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  • Title: [The intrauterine device from today's perspective].
    Author: Kyank HR.
    Journal: Z Arztl Fortbild (Jena); 1983; 77(5):190-5. PubMed ID: 6858215.
    Abstract:
    Currently, the most used IUD's are those containing copper and the ones containing progestins. The foreign body reaction to these IUDs leads to biochemical and biological changes in the uterus which affect ovum and sperm transport and the development of the blastocyst. Copper augments this foreign body reaction and has a cytotoxic effect on sperm and blastocyst. Progesterone causes atrophy of the glands, a pseudodecidual stroma reaction of the endometrium and a change in blastocyst metabolism preventing implantation. Indications for IUD are: 1) older women with completed families, 2) between desired pregnancies, 3) with contraindications for hormonal contraception, 4) low compliance (e.g. mental disorders). Patients should be carefully examined before insertion of a well-fitting IUD. Patient education must include the occurrence of cramplike pain after insertion; light bleeding for a few days; more bleeding at first and, possibly, subsequent menstruation. Patients should be encouraged to see their doctor with more severe pain, bleeding, or fever. IUD should not be inserted immediately following pregnancy or abortion; higher expulsion and/or pregnancy rates have been observed with this in various studies. Follow-up with sonography after insertion should be done the 1st 2 months, then every 6 months. Pregnancy rates for various IUD's in the 1st year of use are between 0.5 and 2.6/100 women. Side effects of IUD's are spontaneous expulsion (1.4-15.7/100 women) in 1st year, bleeding disorders, pain, adnexitis, uterus perforation and ectopic pregnancy. Various contraindications for IUDs are listed. Indications for removal are: desire for children, pregnancy with in-situ IUD, pathological bleeding over more than 3 cycles, severe pain which does not disappear with spasmolytic analgesics, and occurrence of salpingitis.
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