobic environment that allows this organism to flourish. Actinomyces spp. can form biofilms when exposed to copper, potentially enhancing its degradation, leading to fragmentation. Patients with a copper IUD and Actinomyces identified on routine or symptomatic cervical sampling should be counseled regarding potential enhanced copper degradation, fragmentation, and migration of the copper coil. [ABSTRACT FROM AUTHOR]

The intrauterine contraceptive device (IUCD) is the most frequently used method of reversible contraception with high efficacy. Despite these benefits, rare complications, such as spontaneous migration of the device into adjacent organs, particularly the bladder, are possible. Minimally invasive surgery is a safe and effective procedure with few complications for the management of migrated IUCDs. We presented a 36-year-old multiparous woman referred by her gynecologist who had an IUCD inserted 4 years prior. She had been experiencing dysuria and lower abdomen pain for 3 months. Ultrasonography of the abdomen revealed a hyperechoic lesion on the bladder wall's left anterior-superior portion. An MRI revealed that the device was embedded in the bladder's anterior left wall. Under general anesthesia, a cystoscopy and laparoscopy exploration were subsequently scheduled. Cystoscopy was performed, but the long limb of the IUCD was embedded in the mucosal and muscular layers, preventing its removal from the bladder wall. Laparoscopic retrieval of the IUCD was performed without complications. The patient was discharged 2 days after surgery with a Foley catheter inserted in the bladder for 10 days. When the urethral catheter was removed, a cystoscopy was performed to confirm bladder wall healing. In the postoperative follow-up 1 month after IUCD removal, no abnormalities were observed. Patients with a suspected IUCD migration must undergo a comprehensive evaluation, regardless of whether they are symptomatic or asymptomatic. Before surgical retrieval, imaging such as ultrasonography and MRI were utilized to locate the migrated IUCD and consider therapeutic options. Even though cystoscopy is considered as an effective and safe minimally invasive procedure for managing a migrated IUCD to the bladder, laparoscopic removal could serve as an option once cystoscopy retrieval is failed.

BackgroundExtending hormonal intrauterine system duration will allow users to have less need for procedures to provide long-term contraception.ObjectiveThis study aimed to evaluate the efficacy and safety of the levonorgestrel 52 mg intrauterine system during years 7 and 8 of use.Study designA total of 1751 nulliparous and multiparous participants aged 16 to 45 years enrolled in a phase 3, multicenter trial to evaluate the efficacy and safety of the use of the Liletta levonorgestrel 52 mg intrauterine system for up to 10 years. Participants aged 36 to 45 years at enrollment underwent safety evaluation only. After the first year, we evaluated participants every 6 months for intrauterine system location confirmation and urine pregnancy testing at each visit. We assessed the Pearl Indices in years 7 and 8 and the life-table analysis for cumulative pregnancy rates through 8 years of use. For the primary efficacy analyses, all participants aged 16 to 35 years at enrollment were included through year 6; years 7 and 8 included only users aged ≤39 years at the start of each use year. Safety outcomes were assessed in all participants regardless of duration of use. We assessed amenorrhea rates, defined as no bleeding or spotting in the 90 days before the end of the year.ResultsAfter intrauterine system placement, we followed 1568 participants aged 16 to 35 years and 146 participants aged 36 to 45 years. The 16- to 35-year-old participants included 986 (57.5%) nulliparous and 433 (25.3%) obese users. Overall, 569 participants started year 7, 478 completed year 7 (380 aged ≤39 years at beginning of year) and 343 completed year 8 (257 aged ≤39 years at beginning of year); 77 completed 10 years of use. Eleven pregnancies occurred over 8 years, 7 (64%) of which were ectopic. Two pregnancies occurred in year 7 (Pearl Index, 0.49; 95% confidence interval, 0.06-1.78), 1 in a participant with implantation 4 days after a desired removal; no pregnancies occurred in year 8. The cumulative life-table pregnancy rate in the primary efficacy population through year 8 was 1.32 (95% confidence interval, 0.69-2.51); without the postremoval pregnancy, the rate was 1.09 (95% confidence interval, 0.56-2.13). Two perforations (0.1%) occurred, none noted after year 1. Expulsion occurred in 71 (4.1%) participants overall, with 3 in year 7 and 2 in year 8. Pelvic infection was diagnosed in 16 (0.9%) participants during intrauterine system use, 1 each in years 7 and 8. Only 44 (2.6%) participants overall discontinued because of bleeding complaints (4 total in years 7 and 8) with rates per year of 0.1% to 0.5% for years 3 to 8. Amenorrhea rates were 39% at both years 7 and 8.ConclusionThe levonorgestrel 52 mg intrauterine system is highly effective over 8 years of use and has an excellent extended safety profile. This report details the longest period of efficacy and safety data for continuous use of a levonorgestrel 52 mg intrauterine system for contraception.

Aim: Familial Mediterranean fever (FMF) is the most common inherited autoinflammatory disease in the world. There are known triggers to initiate an FMF attack, yet potential effects of intrauterine devices (IUD) in women of reproductive age have not been evaluated before. Method: Consecutive female patients with FMF who ever used IUD over the age of 18 were enrolled. Female patients with FMF were sub grouped according to the type of IUD they use. FMF attack frequency, severity, duration, presence of dysmenorrhea, severity of dysmenorrhea, having attacks during menstruation before and after IUD use were questioned. Demographic and clinical data were collected from hospital database. Results: When all patients with IUD use were evaluated, it was found that the frequency of attacks increased after IUD insertion at 3rd and 12th months (median [min–max] attack frequency at 3rd month, 1 (0–3) vs 1 (0–6), p = 0.002, median [min–max] attack frequency at 12th month, 2 (0–12) vs 3.5 (0–18), p = 0.028). Attack severity measured by VAS pain was also significantly increased. Attack duration and menstrual pain was similar before and after IUD use. Attack frequency at 3rd and 12th months, attack severity and menstrual pain was all increased significantly in Cu-IUD users, whereas none of these parameters deteriorated in LNG-IUD group. Conclusion: IUD use, especially Cu-IUD, may increase the frequency and severity of attacks in female patients with FMF. Clinicians may benefit from considering LGN-IUD if IUDs are preferred as contraception in women of childbearing age with FMF. [ABSTRACT FROM AUTHOR]

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Despite the endorsement of intrauterine device (IUD) use in adolescents and young adults (AYAs) by leading professional organizations and demonstrated acceptance and desirability by AYAs, clinicians may worry about the procedural difficulty of IUD device placement in younger patients. The aim of this study was to evaluate the clinical outcomes of first-attempt IUD placement in an AYA population by vaginal delivery (VD) history. We performed a retrospective cohort study of patients under 25 years old at reproductive health clinics with an IUD placement attempt between January 1 and August 31, 2017. We abstracted sociodemographic characteristics, pregnancy history, and procedural characteristics including complications. Bivariate analyses compared successful first-attempt IUD placement by VD history. We also assessed the frequency of secondary clinical outcomes including ancillary measures used, provider type, symptoms reported during the procedure, and complications. We included 1325 participants (median age = 21.3 years), including 42 (3.2%) with a previous VD. Nearly all IUD placements were successful on the first attempt (n = 1301, 98.2%) and performed by advanced practice clinicians (n = 1314, 99.2%). First-attempt IUD placement success was similar in those participants with and without VD (P >.999). Ancillary measures other than nonsteroidal anti-inflammatory drugs were used infrequently (n = 16, 3.6%). Among participants with an unsuccessful placement, 66.7% returned, and all had a successful IUD placement on the second attempt. Documented complications within 6 months of placement were rare (n = 29) and mostly comprised expulsions (n = 27, 93.1%). IUD placement success among AYAs at community-based reproductive health clinics is high and is not associated with a history of VD. [ABSTRACT FROM AUTHOR]

Use of 52-mg levonorgestrel intrauterine system (LNG-IUS) in adolescents for heavy menstrual bleeding (HMB), dysmenorrhea, and contraception has increased, yet little is known about the factors predicting removal and dissatisfaction in adolescents. The aim of this study was to identify factors predicting LNG-IUS removal in adolescents. This was a retrospective cohort study including all adolescents (9-19 years) who underwent LNG-IUS insertion between 2012 and 2021 (n = 536). A medical record review was conducted and data were collated on medical and gynecological history, age, indications for insertion, complications, expulsions, and removals. The data were analyzed using χ2 tests. Indications for LNG-IUS insertions (n = 536) among 517 individual patients (n = 517) included menstrual management (n = 142), HMB alone (n = 118), HMB and pelvic pain/dysmenorrhea (n = 105), dysmenorrhea/pelvic pain alone (n = 47), and contraception (n = 16). Associated diagnoses included intellectual disability (44.29%, 229/517), chronic pain conditions (12.77%, 66/517), and additional mental health concerns (24.37%, 126/517). Patient dissatisfaction with LNG-IUS led to removal in 61 (11.38%), mostly for pain or persistent bleeding. Higher removal rates occurred in those with associated chronic pain conditions (46.97%, χ2 = 55.9, P <.05), mental health concerns (16.67%, χ2 = 5.06, P <.05), and bleeding disorders (26.32%, χ2 = 5.09, P <.05). Among the cohort with an intellectual disability, lower rates of removal occurred (5.7%, χ2 = 11.2, P <.05). Whereas the LNG-IUS removal rate among gender-diverse youth was 23.07%, this was not statistically significant. Younger age was also not associated with a statistically significant increase in removals (13.72%, χ2 = 0.73, P >.05). Adolescents have a low dissatisfaction and removal rate (11.38%) of LNG-IUS. Chronic pain, bleeding tendency, and mental health concerns are associated with higher removal rates and intellectual disability with lower rates. These findings are useful in counselling patients and families about LNG-IUS. [ABSTRACT FROM AUTHOR]

Objective: To compare the performance of the abdominal handheld point-of-care ultrasonography (POcus) Butterfly-iQ to gold standard transvaginal ultrasonography (Us) in identifying the position of intrauterine devices (lUDs) in the hands of a medical doctor specialised in ultrasonography. Methods: in this diagnostic accuracy study, a single operator conducted abdominal POCUS followed by conventional transvaginal US. Seventy patients utilising copper or hormonal iUDs were assessed between June 2021 and October 2022. iUDs were categorised as entirely within the uterine cavity or malpositioned. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for detecting malpositioned iUDs, with conventional US results serving as the reference standard. Concordance rate and Kappa coefficient were computed to assess the agreement between the two ultrasound modalities. Results: among the 70 patients, 46 (65.7%) used copper iUDs, and 24 (34.3%) used hormonal iUDs. Conventional transvaginal US showed iUDs entirely within the uterine cavity in 56 (80%) patients and 14 (20%) iUDs were malpositioned. Of the 14 malpositioned iUDs seen by conventional US, POCUS identified 13 demonstrating a sensitivity of 92.9% (66.1-99.8). Of the 56 iUDs entirely within the uterine cavity shown by conventional US, only two cases were considered malpositioned by POCUS demonstrating a specificity of 96.4% (87.7-99.6). The concordance rate was 95.7%, and the Kappa value was 0.87 in differentiating between iUDs entirely within the uterine cavity and those that were malpositioned. Conclusion: Abdominal POCUS using Butterfly-iQ, when administered by an imaging specialist, exhibited excellent performance in confirming iUDs entirely within the uterine cavity. [ABSTRACT FROM AUTHOR]

Introduction: Approximately 5% of bladder stones occur in women and are usually associated with foreign bodies or urinary stasis. Spontaneous migration of the intrauterine device (IUD) into the bladder is a rare complication. In this report, we present 2 cases of migrated IUD who had undergone surgery at our clinic due to bladder stones. Case Presentations: We detected migrated IUDs into the bladder in 2 female patients, aged 37 and 56 years, who presented with lower urinary tract symptoms and urinary tract infection. In the first case, endoscopic cystolithotripsy was performed, and the IUD was removed without complications. In the second case, the IUD could not be removed endoscopically since it had fractionally invaded the bladder wall, and the IUD was removed without complications by performing an open cystolithotomy. Conclusion: A comprehensive gynecological history should be taken from every female patient presenting with recurrent urinary tract infections and lower urinary tract symptoms. If these patients have a history of IUD placement, the possibility of the intravesical migration of this device should be kept in mind. [ABSTRACT FROM AUTHOR]

Migration of an intrauterine device (IUD) to the posterior urethra with stone formation has not been previously reported in the literature. A 42-year-old female patient presented to the gynecology clinic with a complaint of “discovered vaginal mass for 2 years, with growth for 5 days.” She was referred to urology on suspicion of IUD migration to the bladder. Physical examination revealed a hard mass palpable on the anterior vaginal wall. Laboratory tests showed normal blood counts, and urinalysis indicated a mild urinary tract infection. Ultrasound and pelvic X-ray indicated IUD migration to the bladder and bladder stones. Cystoscopy revealed that the IUD had migrated to the posterior urethra with stone formation. Holmium laser was used to fragment the stones encasing the IUD’s one arm, and the IUD was successfully removed with grasping forceps. The patient had a urinary catheter placed for 10 days and was followed up for 20 days. During the follow-up, there were no lower urinary tract symptoms (LUTS) or vaginal leakage. To our knowledge, we report the first case of an IUD migrating through the vesicovaginal space to the posterior urethra. Endoscopic removal of the IUD is feasible and safe. Urologists and gynecologists should not limit their diagnosis to IUD migration to the bladder but should also consider the possibility of urethral migration.

Akebom Gebremichael,1 Hale Teka,2 Kidus Kebede Abadi,3 Melkamu Siferih,4 Menberu Moges,5 Muhudin Arusi,1 Abel Shiferaw6 1Department of Obstetrics and Gynecology, St. Peter’s Specialized Hospital, Addis Ababa, Ethiopia; 2Department of Obstetrics and Gynecology, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia; 3Department of Obstetrics and Gynecology, Riwyet Maternal and Child Health Center, Tigray, Ethiopia; 4Department of Obstetrics and Gynecology, Debre Markos University, Debre Markos, Ethiopia; 5Department of Obstetrics and Gynecology, Tayo Hospital, Baidoa, Somalia; 6Department of Obstetrics and Gynecology, Dessie Comprehensive Specialized Hospital, Dessie, EthiopiaCorrespondence: Akebom Gebremichael, Email kidanemariamakebom@gmail.comBackground: The intrauterine device is a popular and highly effective form of long-acting reversible contraception. Although generally safe, complications could happen. One of the most serious complications of intrauterine device use is uterine perforation. Risk factors for perforation include, but are not limited to, postpartum period, breastfeeding, levels of experience, and excessive force exerted during insertion. This case is significant because it demonstrates risk factors for uterine perforation, how to handle missing strings, and care in places with little resources.Case Presentation: We discuss the case of a 27-year-old black Ethiopian woman who presented with chronic pelvic pain and had a perforated intrauterine device discovered in the cul-de-sac. The device had been inserted at six weeks postpartum. The client was unable to feel the strings three months after insertion, and a wrong diagnosis of expulsion was made. After one year of insertion, the intrauterine device was located on a plain abdominal radiograph and removed via laparotomy without complications.Conclusion: Although uterine perforation is a rare complication of intrauterine device insertion, special attention should be paid to women with risk factors. In the absence of a witnessed expulsion, assessments and investigations should be carried out before declaring a device expelled. In patients with chronic pelvic pain complaints in the presence of an intrauterine device, perforation and migration outside the uterine cavity should be considered. Abdominal X-rays and laparotomies can be used to find and manage extrauterine migrating devices in environments with limited resources.Keywords: intrauterine device, missed uterine perforation, intraperitoneal migration

Aim: To compare and evaluate the efficacy of the levonorgestrel‐releasing intrauterine system (LNG‐IUD) and resectoscopy remodeling procedure for intermenstrual bleeding associated with previous cesarean delivery scar defect (PCDS). Methods: A retrospective comparative study was conducted on patients with PCDS receiving LNG‐IUD (levonorgestrel 20 μg/24 h, N = 33) or resectoscopy remodeling (N = 27). Treatment outcomes were compared over 1, 6, and 12 months. Outcomes in patients with a retroverted or large uterus size, defect size, and local vascularization also were evaluated. Results: At 12 months post‐treatment, there were no significant differences between groups in efficacy rate; however, the reduction of intermenstrual bleeding days was higher in the LNG‐IUD group than in the resectoscopy group (13.6 vs. 8.5 days, p = 0.015). Within the first year, both groups experienced a reduction in bleeding days, but the decrease was greater in the LNG‐IUD group. Individuals exhibiting increased local vascularization at the defect site experienced more favorable outcomes in the LNG‐IUD group than the resectoscopy group (p = 0.016), and who responded poorly tended to have a significantly larger uterus in the LNG‐IUD group (p = 0.019). No significant differences were observed in treatment outcomes for patients with a retroverted uterus or large defect in either group. Conclusions: Our findings support that the LNG‐IUD is as effective as resectoscopy in reducing intermenstrual bleeding days associated with PCDS and can be safely applied to patients without recent fertility aspirations. Patients with increased local vascularization observed during hysteroscopy may benefit more from LNG‐IUD intervention than resectoscopy. [ABSTRACT FROM AUTHOR]

Objectives: To describe how frequently a national sample of patients with experience discontinuing or desiring discontinuation of long-acting reversible contraception (LARC) experienced barriers to discontinuation. Methods: We conducted an online survey of individuals ages 18 to 50 in the United States who had previously used and discontinued or attempted to discontinue LARC. We recruited respondents using the Amazon platform MTurk. Respondents provided demographic information and answered questions regarding their experience discontinuing LARC, including reasons removal was deferred or denied. We analyzed frequency of types of barriers encountered and compared these by demographic factors. Results: Of the 376 surveys analyzed, 99 (26%) described experiencing at least one barrier to removal. Barriers were disproportionately reported by those who had public health insurance, a history of abortion, and a history of birth compared to those who did not report barriers to removal. They also more frequently identified as Latinx, Asian, or Middle Eastern. Most barriers were provider-driven and potentially modifiable. Conclusions for Practice: Barriers to LARC discontinuation are common and may be provider- or systems-driven. Providers should be mindful of biases in their counseling and practices to avoid contributing to these barriers. Significance: Provider bias and systemic barriers have been shown to impact patients' experiences with LARC removal. This study aims to characterize the frequency and types of barriers experienced by patients. Results suggest that patients often face barriers when attempting to discontinue LARC and data from this study support that barriers are often driven by providers or systemic factors. [ABSTRACT FROM AUTHOR]

Single-visit long-acting reversible contraception (LARC) is cost-effective and convenient. Our objective was to compare incidence of single-visit LARC placement and associated factors during the year before the COVID-19 pandemic (March 15, 2020) and the first year of the pandemic. This retrospective cohort study analyzed electronic health records from a large healthcare system. Eligible adolescents were aged 10–19 years and received outpatient LARC from March 15, 2019 to March 14, 2021. Logistic regression models determined the relationship of patient and provider characteristics on single-visit LARC before and during COVID-19. One thousand six adolescents initiated LARC during the study period. Fewer adolescents received single-visit LARC during COVID-19 (289/506, 57.1%) compared to before (315/500, 63.0%), although changes in odds of single-visit LARC were not statistically significant. Concordance between county of patient residence and the location of the LARC placement facility was associated with single-visit LARC before (adjusted odds ratio [aOR] = 2.75) and during (aOR = 1.74) the pandemic (both p <.05). During the pandemic, a few factors were associated with reduced odds of single-visit LARC: (1) public insurance (aOR = 0.49, p <.01), (2) nonobstetricians/nongynecologists providers (pediatrics [aOR = 0.35, p <.01], family medicine [aOR = 0.53, p <.01], or internal medicine [aOR = 0.14, p <.05]), and (3) advanced practice practitioners (aOR = 0.49, p <.01). Incidence of single-visit LARC was similar before and during the pandemic. Certain factors were associated with lower odds of single-visit LARC insertion, suggesting differential access during the pandemic for subgroups of adolescents. Our findings may guide policy and programmatic interventions to improve access to single-visit LARC for all adolescent populations. [ABSTRACT FROM AUTHOR]

Background: The Levonorgestrel-releasing intrauterine system was inserted in patients with conditions like Abnormal Uterine Bleeding (AUB), adenomyosis and Perimenopausal Bleeding (PMB). This study aimed to find the effectiveness and safety of the intrauterine device in AUB, adenomyosis and PMB. Materials and Methods: This observational study enrolled 100 patients with AUB, adenomyosis and PMB who had levonorgestrel IUD inserted for treatment between the years 2015 to 2022. The data has been collected from the Department of Obstetrics and Gynecology at Krishna Institute of Medical Sciences, Secunderabad and analyzed based on the Institutional outcome scoring form. The post-insertion responses, expulsion rates and clinical outcomes towards IUD were observed in patients after insertion. Results: The analysis of post-insertion responses showed a significant statistical P value of 0.001 which implies the effectiveness of IUD. This study resulted in a 90% positive clinical outcome which implies the safety of levonorgestrel IUD. The expulsion rate was also very low that was 5 out of 100 patients had the device expelled. Conclusion: The levonorgestrel IUD showed significant positive clinical outcomes in patients with AUB, Adenomyosis and PMB with low expulsion rates and can be considered a good alternative for conservative management of AUB, Adenomyosis, and perimenopausal bleeding. [ABSTRACT FROM AUTHOR]

The postpartum period is the perfect time to access family planning services. WHO guidelines contraindicate combined hormonal contraceptives postpartum in breastfeeding patients between 6 weeks and 6 months after delivery (Medical Eligibility Criteria category 3). On the contrary, the Faculty of Sexual and Reproductive Healthcare and the Centers for Disease Control and Prevention guidelines do not contraindicate their use in women who breastfeed from 6 weeks to 6 months postpartum. New combined hormonal contraceptives with natural estrogens have never been studied in this setting. Guidelines agree on the prescription of the progestin‐only pill postpartum in non‐breastfeeding women (category 1). Differences are found in women who breastfeed. In non‐breastfeeding women, an implant is considered safe (category 1) by all guidelines, without any distinction in time. Regarding postpartum breastfeeding women, the guidelines for implants give quite different indications but are still permissive. Intrauterine devices are viable options for postpartum contraception but guidelines give different indications about the timing of insertion. Postplacental intrauterine device placement can reduce the subsequent unintended pregnancy rate, particularly in settings at greatest risk of not having recommended postpartum controls. However, it has yet to be understood whether this approach can really have an advantage in high‐income countries. Postpartum contraception is not a 'matter of guidelines': it is the best customization for each woman, as early as possible but at the ideal timing. Synopsis: Guidelines do not entirely agree on the prescription of combined or progestin‐only pill, implants, and intrauterine contraceptives, depending on the postpartum interval and breastfeeding state. [ABSTRACT FROM AUTHOR]

Family planning is an essential human right guaranteed by law, many women who do not desire to become pregnant find themselves lacking information about modern contraceptives. The intrauterine device (IUD) is a long-term reversible contraceptive method widely used around the world. In Brazil, in 2017 the Ministry of Health launched new guidelines focusing on the role of women in humanized birth, and also on the provision of copper IUDs in maternity wards. The objective of this study was to analyze the expulsion rate of the copper IUD with insertion in the immediate postpartum period, in order to evaluate its efficacy. This is a retrospective cohort study, with a quantitative approach. The study showed that the expulsion rate among parturients by cesarean section and vaginal delivery, respectively, was 26.1% and 49.0%. The odds ratio (OR) was 2.8 (1,2; 6,7), indicating that, according to logistic regression adjusted to the data, vaginal delivery increased the chance of IUD expulsion by 2.8 times. Since, the IUD offers a reduction in the number of unwanted pregnancies and consequently acts to reduce maternal and child morbidity and mortality. It is concluded that the IUD in the immediate postpartum period is effective and safe, however, it is necessary to expand the offer, create protocols and standardized training in order to improve the service. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to document the preoperative evaluation techniques of mislocated intrauterine device (IUD) patients and discuss the optimal management of these cases. Material and Methods: This study was conducted between January 2016 and October 2021 at an obstetrics and gynecology department of a tertiary center. A total of 25 patients presenting with mislocated IUDs were retrospectively analyzed. Demographic findings, diagnostic and preoperative evaluation methods, and operation notes were collected from the patients’ files and hospital patient information programs. Results: Every patient had initially undergone a preoperative gynecologic examination and transvaginal ultrasonography (TVUSG). After TVUSG, other preoperative techniques were used alone or in combination according to each finding and need of further technique. Plain radiography, hysteroscopy, computed tomography (CT), magnetic resonance imaging (MRI), and colonoscopy were the techniques used. Of the 25 patients with missing IUDs, it was observed that 23 had successful removal of their IUDs. All but two of the patients were operated on laparoscopically. Conclusion: In cases of mislocated IUDs, all patients should undergo a vaginal examination and TVUSG. Although ultrasonography and radiography are the basic diagnostic techniques; radiography, hysteroscopy, CT, MRI, and colonoscopy are the techniques that can be used according to each case’s condition. For these patients, laparoscopy was the first line of therapy. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of levonorgestrel-releasing intrauterine device (LNG-IUD) during controlled ovarian stimulation (COS) in patients with early-stage endometrioid endometrial cancer (EEC). Methods: A retrospective study was conducted on patients with stage IA1 EEC who achieved complete response after fertility-sparing treatment from December 2018 to December 2021, with all the women who underwent COS having LNG-IUDs inserted in their uterine cavity. Results: 16 patients were enrolled who underwent 26 COS cycles and average age was 33.19 ± 4.04 years. 12 patients had 19 subsequent frozen-thawed embryo transfer (FET) cycles. Among the other four patients, no embryos were obtained in 1 patient, 1 patient got pregnancy spontaneously with term delivery after COS, 1 patient relapsed before FET, and 1 patient did not receive embryo transfer for personal reason. Among 19 FET cycles, the clinical pregnancy and live birth rates in each ET cycle were 36.84% (7/19) and 26.32% (5/19), respectively. 7 clinical pregnancies resulted in 2 miscarriages (28.6%), and 5 live births (71.4%). Totally 6 patients achieved 7 live births, and the cumulative live birth rate was 37.5% (6/16). Three (18.75%) out of 16 patients relapsed after COS during the follow-up period (31.31 ± 15.89 months) and two of them were initially diagnosed with moderately differentiated EEC. Time interval from COS to relapse was 6.63,11.67 and 16.23 months, respectively. Conclusion: The combination of LNG-IUD treatment and segmented IVF may be a viable treatment strategy to improve oncological and reproductive outcomes for patients with early-stage EEC. [ABSTRACT FROM AUTHOR]

Abstract Objective To assess placement outcomes using a levonorgestrel 52 mg intrauterine device (IUD) inserter designed for single‐handed use. Methods Investigators enroled participants 18–45 years to have the IUD inserted using a redesigned inserter with removal 5–15 min after placement. Physicians and participants provided feedback on their insertion experience. Results Successful placement occurred in 48 of 50 (96.0%) enroled participants. Investigators rated insertion device loading “easy” in 49 (98.0%) and placement “easy” in 44 (88.0%) cases. Cramping pain was reported at insertion by 47 (94.0%) participants, mostly mild (32 [64.0%]) or moderate (11 [22.0%]). Conclusion The single‐handed inserter is easy to use and results in high rates of insertion success.

Background BRCA1 and BRCA2 (BRCA) mutation carriers face a high lifetime risk of developing ovarian cancer. Oral contraceptives are protective in this population; however, the impact of other types of contraception (e.g. intrauterine devices, implants, injections) is unknown. We undertook a matched case-control study to evaluate the relationship between type of contraception and risk of ovarian cancer among women with BRCA mutations. Methods A total of 1733 matched pairs were included in this analysis. Women were matched according to year of birth, date of study entry, country of residence, BRCA mutation type and history of breast cancer. Detailed information on hormonal, reproductive and lifestyle exposures were collected from a routinely administered questionnaire. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) associated with each contraceptive exposure. Results Ever use of any contraceptive was significantly associated with reduced risk of ovarian cancer (OR = 0.62; 95% CI 0.52-0.75; P

Although intrauterine devices (IUDs) are known for their low failure rate in pregnancy prevention, potential risksassociated with their use include uterine perforation and migration through the abdomen. In this particular case, thepatient experienced simultaneous IUD failure and perforation, with the device becoming embedded in an omentum. A28-year-old woman who was 39 weeks plus one day gestation presented for caesarean section. During the caesareansection, it was discovered that the IUD had entered the omentum through a hole in the posterior part of the uterus.The result of the birth was a live boy. IUD perforation is most commonly observed during the insertion procedure;however, it may rarely occur at a later stage. IUD perforations are frequently asymptomatic and remain undetecteduntil follow-up assessments are conducted or clinical manifestations become apparent. The presence of gastrointestinalsymptoms is commonly observed in cases with intraperitoneal migration of the IUD. Although the occurrence ofabdominal pain, diarrhoea, and fever with a missing IUD are indicative, they may not always be present. Nonspecificsigns and symptoms lead to misdiagnosis and the consequent delay in initiating appropriate treatment. In the presentcase, the co-occurrence of IUD embedded in the omentum and pregnancy posed a challenge due to the device’s rapidand imprecise shift, which complicated its accurate localisation. In such scenarios, ultrasonographic guidance canserve as a valuable tool to enhance accuracy and decrease adverse outcomes.

Splenic ectopic pregnancy (SEP) is a rare high-mortality condition, particularly relating to life-threatening intraperitoneal bleeding due to a high risk of spontaneous rupture. Diagnosing in a timely fashion is extremely crucial and the patients could benefit from active treatment strategies and early management. In this article, we reviewed a case of 40 years-old female who complained of lower quadrant abdominal pain and amenorrhea with a history of intrauterine device (IUD) insertion for over 6 years. Elevating b-human chorionic gonadotropin (HCG) blood levels were documented, raising concern about pregnancy-related emergency conditions. Ultrasound and magnetic resonance imaging results suggested a splenic ectopic pregnancy entity with a high rupture rate. The patient subsequently underwent laparoscopic resection for splenic mass removal. Ectopic pregnancy should cautiously be excluded in all cases of abdominal pain in childbearing-age women.

Case: Intrauterine device (IUD) is used worldwide as an effective contraceptive method, but the migration of IUD is a serious complication. We report the case of IUD migration leading to bladder calculus formation and a minimally invasive transurethral surgical approach was performed for treatment. Holmium laser was used to break up the bladder calculus and cut through the bladder mucosa where the IUD was attached, finally the IUD was removed through the urethra. this minimally invasive procedure is a safe and effective treatment for IUD migration, and similar cases have not been reported in the literature. Conclusion: that the secondary bladder calculus were smashed by intense pulse mode of holmium laser, and the bladder tissue around the attached IUD was opened by cutting mode of holmium laser, and finally the IUD was completely removed from urethra, this surgical method is safe and effective, and there is no case report on IUD removal of transurethral cystoscope in the literature. [ABSTRACT FROM AUTHOR]

According to reports, there are 1.9–3.6 incidences of IUD migration and uterine perforation for every 1000 IUD insertions. It is important to note that bladder perforation caused by a misplaced IUD is uncommon and is thought to happen most frequently during insertion. Here, we describe a patient who presented with symptoms related to the malposition of IUD inside the bladder. It is feasible to draw the conclusion that the cystoscopy technique should be taken into consideration as a suitable therapy option for such injuries in this organ. When a problem cannot be effectively treated by cystoscopy alone, laparotomy should be considered.

The effects of female sex hormones on optimal performance have been increasingly recognized as an important consideration in exercise and sport science research. This narrative review explores the findings of studies evaluating the effects of menstrual cycle phase in eumenorrheic women and the use of hormonal contraception (oral contraceptives and hormonal intrauterine devices) on metabolism, muscular strength, and recovery in active females. Ovarian hormones are known to influence metabolism because estrogen is a master regulator of bioenergetics. Importantly, the menstrual cycle may impact protein synthesis, impacting skeletal muscle quality and strength. Studies investigating muscular strength in eumenorrheic women report equivocal findings between the follicular phase and luteal phase with no differences compared to oral contraceptive users. Studies examining recovery measures (using biomarkers, blood lactate, and blood flow) do not report clear or consistent effects of the impact of the menstrual cycle or hormonal contraception use on recovery. Overall, the current literature may be limited by the evaluation of only one menstrual cycle and the use of group means for statistical significance. Hence, to optimize training and performance in females, regardless of hormonal contraception use, there is a need for future research to quantify the intra-individual impact of the menstrual cycle phases and hormonal contraceptive use in active females.