35 predominantly multiparous, sexually active women aged 25-44 years were fitted with levonorgestrel 20 T (Schering) IUDS in the post- menstrual phase, or in rare instances, right after abortion. the devices contained 60 mg of levonorgestrel releasing 20 mcg/day with the life span of 5 years. The patients were followed up every 3-6 months to detect side effects and complications. The first year contained a total of 339 months of observation, while the figure rose to 461 months in the second year. Spotting lasting 15-20 days followed insertion, but in later months only 7% of patients complained of bleeding or menstrual spotting. 7-8% of cases tended to have oligomenorrhea in the first year; 1/3 to 1/2 of them had hypomenorrhea during the first and second year. True amenorrhea started in 20-30% of women, persisting through both years. Longer duration of flow occurred in 32.4-4.57.1% of cases during these 2 years. Hormonal effects (headache, acne, hirsutism, depression, mastalgia, and inflamed varicose veins) ranged from 18.2- 33.3%. Levonorgestrel 20 T demonstrated more superior contraceptive efficacy than Progestasert; however, serious menstrual cycle disorders associated with it also increased. All progestin-releasing devices (the minipill, Norplant, Progestasert) induced menstrual changes, thus their use is preferable for therapeutic indications such as hypermenorrhea and uterine fibroid.
A device invented in the US measuring the concentrations of electrolytes present in the saliva and cervical mucus was first used in italy for early prediction of ovulation with a degree of certitude. The Cue test was also used. The oral sensor was used daily, while the vaginal sensor was employed only on certain days of the cycle measuring ionic concentrations of sodium (Na), calcium (Ca), and potassium (K). The experiment was carried out in 61 menstrual cycles of a group of patients with sterility and infertility. The start of ovulation could be predicted 6 days and 19 hours after the peak oral values. In anovulatory cycles and ovarian polycystic disease, the oral peak values could not be verified. The peak oral values were the first sign of the start of ovulation which ensued after 7 days later with fluctuating high and low values in successive days of the cycle. If the menstrual cycle lasted 26-30 days, the oral peak was registered between the fifth and ninth day of the start of menstruation. If the cycle was long (35 days) one peak did not follow the other: 2 successive ovulations occurred. Abrupt rise of low vaginal values occurred 4 days after the oral peak. THe very low vaginal values indicated the onset of ovulation, but their sudden rise confirmed the day of ovulation. Comparisons of luteinizing hormone (LH) levels and cervical flow have been used for predicting ovulation; nonetheless, the present method has also proved to be valid.
In recent years new protocols of post-coital hormonal contraception have been devised that cause fewer side-effects. 0.2 mg ethinyl-estradiol with 2 mg norgestrel twice within 72 hours after intercourse were among the first combinations that would utilize low doses of hormones. Other authors use even smaller doses; preparations for intramuscular injection are available if the woman vomits the tablets. Progesterone has been used alone within 12 hours following intercourse with a success rate close to estrogen-progestin combinations. Quingestanol acetate is used for 5 days, 0.9-1.5 mg/day. With danazol fewer side-effects are seen; 400 mg are taken twice within 72 hours with a good rate of success.
330 women with a median age of 30.15 (+- 9.5) years sought gynecological consultation for advice on contraception and for cervical carcinoma screening. Anamnesis explored the presence of dysuria, dyspareunia, secretions, and pelvic pain, the number of partners, and type of contraceptive used. Endocervical samples were collected by means of tampon and the specimens were analyzed for 48 to 120 hours to find antigens of Chlamydia trachomatis (C.T.) by a solid phase immunoenzymatic test. Peripheral blood samples were also taken from all women to look for antibodies of C.T. and also the indirect immunoperoxidase test was used to search for specific antibodies of C.T. (IgM, IgA, IgE, IgG). The chi-square test was applied for statistical analysis. None of the women who used oral hormonal contraceptives or condoms were infected (presence of antigens and positivity for IgM and/or IgE and/or IgA), however, 36 of 90 IUD users (40%) were infected, 18 of 132 women who used no contraceptives whatsoever (13.7%) were also infected. 91% of the subjects had a single partner. In view of these findings the use of the condom and oral contraceptives is recommended with proper instruction about their potential side effects.
The article documents a clinical case involving allergy to the copper IUD. A 28-eight year old woman, with a normal family medical history, received a copper-medicated IUD (MLCu250) in March 1985, that initially was well tolerated both gynecologically and psychologically. After approximately 2 months, palpebral and perioral edema occurred that regressed following antihistamine treatment. After 5-6 months, erythema and an intense itching along with pruriginous symptoms spreading all over her body occurred at menstruation time. These symptoms responded to antihistamine and cortisone, but reappeared after discontinued treatment. The patient received the patch test revealing a pronounced positivity to copper sulphate. Other clinical tests revealed that cupremia during the acute phases was 110g/100 ml. (fully within the normal limits). A direct allergic, but nontoxic connection to the presence of IUD was established. Numerous studies have revealed that the copper contained in IUD is liberated in the uterine cavity in the form of ions and it is hypothesized during menstruation released into the blood stream, which is supported by the fact that allergic episodes were verified during menstrual bleeding. However, skin complications could also be the result of absorption and diffusion of plasmatic proteins in the blood stream whose molecular configurations are altered in the endometrium as a result of the copper ions, thus causing allergic reactions. Allergies should be considered a possibility with the IUD, but it is not advised to perform allergometric tests in all patients who receive one.
