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  • Title: Long-term cytologic studies of copper-IUD users.
    Author: Engineer AD, Misra JS, Tandon P.
    Journal: Acta Cytol; 1981; 25(5):550-6. PubMed ID: 6945020.
    Abstract:
    Cytologic evaluation was carried out in 198 women using copper T-200-mm intrauterine devices (IUDs) for periods ranging from four to eight years. Preinsertional cytology revealed one mild dysplasia; the lesion reverted to normal six months later and has remained normal after five years of copper T contraception. A total of 18 dysplasias (16 mild and 2 moderate) were found in post-IUD-insertion smears during follow-ups after one to eight years of IUD use. Regression of the lesion was noticed in 14 of the 18 within 6 to 12 months with the device in situ. Persistence of the lesion was found in one case and a waxing and waning pattern in two, necessitating removal of the device in all three. In the remaining case, the device was removed due to menopausal menstrual irregularity. In 1971, a preliminary study of 293 women using Copper T 200 was started at the Contraceptive Clinic, Queen Mary's Hospital, Lucknow. A follow-up study of 38 cases for 5 years showed a low incidence of cervical dysplasia and no case of cervical carcinoma. This paper presents the results of a cytologic follow-up for an additional 36 months for 198 of the 293 women. The 198 women were aged 21 to 42 years with parity ranging from 1 to 8. Annual follow up rate ranged from 66.1% to 100%. Preinsertional smears were available in all 198 women and were collected from 3 sites: ectocervix-squamo-columnar junction, endocervical canal and endometrium. Smears from the first 2 sites were repeated at 6-month intervals and evaluated using the nomenclature of World Health Organization (WHO) study group. 125 had their IUDs changed after 3 to 6 years (group 2), while 73 had worn the same devices continuously for periods ranging from 3 to 8 years (group 1). Preinsertional cytology of the 198 women revealed 118 negative smears (59.7%); 70 exhibited evidence of inflammation (39.8%), and 1 had dysplasia of a mild degree (0.5%). 18 (9.06%) dysplastic smears were seen during follow-up of the 198 women over the 8-year period. 11 were found in group 1 and 7 in group 2. Regression of the lesion occurred in 14 of the 18 women within 6 to 12 months with the IUD in situ. IUD was removed in 1 case due to menopausal menstrual irregularity and in 3 patients with persistent lesion, and a waxing and waning pattern. These 3 patients should be considered a risk for cervical carcinoma and need observation for at least another 5 years. The incidence of dysplasia increased progressively with increasing duration of device use, regardless of whether the devices had been changed. In women with unchanged IUDs, the maximum incidence of dysplasia was observed after 5 years of use (5.0%), while in those whose IUDs have been changed, a higher incidence was seen 2 to 3 years after the device has been changed (6.2% and 8.0%, respectively). The findings suggest that uninterrupted use of a copper IUD should not exceed 5 years. Thereafter, another mode of contraception should be offered to the patient.
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