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  • Title: Risk factors for copper T IUD expulsion: an epidemiologic analysis.
    Author: Zhang J, Feldblum PJ, Chi IC, Farr MG.
    Journal: Contraception; 1992 Nov; 46(5):427-33. PubMed ID: 1458889.
    Abstract:
    Little is known of the factors associated with expulsion of intrauterine devices (IUD). We conducted a nested case-control study to examine the risk factors for copper T IUD expulsion using data from a multicenter international clinical trial. We included 70 cases with expulsion and 1,536 controls, and we examined a variety of characteristics of the IUD wearers. The proportional hazards model showed that young maternal age, abnormal amount of menstrual flow and dysmenorrhea before IUD insertion are risk factors for copper T IUD expulsion. The risk of expulsion steadily increased as age decreased, and as the severity of dysmenorrhea increased. Data on 70 women who experienced expulsion of a copper releasing IUD were compared with data on 1536 women who still retained a copper releasing IUD to determine risk factors for IUD expulsion and calculate the magnitude of the association. The 18-40 year old women were part of an international multicenter clinical trial. Adolescents were at a 5.5 (unadjusted crude odds ratio) higher risk of IUD expulsion than women of at least 35 years old. The risk of expulsion decreased with age (odds ratio [OR] = 2.1 for 20-29 year olds and 1.1 for 30-34 year olds). Women whose menstrual flow was higher than normal were also at greater risk of IUD expulsion (OR = 2.4). The risk was the same for women who experienced severe pain during menstruation (OR = 2.4). The proportional hazards regression analysis showed maternal age (adjusted hazard ration = 5.4 for teenagers), amount of menstrual flow (2.4 for abnormal flow), and dysmenorrhea (1.8 for severe menstrual pain) were risk factors for expulsion of the copper releasing IUDs. Further, the trend test revealed a significant dose response pattern between maternal age and IUD expulsion (p .001) and between dysmenorrhea and expulsion (p = .011). The small sample size of nulliparous women (1 case and 7 controls) limited the ability of the analysis to identify parity as a risk factor which has been identified as a risk factor in other studies. In conclusion, these findings indicated that maternal age, amount of menstrual flow, and severe pain during menstruation are risk factors for expulsion of copper releasing IUDs.
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