Search Results (12)

Background: Intrauterine device (IUD) insertion is a highly effective contraceptive procedure but is frequently associated with pain and bleeding, which may negatively influence patient acceptance and continuation rates. Although traditionally performed during menstruation, the optimal timing of insertion within the menstrual cycle remains uncertain, with limited data regarding patient-centered outcomes. Objective: The aim of this study was to evaluate the impact of menstrual cycle timing on pain, intra-procedural bleeding, and postprocedural outcomes in women undergoing IUD insertion. Methods: A comparative observational study was conducted including 200 parous women aged 20–40 years. Participants were consecutively enrolled and classified into two groups according to the day of the menstrual cycle at presentation for IUD insertion: Group A (days 3–7 of the menstrual cycle) and Group B (days 10–14). All procedures were performed by the same experienced gynecologist using a standardized technique. Pain was assessed using a Visual Analog Scale (VAS), intra-procedural bleeding was graded on a 0–3 scale, and postprocedural outcomes included analgesic use and bleeding characteristics. Statistical analysis was performed using independent t-tests and chi-square tests. Results: Baseline characteristics were comparable between groups (p > 0.05). Mean pain scores were significantly lower in Group B compared to Group A (3.1 ± 1.2 vs. 5.8 ± 1.4, p < 0.001). Intra-procedural bleeding was also significantly reduced in the mid-cycle group, with higher rates of minimal or no bleeding (85% vs. 20%, p < 0.001). The need for postprocedural anti-inflammatory medication was significantly lower in Group B (22% vs. 76%, p < 0.001). Additionally, postprocedural bleeding duration and intensity were reduced in the mid-cycle group. Conclusions: IUD insertion performed during the mid-cycle phase was associated with significantly better tolerability, including reduced pain, less bleeding, and decreased need for analgesia. While current guidelines allow flexible timing, these findings suggest that mid-cycle insertion may be associated with improved patient comfort when clinically feasible to improve patient experience without compromising access to contraception. Further randomized studies are warranted to confirm these results. Full article

Background: Perforation associated with intrauterine devices (IUDs) occurs in approximately 1 in 1000 insertions and may be either partial or complete. Perforation may be primary, occurring during device insertion, or secondary, developing after the device has remained in situ for more than eight weeks. Typical symptoms of IUD perforation include chronic pain and intestinal obstruction. Rarely, the device is found either completely within the rectal lumen or partially embedded in the rectal wall with partial intraluminal extension. Removal of the device may require colonoscopy, laparoscopy, or a combination of both. Case: A 45-year-old woman was referred for evaluation of intermittent rectal bleeding. Initial outpatient evaluation included contrast-enhanced computed tomography (CT), which demonstrated two intrauterine devices: one appropriately positioned within the uterine cavity and another located within the rectouterine pouch. A multidisciplinary discussion involving gastroenterologists, gynecologists, and colorectal surgeons was subsequently conducted. Under general anesthesia, laparoscopy was initiated. Upon entering the abdominal cavity, a free IUD string was visualized embedded within the pelvic peritoneum. Using simultaneous colonoscopic guidance with transillumination, a targeted peritoneal incision was made overlying the IUD. The arms were removed laparoscopically. Subsequent colonoscopy removed the remaining segment of the IUD traversing the rectal wall. Conclusions: Although uterine perforation and migration of intrauterine devices are uncommon, they may result in severe and potentially life-threatening complications. Early diagnosis, careful documentation, routine follow-up, and timely removal of misplaced devices remain essential to minimizing morbidity and preventing adverse outcomes. Full article

Background: TikTok has emerged as a major source of health information, including content related to intrauterine devices (IUDs). However, the accuracy, quality, and engagement patterns of IUD-related content on this platform remain insufficiently characterized. This study evaluated the informational quality, thematic focus, misinformation prevalence, and engagement metrics of widely viewed IUD-related TikTok videos. Methods: A descriptive cross-sectional content analysis was conducted of TikTok videos retrieved using 12 IUD-related search terms. Engagement metrics, creator characteristics, and content features were extracted, including educational, testimonial, and advice-seeking videos. Advice-seeking videos were included to capture user-generated concerns and inquiries that may influence engagement with health-related content on social media platforms. Informational reliability and quality were assessed using the Modified DISCERN instrument and the Global Quality Scale (GQS). Differences across groups were examined using t-tests, ANOVA, and chi-square tests. Results: A total of 458 videos were included. Nearly half were testimonial or advice-seeking (47.8%), while 38.9% were educational. Most content was produced by non-healthcare creators (76.4%). Engagement metrics did not differ significantly across video type, source, or creator qualification (all p > 0.05). Frequently discussed topics included adverse effects (36.5%), insertion experiences (31.2%), and device removal or discontinuation (19.9%). Overall informational quality was low, with mean GQS and Modified DISCERN scores of 2.0 and 1.8, respectively. Physician-created content demonstrated significantly higher quality and reliability scores (both p < 0.001). Conclusions: Widely viewed IUD-related TikTok content demonstrates high engagement but generally low informational quality. Full article

Increasing use of intrauterine devices (IUDs) makes effective pain management essential for high-quality care. However, gaps between patient and clinician pain perceptions, along with limited training in managing IUD-related acute pain, contribute to barriers in IUD use and patient–provider mistrust. This narrative review aims at (1) summarizing current IUD-related pain management, (2) evaluating the emphasis on pain education and management, including IUD insertion pain, in medical education, and (3) examining how gaps in pain education and management may affect clinicians’ preparedness to manage patients’ IUD-related pain. Relevant literature was identified through keyword searches across major databases and national organizations. Studies on IUD pain management approaches and pain education in undergraduate medical education (UME), graduate medical education (GME), and residency programs were included. The results section outlines the current IUD insertion pain-management options available and their limitations, alongside evidence of insufficient emphasis on pain education and its management in medical school and residency training. In conclusion, the study indicates that, although all pain-management approaches reduce perceived IUD-related pain, significant gaps in national guidelines, clinician–patient pain-perception non-alignment, and pain-education across UME and GME may be contributary to inconsistent clinical practices. A multi-pronged approach that includes strengthening pain-education throughout medical training could be one way to reduce these disparities by improving clinicians’ competence to manage pain effectively. Full article

Background: Emergency contraception (EC), also known as postcoital contraception, is a method used to prevent an unintended pregnancy following unprotected or inadequately protected sexual intercourse. The available options include emergency contraceptive pills or the insertion of an intrauterine device (IUD). Emergency contraception pills contain either levonorgestrel (a single 1.5 mg dose, effective within 72 h) or ulipristal acetate (a single 30 mg dose, effective within 120 h), both of which are most effective when taken as soon as possible after unprotected intercourse. Another highly effective option is the insertion of a copper or levonorgestrel-releasing intrauterine device, although IUDs are not registered for EC use in all countries. The aims of this cross-sectional, comparative, observational study were to collect data on the emergency contraception methods used by adolescent girls and young women to examine their association with various factors, such as religious beliefs, and to evaluate the effectiveness of different emergency contraception methods, including hormonal options and intrauterine devices. Methods: Data were collected from 240 women who attended our Family Planning Clinic using a structured questionnaire that included items on their demographic characteristics, religious beliefs, medical history, lifestyle factors, contraceptive use and side effects, prior use of emergency contraception, method selected, and reasons for seeking emergency contraception. Descriptive statistics were used to summarize the data, comparisons between religious groups were conducted using chi-square tests, and factors related to the timing of emergency contraceptive use were investigated using multinomial logistic regression analysis. Results: Most of the reasons for emergency contraception use did not differ significantly between Christian and Muslim participants. However, Christians were significantly more likely to use emergency contraception due to missed contraceptive doses (20.9% vs. 6.7%, p = 0.004) or the failure to take a progesterone-only pill (19.1% vs. 3.3%, p = 0.001). Levonorgestrel was the most frequently used method in both groups (48.9% of Christians vs. 60% of Muslims, p = 0.132), followed by ulipristal acetate (30.9% vs. 40%, p = 0.180). Notably, 18.5% of Christian participants used an intrauterine device (IUD) for emergency contraception, while no Muslim participants reported IUD use (p < 0.001), indicating a significant difference potentially influenced by cultural or religious factors. Conclusions: Both religious and individual sociodemographic factors affect not only the choice of emergency contraception but also the urgency with which the emergency contraception is used. Interventions aimed at improving contraception education, addressing partner-related challenges, and promoting timely access could improve reproductive health outcomes. Full article

Intrauterine devices (IUDs) are highly effective long-acting contraceptives. However, pain associated with insertion deters some women and impacts satisfaction. This systematic review critically evaluates the effectiveness of local anesthetics, misoprostol, nonsteroidal anti-inflammatory drugs (NSAIDs), and conscious sedation for managing pain associated with IUD insertion. A comprehensive database search including PubMed, Web of Science, Google Scholar, ClinicalTrials.gov, and ProQuest was conducted from inception to July 2023 for randomized controlled trials (RCTs). RCTs assessing interventions for IUD insertion pain were included. Case reports, non-randomized studies, and non-English papers were excluded. Two independent reviewers extracted data on pain outcomes and adverse effects. The risk of bias was assessed using Cochrane tools. Thirty-nine RCTs (n = 12,345 women) met the inclusion criteria. Topical lidocaine effectively reduced pain on consistent findings across multiple high-quality RCTs. Misoprostol pretreatment facilitated easier insertions through cervical ripening. However, evidence for NSAIDs was inconclusive, with some RCTs finding no additional benefits versus placebo. Results also remained unclear for nitrous oxide conscious sedation due to variability in protocols. Nulliparity predicted higher reported pain consistently. Lidocaine and misoprostol show promise for minimizing IUD insertion pain and difficulty. Further optimization is required to standardize conscious sedation and fully evaluate NSAIDs. Improving pain management may increase favorable experiences and uptake of this reliable method. Full article

Objectives: The downregulation of anti-adhesive regulatory proteins and upregulation of adhesive genes are critical for the receptive endometrium. This study was designed to determine whether switching between the anti-adhesive podocalyxin (PDX) and adhesive HOXA10 receptivity modulator occurs in the endometrium of women with recurrent implantation failure (RIF). Methods: Twenty-four patients with RIF who could not conceive for three or more cycles despite good-quality embryo transfer constituted the study group. Twenty-four patients with unexplained infertility (UEI) matched for age, BMI, and infertility duration were included in the control group. Twenty women scheduled to undergo intrauterine device (IUD) placement for birth control were included in the comparative group. Endometrial tissue was collected from patients with RIF and UEI during egg retrieval after ovarian stimulation using the GnRH antagonist protocol. In the fertile group, endometrial tissues were collected during IUD insertion. HOXA10 mRNA expression was analyzed by qRT-PCR and PDX protein expression was analyzed by ELISA. The relative expression of endometrial HOXA10 mRNA was calculated using the 2^−ΔΔCt equation. Results: The relative expression of HOXA10 mRNA in the RIF group was significantly lower than that in the UEI group (p < 0.001). HOXA10 mRNA expression in the fertile group was significantly higher than that in the RIF group and was similar to that in the UEI group. PDX expression in the RIF group was significantly higher than that in the UEI group (p < 0.001). PDX expression in the fertile group was significantly lower than in the RIF and UEI groups. A negative correlation was detected between the anti-adhesive PDX protein and adhesive HOXA10 (r = −0.797, p < 0.001). Although there was a positive correlation between endometrial thickness recorded on the day of hCG administration and HOXA10 (r = 0.590, p < 0.01), endometrial thickness was negatively correlated with PDX (r = −0.529, p < 0.01). Conclusions: The failed physiological downregulation of the anti-adhesive PDX protein in patients with RIF prevented the upregulation of adhesive HOXA10 mRNA. Full article

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. Full article

We aimed to evaluate the pregnancy characteristics and obstetric outcomes in patients after perforation of the uterus. Study design: A retrospective cohort study was conducted and included all patients who were diagnosed with uterine perforation and treated in a tertiary referral medical center between the years 1996 and 2018. Up to two deliveries after perforations were investigated. Results: During the study period, 51 women were diagnosed with uterine perforation during gynecological procedures, including intrauterine device (IUD) insertion. The mean age of patients at the time of diagnosis was 27.9 (±4.7) years. The majority, 76.5% (n = 39), experienced perforation during IUD insertion, and 23.5% (n = 12) of the patients experienced perforation during surgical procedures. Most of the patients were multiparous or grand multiparous, 45.8. % (n = 22) and 39.6% (n = 19) respectively. Anteflexed uterus was found in 86.4% of the patients (n = 38). Five patients (9.8%) had pelvic abscesses after the IUD insertion. A total of 50 patients had 71 deliveries subsequent to uterine perforation. One patient experienced intrauterine fetal death due to fetal malformations. One patient experienced uterine rupture. No other major obstetric complications were noted. Conclusions: Uterine perforation may be associated with adverse obstetric outcomes. The possibility of uterine rupture must be considered while managing the deliveries of patients after uterine perforation. Moreover, a larger cohort and further studies are needed to establish an association between uterine perforation and adverse outcomes of the subsequent deliveries. Full article

Intrauterine devices (IUDs) are used in mares to suppress oestrous behaviour, but the underlying mechanism is yet to be elucidated. The presence of an embryo or an IUD prevents cyclooxygenase-2 (COX-2) and, subsequently, prostaglandin (PG) release and luteolysis. However, inflammation may also be involved. Endometrial inflammatory markers in uterine lavage fluid were measured on Day 10 (EXP 1, n = 25) and Day 15 (EXP 2, n = 27) after ovulation in inseminated mares, non-pregnant or pregnant, and in mares in which a small plastic sphere had been inserted into the uterus 4 (EXP 1) or 3 days (EXP 2) after ovulation. Uterine lavage fluid samples were analysed for nitric oxide (NO), prostaglandin E₂ (PGE₂) (only EXP 1), prostaglandin F_2α (PGF_2α), inhibin A and cytokines, and blood samples for progesterone and oestradiol. On Day 10, the concentration of PGF_2α was lower (p < 0.05) in the IUD group than in pregnant mares. The concentration of the modulatory cytokine IL-10 was significantly higher in the IUD group in comparison to non-pregnant mares, and inhibin A was significantly higher in IUD mares than in the pregnant counterparts on Day 15. The results suggest that the presence of IUD causes endometrial inflammation which is at a resolution stage on Day 15. Full article

Progestin-only contraceptive implants provide long-acting, highly effective reversible contraception. We searched the medical publications in PubMed, CENTRAL, and EMBASE for relevant articles on hormonal implants published in English between 1990 and 2021. Levonorgestrel (LNG) 6-capsule subdermal implants represented the first effective system approved for reversible contraception. The etonogestrel (ENG) single rod dispositive has been widely employed in clinical practice, since it is a highly effective and safe contraceptive method. Abnormal menstrual bleeding is a common ENG side effect, representing the main reason for its premature discontinuation. Emerging evidence demonstrated that it is possible to extend the use of the ENG implant beyond the three-year period for which it is approved. The ENG implant could be an effective and discrete alternative to the IUD in young girls, such as post-partum/post-abortion. Implants should be inserted by trained skilled clinicians who previously provide adequate counselling about their contraceptive effect, benefits, and any possible adverse events. More studies are needed to validate the extended use of the ENG implant for up to 5 years. Full article

Long-Acting Reversible Contraception (LARCs) has the potential to decrease unintended pregnancies but only if women can easily access a requested method. Retrospective electronic chart review identified women desiring LARC placement over a one-year period ending 31 December 2016. Most of the 311 insertions were for family planning, with 220 new insertions and 60 replacements. Delays occurred in 38% (n = 118) of patients, averaged 5 ± 5 weeks, and 47% received interval contraception. Reasons included absence of qualified provider (n = 44, 37%), pending cultures (n = 31, 26%), and Mirena availability. Teenage LARC use favored Nexplanon whereas older women preferred Mirena (p < 0.01). Of the 11% choosing early LARC removal, a significant number were African Americans (p = 0.040) or teenagers (p = 0.048). Retention time varied by device type; most patients switched to other contraceptives. No patients experienced IUD expulsion. Understanding barriers, attempting to remedy them, and addressing the side effects associated with LARC use is of importance in this inner-city patient population in the United States. Full article