Objective: The purpose of this study was to determine the barriers to intrauterine device (IUD) use at a University-Based Women’s Clinic. Methods: This study is a cross-sectional survey of a con- venience sample of subjects receiving obstetrical care at a University-Based Women’s Clinic. Eligi- ble women who consented to participate self-administered a 16-question survey during a routine prenatal visit. Descriptive statistics were used to report participants’ demographics and history of contraception use. Additionally, subjects were asked if they would consider IUD use in the future. Results: A total of 160 women participated in this study. The average age of this sample was 24.9 (SD = 6.3). The majority were in low income and low education categories. Only 5% of women re- ported previous IUD use. 27% of women surveyed desired more information regarding IUD con- traception. 19% of participants would consider using an IUD in the future and 25% would consider IUD in the future if they knew more about them. Insurance and financial constraints were cited as barriers to IUD use. 4% of the sample reported that they had used an IUD previously and were unhappy with it due to pain and discomfort. 18% would not consider an IUD because they had heard about side effects. 68% of the surveyed sample reported unintended pregnancies. Conclu- sion: The two most common barriers to IUD use in this patient population was lack of knowledge and concern about side effects. Increasing patients’ knowledge of IUDs has the potential to increase IUD utilization in this clinic population which reported a 68% rate of unintended pregnancy.
Helsinki, they completed a demographics form to en- sure that they met inclusion criteria and had no ex- clusion criteria. Inclusion criteria included Defense Enrollment Eligibility Reporting System (DEERS)-eligible women aged 18 years and older desiring Copper T380A or levonorgestrel 52 mg intrauterine device insertion. DEERS eligibility would allow them to receive care at a Military Treatment Facility. Exclusion criteria were current pregnancy, history of cervical stenosis, severe medical illness, known allergy or sensitivity to lidocaine or naproxen, peptic ulcer disease, current pelvic inflamma- tory disease, patients with known renal insufficiency, and patients using chronic NSAIDs or on chronic pain medi- cation. Due to the infrequency of Skyla IUD use in our clinic and the non-availability of Liletta and Kyleena at the time of the study, women desiring these devices were also excluded.
Women in the United States are increasingly choosing an intrauterine device (IUD) for contraception. Since the postpartum period is an important time to consider a patient ’ s need for contraception, offering postpartum IUD placement is considered best practice. Effective implementation of postpartum IUD placement occurs within a context of shared decision making wherein patients are given full information about all options and guided to methods that best fit their lifestyle. Within this context, both the non-hormonal and hormonal IUDs are safe, highly effective, well tolerated, and convenient options. National guidelines support the placement of IUDs, whether immediate (within 10 min of placental delivery) or early postpartum (after 10 min and before 4 weeks after placental delivery), for breastfeeding or non-breastfeeding women. Studies have noted increased IUD expulsion rates, but equivalent IUD usage rates with immediate or early postpartum placement. Postpartum placement requires additional skills that can be easily taught. Finally, successful implementation of a postpartum IUD placement program can be accomplished in hospitals using a team-based approach.
Materials and methods: This was an insertion-related, prospective, postmarketing study in 309 women. Following insertion, women were followed up at 4–6 weeks, 6 months, and yearly thereafter. The position of the visualized anchor in the fundus of the uterus was evaluated using ultrasound by measuring its distance from the serosal surface of the uterus (SA-distance). Results: A total of 309 parous (n=115) and nulliparous (n=194) women were fitted with the frameless GyneFix 200 or the GyneFix 330 intrauterine device for contraception. The mean SA-distance in 306 parous and nulliparous women was 6.0 mm (range 2.0–24.0 mm) at insertion in the parous group and 5.4 mm (range 1.3–11.0 mm) in the nulliparous group. At the first follow- up in 281 women, the SA-distance was 6.0 mm (range 2.0–12.0 mm) in the parous group and 5.5 mm (range 1.1–11.0 mm) in the nulliparous group. The SA-distance was not significantly different. One patient had an exceptionally large SA-distance of 24 mm, probably due to insertion in the posterior wall. No follow-up could be done in this patient. In 77 women, the SA-distance was measured up to 42 months. The mean SA-distance at insertion in the parous group was 5.2 mm (range 3.0–8.5 mm) and 4.8 mm (range 1.3–7.0 mm) in the nulliparous group. At the last follow-up up to 36 months or longer, the SA-distance was 5.1 mm (range 3.0–8.5 mm) in the parous group and 4.9 mm (range 1.3–7.0 mm) in the nulliparous group. The SA-distance was not significantly different. The visualized anchor was highly visible on ultrasound in all cases. Conclusion: The visualized anchor is a key element in the optimization of frameless technol- ogy, with the aim of allowing the provider to check its placement at insertion and at follow-up, which enhances provider confidence and assurance. The authors recommend measuring the thickness of the fundus prior to inserting the frameless intrauterine device and to measure the distance between the serosa and the visualized anchor following insertion and at the first follow-up examination.
Young men and women are a highly vulnerable population. They deserve to be informed correctly and have access to high-quality and effective reproductive health care assistance. Discussions about contraception should address risks and benefits associated with IUDs, and the different designs that may be better tolerated and result in high use continuation. Moreover, same-day postcoital and immediate postabortion IUD insertion (or referrals to facilities that provide this service) should be offered as an option whenever possible. The consequences of unintended sex and unintended preg- nancy are far too great. As adolescent pregnancy remains a huge public health problem, more research is urgently needed to study new IUD methods as those described in this article, and compare them with existing birth control methods, in adolescent and young women for interval, postcoital, and
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All reported side effects beyond the 6-week initial follow-up appointment were recorded, given the known initial adjustment period, as well as any complications, including pregnancy, pelvic in ﬂ ammatory disease (PID), device expulsion, malposition, or uterine perforation. PID was clinically de ﬁ ned by the provider seeing the patient in the outpatient, inpatient, or emergency department setting. It was considered a complication of IUD use only when it occurred within 20 days of insertion because of the known increased risk of infection due to IUD insertion during that time period. 18 Expulsion was deﬁned as partial extrusion of the device through the cervix or complete expulsion from the uterus. Malposition was noted when the device was in the uterus but with concern on imaging that it was embedded in the myometrium or positioned in the lower uterine segment. Uterine perforation was de ﬁ ned as an IUD positioned in the abdominal or pelvic cavity outside the uterus. Descriptive statistical analysis was performed on abstracted data by using SAS version 9.3 (SAS Institute, Inc, Cary, NC). Kaplan-Meier survival analysis was used to estimate IUD continuation rates at each year after insertion. Subjects were censored at their last known contact point. They were also censored at the end of the study period if IUD use was ongoing. Survival curve graphs were generated by using GraphPad Prism version 8.4.2 (GraphPad Software, San Diego, CA). This study was approved by the Cincinnati Children’s Hospital Medical Center Institutional Review Board.
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Most women who approached for IUCD removal belonged to 21-25 years of age- 46.9% which correlates with study by Samar et al., where Most of IUD users were in the age group 20-30, and 30-40 years (35% and 28% of the study sample). 59.06% of the subjects had finished their high school. This was similar to study by Samar et al. where More than 50% of the sample had good education (39.5% had secondary education, and 12.5% had college education). Most of women in Samar et al. study were housewives (85.5%) which is similar to ours 89.06 % of the study group were home makers. 19
Abstract: Many more women in the US today rely upon intrauterine devices (IUDs) than in the past. This increased utilization may have substantially contributed to the decline in the percentage of unintended pregnancies in the US. Evidence-based practices have increased the number of women who are medically eligible for IUDs and have enabled more rapid access to the methods. Many women enjoy freedom to use IUDs without cost, but for many the impact of the Affordable Care Act has yet to be realized. Currently, there are three hormonal IUDs and one copper IUD available in the US. Each IUD is extremely effective, convenient, and safe. The newer IUDs have been tested in populations not usually included in clinical trials and provide reassuring answers to older concerns about IUD use in these women, including information about expulsion, infection, and discontinuation. On the other hand, larger surveillance studies have provided new estimates about the risks of complications such as perforation, especially in postpartum and breastfeeding women. This article summarizes significant features of each IUD and provides a summary of the differences to aid clinicians in the US and other countries in advising women about IUD choices.
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Perforation is a rare but serious complication of IUD use. There is considerable diversity of opinion as to whether it occurs only at the time of insertion and also as a secondary phenomenon, ie, after the device is already in place. In order for a properly placed device to leave the endometrial cavity, the myometrium must be able to exert sufficient force to drive the device through the uterine wall. Prior to perforation, the IUD projections can penetrate the muscle wall and cause damage and side effects which are a warning sign. In these cases, three-dimensional sonography is very useful to deter- mine the exact position of the IUD, including the transverse arms. Two-dimensional sonography is much less suitable for seeing the transverse arms. Expulsion is a not uncommon complication of IUD use and may cause the device to fail.
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Background: During the year following the birth of a child, 40% of women are estimated to have an unmet need for contraception. The copper IUD provides safe, effective, convenient, and long-term contraceptive protection that does not interfere with breastfeeding during the postpartum period. Postpartum IUD (PPIUD) insertion should be performed by a trained provider in the early postpartum period to reduce expulsion rates and complications, but these services are not widely available. The International Federation of Obstetricians and Gynecologists (FIGO) will implement an intervention that aims to institutionalize PPIUD training as a regular part of the OB/GYN training program and to integrate it as part of the standard practice at the time of delivery in intervention hospitals. Methods: This trial uses a cluster-randomized stepped wedge design to assess the causal effect of the FIGO intervention on the uptake and continued use of PPIUD and of the effect on subsequent pregnancy and birth. This trial also seeks to measure institutionalization of PPIUD services in study hospitals and diffusion of these services to other providers and health facilities. This study will also include a nested mixed-methods performance evaluation to describe intervention implementation.
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Furthermore, the size of our study was limited, particularly for the group in which we examined A1C data from before and after IUD placement. Only 39 patients met our criteria of having an A1C value within 3 months before to 10 days after LNG-IUD place- ment and an A1C value 3 months to 24 months after placement while the device was still in place. Our inclu- sion criteria for A1C data excluded a large number of laboratory values but allowed us to more reliably measure the temporal effect of the LNG-IUD on glycemic control, thereby assessing diabetes control. Because individuals with longitudinal A1C measurements and those without did not statisti- cally differ in their characteristics, we believe that those patients with A1C values are an adequate representa- tion of the entire sample of patients. TABLE 1. Patient Characteristics by Age-Group
Abstract: Aim: This study aims to investigate the clinical and perinatal outcomes of pregnancies occurring in the presence of an intrauterine device (IUD). Material and Method: A total of 132 women diagnosed as having preg- nancies complicated by IUDs in situ with visible strings were retrospectively examined during a period of six years. Twenty-nine women who chose to keep their IUDs in situ during pregnancy were included in Group 1 whereas 103 women who had their IUDs removed during pregnancy were included in Group 2. Results: Age, parity, frequency of IUD insertion at a maternity hospital and frequency of IUDs located within the uterine corpus were significantly high- er in women who retained their IUDs compared to women who had their IUDs removed (p=0.02, p=0.04, p=0.02 and p=0.01, respectively). Although women who retained their IUDs had a significantly higher frequency of perinatal complications, they had a higher gestational week at delivery as well as higher Apgar scores at both 1 and 5 minutes (p=0.01, p=0.02 and p=0.02, respectively). Gestational age at preterm delivery was significantly lower in women who retained their IUDs during pregnancy (31.4±6 weeks vs. 33.0±4 weeks, p=0.01). Conclusion: Although remov- ing IUDs with visible strings during pregnancy may increase the abortion risk, retaining them is also associated with adverse perinatal outcomes such as preterm premature rupture of membranes and preterm delivery. If an IUD lo- cated within the uterine cavity is retained during pregnancy, it may act as a filter allowing pregnancies to reach term.
trolled studies, but were modified as described in the follow- ing section. The reference list for this study was generated from searching for references from the following databases: MEDLINE: “Intrauterine device (IUD, IUCD)”/“Intrauterine system (IUS) [MeSH]” AND “Cesarean section, caesar- ean section CS, C/S [MeSH]”. “Intrauterine device (IUD, IUCD)”/“Intrauterine system (IUS)”. POPLINE: “IUD” AND “cesarean section”. PubMed: “IUD” AND “cesarean section”. Google Scholar: “IUD”, “IUS” AND “post-placental cesarean section”, AND “IUD” AND “interval cesarean section”, the terms were filtered so as not to overlap in the advanced search. ClinicalTrials.gov: “intrauterine device” AND “cesarean section”. We did not search Wangfang Data and Weipu Data. Significant Chinese articles are beginning to appear in English language databases. Our study updates peer-reviewed papers from January 1968 to December 2012, which formed the basis of the previous report. In that study we searched for references from January 1968 to December 2012. The current search was divided into two parts: 1) to see if new references (especially foreign language) were added to the databases during that period (January 1968 to December 2012); and 2) to do an updated search from December 2012 to June 2015. This latter search is the main focus of this report.
and the WHO in various countries  have shown the decrease in iron reservoir and in- crease the rate of iron deficiency anemia among IUD users, Milson in Sweden  showed that despite the increase in menstru- al bleeding there is no significant change in the amount of reserved iron. Due to the side effects of copper releasing IUDs, they have been substituted by progesterone releasing IUDs in many parts of the world. However, in iran CUT380 A IUD still is being used and there are no documented studies about Iron deficiency anemia among IUD users in Iran. There are many studies which have been carried out in Iran only about the com- plaints of IUD users [5-8]. Additionally, in Iran IUD users do not receive iron supple- ment as a routine practice.
Nearly a third of Canadian women have at least one abortion . Annually about 100,000 abortions are per- formed in Canada . In 2009, at least 30.7% of these were repeat abortions . Women having repeat abor- tions are more likely to be from ethno-cultural minor- ities, to report problems with a male partner, to have a lower level of education, and to have other children at home [4,5]. Thus, research to delineate methods to pre- vent recurrent unwanted pregnancies in this vulnerable population is a high priority. Ames  found a 5-year re- peat abortion rate of 9.4% for Canadian women who had an IUD (Flexi-T380(+) W ; Prosan International BV. Arnhem, The Netherlands)  placed immediately after a first-trimester abortion. However, this retrospective study was only able to determine the recurrent abortion rate of women returning to the index abortion clinic; thus, it is possible that the number of pregnancies was significantly higher than the number of repeat abortions reported. Even so, the reported repeat abortion rate of 9.4% is significantly higher than would be expected based on evidence for the post-abortion effectiveness of a copper IUD [8,9]. Overall 5-year pregnancy rate for IUD users is estimated to be less than 2% [10-12], or a repeat abortion rate of 35 per 1000 women-years of follow-up for women with other models of IUD placed post-abortion . Indeed, the placement of copper IUD types available in other jurisdictions as an effective contraception method following a first-trimester (before 12 weeks of gestational age) abortion is well supported by systematic reviews [8,14].
and are similar to the mechanisms of the progesterone-releasing IUD. The cervical mucus thickens and prevents the passage of sperm into the upper genital tract. The inflammatory changes induced by the plastic frame also contribute to efficacy by acting as a spermicide. The progestin suppresses the endometrium and occasionally suppresses ovulation. The side effects with this device are also influenced by the progestin. Menstrual changes are noted by most users. Women generally experience heavier bleeding in the first cycle but are more likely to experience oligomenorrhea, spotting, or amenorrhea in subsequent cycles. Although the progestin will not reliably suppress ovulation, it can show the atresia of existing follicles; therefore, an increased risk of functional ovarian cysts in associated with the levonorgestrel IUD. The circulatory levels of progestin are lower than with other progestin contraceptives, thus a few women may complain of bloating or breast tenderness with the levonorgestrel-releasing IUD. This IUD has many attractive feature.
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Currently, education on family planning services is inte- grated into general sexual and reproductive health pro- motion and education programmes at the local, regional and national levels. The scope of the sexual education at the public level is basic information on human reproduction and mechanism of how contraceptives work. Although there is a national family planning stan- dards and protocols guiding family planning educational activities, the implementation of this protocol is deter- mined by who is doing the education, the target popula- tion, mode of education and the level of theoretical and practical experience of the educator. In this regard, com- prehensive education on long acting and reversible con- traceptives as well as permanent methods looking at medical eligibility, side effects and complications are usually reserved for clinical trainings of providers and not the general public. Consequently, the limited scope of IUD education compels potential clients’ new users or adopters of IUD to rely on self-education by reading or information from significant others some of whom have limited knowledge shrouded with some of the identified myths and misconceptions that prevents IUD use and encourages discontinuation when side effects occur among users.
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After answering any questions and obtaining informed consent JG conducted all interviews with the aid of an interpreter (SH or HM). Using an interview guide devel- oped specifically for this study, we began the semi- structured interview with general demographic questions before moving to questions related to the participant’s sexual, contraceptive, reproductive and pregnancy his- tory, her experience(s) with the IUD, and her knowledge of the IUD and contraception in general. We concluded the interview with a discussion of ways in which repro- ductive health services could be improved along the border. We modified the initial guide in light of early interviews and participant feedback to ensure that ques- tions were clear and culturally resonate. With participant permission, we audio-recorded interviews and took ex- tensive field notes during and after the encounter; JG also formally memoed after each interview and regularly debriefed with other study team members. Interviews lasted an average of one hour and took place in a quiet and secure location (either at one of the clinics or at a place of the participant’s choosing). As a thank you for participating in the study and to cover any associ- ated travel costs, each woman received 300 Thai Baht (approximately USD10) as well as snacks and drinks throughout the interview.
Stewriffic wyzewoman et.al(2011) conducted a descriptive study that I'm also crazier than normal. I've always been depressed, and I've recently switched to bipolar meds because of increased mania, but I have daily crying jags (usually on the drive to work) and an increasingly short temper. I just feel like my emotions are not under my control. In my case, I had a really flattened affect, and it was just..bizarre, and the emotional impact was more noticeable, and less desirable. I'd be extremely surprised if it was indeed the IUD TCU380A exacerbating depression. When I had my IUD TCU380A inserted, I lost weight and recovered from a bad depression since the point is to, effect your moods. I would check out other things in your life before pinning the mood swings on the IUD TCU380A.
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Abstract: Tranexamic acid has proven to be an effective treatment for heavy menstrual bleeding (HMB). It reduces menstrual blood loss (MBL) by 26%–60% and is significantly more effective than placebo, nonsteroidal anti-inflammatory drugs, oral cyclical luteal phase progestins, or oral etamsylate, while the levonorgestrel-releasing intrauterine system reduces MBL more than tranexamic acid. Other treatments used for HMB are oral contraceptives, danazol, and surgical interventions (endometrial ablation and hysterectomy). Medical therapy is usually considered a first-line treatment for idiopathic HMB. Tranexamic acid significantly improves the quality of life of women treated for HMB. The recommended oral dosage is 3.9–4 g/day for 4–5 days starting from the first day of the menstrual cycle. Adverse effects are few and mainly mild. No evidence exists of an increase in the incidence of thrombotic events associated with its use. An active thromboembolic disease is a contraindication. In the US, a history of thrombosis or thromboembolism, or an intrinsic risk for thrombosis or thromboembolism are considered contraindications as well. This review focuses on the efficacy and safety of tranexamic acid in the treatment of idiopathic HMB. We searched for medical literature published in English on tranexamic acid from Ovid Medline, PubMed, and Cinahl. Additional references were identified from the reference lists of articles. Ovid Medline, PubMed, and Cinahl search terms were “tranexamic acid” and “menorrhagia” or “heavy menstrual bleeding.” Searches were last updated on March 25, 2012. Studies with women receiving tranexamic acid for HMB were included; randomized controlled studies with a description of appropriate statistical methodology were preferred. Relevant data on the physiology of menstruation and the pharmacodynamics and pharmacokinetics of tranexamic acid are also included.