Fadiloglu Seyma, Dilbaz B, Fadiloglu E, Dilbaz S
Etlik Zubeyde Hanim Women's Health Teaching and Researching Hospital, Ankara, Turkey.
Arch Gynecol Obstet. 2018 Apr;297(4):989-996. doi: 10.1007/s00404-018-4711-y. Epub 2018 Feb 10.
Intrauterine device (IUD) is a widely used long-acting contraceptive method; however, the side-effects related to IUD may lead to method discontinuation. The aim of this study is to evaluate the relation between the most common side-effects of IUD use; mainly dysmenorrhea, menorrhaghia, pelvic cramping and the relation of these complications with the position of the IUD device within the cavity and uterine dimensions evaluated by transvaginal ultrasonography.
Two hundred and eighty-four patients who had Cu-T380A IUD insertion at the Family Planning Clinic of a tertiary health center were evaluated at insertion and 6 and 12 weeks after the insertion. Demographic characteristics, medical history, symptoms and findings of the gynecological examination were recorded. Transvaginal ultrasonographic measurement of the uterine dimensions, the distance between the tip of the Cu-IUD and the fundus, myometrium and endometrium were measured to evaluate the displacement of the IUD. The relationship between the symptoms and IUD displacement diagnosed by ultrasonographic examination were investigated.
Two hundred and sixty-seven patients were followed-up for 12 weeks as the remaining 16 had partial or complete IUD expulsion. A statistically significantly shorter uterine length was measured in patients who complained of menorrhagia in comparison to the ones without this complaint (54.27 ± 6.11 vs 60.25 ± 10.52 mm, p = 0.02) while uterine length was similar in patients with or without dysmenorrhea at 12 weeks (59.60 ± 10.25 vs 60.33 ± 10.68 mm, p = 0.71). The distances between the tip of the IUD and the endometrium, myometrium and the uterine fundus, were statistically and significantly longer in patients who experienced pelvic cramping at 3rd month, showing a downward movement of the IUD. (Endometrium; 0.29 ± 0.72 vs 0.45 ± 0.35 mm, p = 0.02, Myometrium; 1.25 ± 1.39 vs 2.38 ± 2.26 mm p < 0.05, Fundus; 1.68 ± 2.39 vs 2.92 ± 1.78 mm, p < 0.05).
A shorter uterine cavity length seems to be a predictor of menorrhagia in patients with Cu-T 380A IUD. Patients experiencing pelvic cramping with IUD are more susceptible for IUD expulsion as the downward movement of IUD is more prominent in these patients.
宫内节育器（IUD）是一种广泛使用的长效避孕方法；然而，与IUD相关的副作用可能导致停用该方法。本研究的目的是评估使用IUD最常见的副作用之间的关系；主要是痛经、月经过多、盆腔痉挛，以及这些并发症与经阴道超声评估的IUD在宫腔内的位置和子宫大小的关系。
在一家三级医疗中心的计划生育诊所接受Cu-T380A IUD植入的284例患者在植入时以及植入后6周和12周进行了评估。记录人口统计学特征、病史、妇科检查的症状和结果。经阴道超声测量子宫大小、Cu-IUD尖端与宫底之间的距离、肌层和子宫内膜，以评估IUD的移位情况。研究超声检查诊断的症状与IUD移位之间的关系。
267例患者随访12周，其余16例IUD部分或完全排出。与无月经过多主诉的患者相比，主诉月经过多的患者子宫长度在统计学上显著较短（54.27±6.11 vs 60.25±10.52mm，p = 0.02），而在12周时有无痛经的患者子宫长度相似（59.60±10.25 vs 60.33±10.68mm，p = 0.71）。在第3个月出现盆腔痉挛的患者中，IUD尖端与子宫内膜、肌层和子宫底部之间的距离在统计学上显著更长，表明IUD有向下移动。（子宫内膜；0.29±0.72 vs 0.45±0.35mm，p = 0.02，肌层；1.25±1.39 vs 2.38±2.26mm，p < 0.05，宫底；1.68±2.39 vs 2.92±1.78mm，p < 0.05）。
子宫腔长度较短似乎是Cu-T 380A IUD患者月经过多的一个预测因素。出现IUD盆腔痉挛的患者更容易发生IUD排出，因为这些患者中IUD的向下移动更为明显。
