Practical tips for intrauterine devices use in adolescents

Strangulated intestinal obstruction caused by ectopic intrauterine device: a case report

An intrauterine contraceptive device (IUCD) is a widely utilized contraceptive method. However, in rare instances, it may lead to severe complications such as strangulated intestinal obstruction. This paper presents a case involving an elderly female patient who developed acute abdominal pain and was subsequently diagnosed with strangulated intestinal obstruction attributed to an ectopic IUCD. The patient's initial symptomatology included upper abdominal pain and severe vomiting, which led the clinician to perform only an upper-abdominal CT scan, yielding no significant findings. Following three days of conservative management, the symptoms persisted without relief. The patient continued to experience abdominal pain, accompanied by abdominal distension, and a cessation of both flatus and bowel movements. Consequently, a comprehensive abdominal CT scan was performed, revealing bowel obstruction with peritonitis. An urgent laparotomy was subsequently undertaken. Due to the necrotic condition of the bowel, a resection of the affected segment was performed, followed by a one-stage end-to-end intestinal anastomosis after the removal of the intrauterine device (IUCD). By the ninth postoperative day, the patient had recovered sufficiently to be discharged from the hospital. This case underscores the importance for women with an IUCD to regularly assess the device's position and depth to prevent serious complications. It is also advisable to remove the IUCD promptly upon reaching the end of its effective lifespan or following menopause. Clinicians should be vigilant in monitoring and addressing abdominal pain in women with an IUCD.

Effect of a copper intrauterine device on HLA-G and IGF-II levels during pregnancy

OBJECTIVE

An intrauterine device (IUD) is one of the most effective reversible contraceptive methods currently available. Women who use IUDs may become pregnant, albeit rarely, and many such women continue to use IUDs. Because it is difficult to remove or it may cause miscarriage. This study measured the changes in human leucocyte antigen-G (HLA-G) and insulin-like growth factor II (IGF-II) levels in the decidua and villi to explore the effect of a copper IUD on embryonic development.

DESIGN

A total of 54 samples of decidual and villus tissue were collected from pregnant women with IUDs (27 samples) or without IUDs (27 samples). Hematoxylin-eosin staining was used to identify morphological characteristics. Immunohistochemistry was used to detect HLA-G and IGF-II; the protein expression levels were measured via Western blotting.

RESULTS

HLA-G was expressed on the membranes of trophoblasts of villus tissues and the glandular epithelium, and in stromal cells of decidual tissues, in both the IUD and control groups. IGF-II was expressed in the glandular epithelium and cytoplasm of trophoblasts and decidual cells in both groups. Compared to the control group, IGF-II expression was significantly reduced in villus tissues of the IUD group (p < 0.05). The mean sac diameter was significantly positively correlated with IGF-II expression in the villi (p < 0.05).

CONCLUSIONS

A copper IUD may affect embryonic development by regulating the expression of villus IGF-II.

Contraception across the transmasculine spectrum

The field of transgender health continues to expand rapidly, including research in the area of family planning. While much attention has been given to fertility preservation and the parenting intentions of transgender individuals, far less has been paid to pregnancy prevention and contraceptive needs of people along the transmasculine gender spectrum (transgender men and gender-nonbinary persons who were assigned female at birth). Existing research illustrates that many clinicians and transmasculine individuals falsely believe that there is no risk of pregnancy while amenorrheic. These studies also show inconsistent counseling practices provided to transmasculine persons surrounding contraception and pregnancy while falling short of providing robust clinical guidance for improvement. Clinicians report a lack of adequate training in transgender reproductive health, and consequently, many do not feel comfortable treating transgender patients. The aim of this publication is to consolidate the findings of these prior studies and build upon them to offer comprehensive clinical guidance for managing contraception in transmasculine patients. To do so, it reviews the physiologic effects of testosterone on the sex steroid axis and current understanding of why ovulation and pregnancy may still occur while amenorrheic. Gender-inclusive terminology and a suggested script for eliciting a gender-affirming sexual history are offered. Common concerns (such as the effects on gender dysphoria and gender affirmation) and side effects of available contraceptive methods are subsequently addressed and how these may have a unique impact on transmasculine persons as compared with cisgender women. Lastly, a model is provided for approaching contraceptive counseling in the transmasculine population to assist clinicians and patients in determining the need for and selection of the type of contraception. To center transmasculine voices, the development of this publication's guidelines have been led by reproductive care clinicians of transgender experience.

Practical Tips for Intrauterine Device Counseling, Insertion, and Pain Relief in Adolescents: An Update

The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists have endorsed intrauterine devices as first-line contraceptive choices for nulliparous and parous adolescents. Practical concerns about intrauterine devices might be barriers to use for teens and clinicians; this review is devoted to "practical tips" for clinicians, on the basis of an update of the available literature as well as the author's clinical experience. Counseling about contraceptive choices, preventive guidance about possible side effects, informed consent, and pain management are addressed to promote successful use of this long-acting reversible contraption option.

Long-acting reversible contraceptives: Addressing adolescents' barriers to use

NPs caring for adolescent females have an opportunity to reduce US teen pregnancy rates through unbiased counseling on contraception options, including highly effective long-acting reversible methods. Intrauterine devices and subdermal implants are safe, effective contraception options for adolescents, but their rates of use remain low among this patient population. This article discusses current adolescent contraceptive practices, barriers to access, and current recommendations for long-acting reversible contraceptive use.

Postinsertional Pain after Intrauterine Device Placement among Nulliparous Adolescents

STUDY OBJECTIVE

To quantify the "normal" adolescent experience after intrauterine device insertion, to provide appropriate counseling for future adolescents.

DESIGN

Prospective cohort study.

SETTING

Marshall University Department of Obstetrics and Gynecology generalist and adolescent gynecology clinics.

PARTICIPANTS

Nulliparous adolescents age 13-18 years and parous adults 18 years of age or older who received a levonorgestrel intrauterine system (LNG-IUS).

INTERVENTIONS

Visual analogue scale (VAS) pain score and medication log was used for data collection for 2 weeks after LNG-IUS insertion. A separate chart review was completed for demographic factors and indications for procedure.

MAIN OUTCOME MEASURES

VAS pain scores and medication use was compared between groups.

RESULTS

Ninety-three subjects returned the VAS record and medication log (46 adolescents and 47 adults). There was no difference in the incidence of endometriosis or dysmenorrhea, but there was a higher prevalence of menorrhagia among adolescents (30/46, 65.2% vs 10/47, 21.3%; P < .001). Forty-five of forty-seven (95.7%) adults vs 25/46 (54.3%) adolescents had contraception as an indication for intrauterine device use (P < .001). Pain scores were statistically higher among the adolescent group each day (P < .05) in the 2-week study period. The greatest mean differences occurred in the first 4 days. More adolescents (15/46, 32.6%) than adults (6/47, 12.8%) had a pain score greater than 5 during the first 3 days (P = .022). A statistical difference in amount of ibuprofen recorded was only noted on day 1 (P = .023) and day 4 (P = .046).

CONCLUSION

Nulliparous adolescents who undergo LNG-IUS placement experience more postinsertional discomfort compared with parous adults; however, this method should still be considered first-line treatment in this age group.

Choice of Postpartum Contraception: Factors Predisposing Pregnant Adolescents to Choose Less Effective Methods Over Long-Acting Reversible Contraception

PURPOSE

The purposes were to determine contraceptive methods pregnant adolescents intend to use postpartum and to understand factors that predispose intention to use less effective birth control than long-acting reversible contraception (LARC).

METHODS

Participants were 247 pregnant minority adolescents in a prenatal program. Intention was assessed by asking "Which of the following methods of preventing pregnancy do you intend to use after you deliver?" Multinomial logistic regression analysis was used to determine factors associated with intent to use nonhormonal (NH) contraception (male/female condoms, abstinence, withdrawal and no method) or short-/medium-acting hormonal (SMH) contraception (birth control pill, patch, vaginal ring, injectable medroxyprogesterone acetate) compared with LARC (implant and intrauterine device) postpartum.

RESULTS

Twenty-three percent intended to use LARC, 53% an SMH method, and 24% an NH method. Participants who intended to use NH or SMH contraceptive methods over LARC were significantly more likely to believe that LARC is not effective at preventing pregnancy, to report that they do not make decisions to help reach their goals and that partners are not important when making contraceptive decisions. Other important factors were having a mother who was aged >19 years at first birth and had not graduated from high school, not having experienced a prior pregnancy or talked with parents about birth control options, and the perception of having limited financial resources.

CONCLUSIONS

Distinct profiles of factors associated with intending to use NH or SMH contraceptive methods over LARC postpartum were identified and may inform future interventions to promote the use of LARC to prevent repeat pregnancy.

Three-dimensional ultrasonography versus two-dimensional ultrasonography for the diagnosis of intrauterine device malposition

OBJECTIVE

To compare the diagnostic accuracy of two-dimensional (2D) versus three-dimensional (3D) ultrasonography for the diagnosis of intrauterine device (IUD) malposition.

METHODS

In a prospective study, women with a history of failed IUD removal and/or ultrasonography results indicating malposition were recruited at a center in Hangzhou, China, between March 1, 2009, and September 30, 2011. All patients underwent 2D and 3D ultrasonography. Hysteroscopy, laparoscopy, or laparotomy was carried out to remove the IUDs and was considered the gold standard for diagnosing malposition.

RESULTS

Among 130 participants, 128 (98.5%) were diagnosed with IUD malposition by hysteroscopy, laparoscopy, or laparotomy. Malposition had been correctly identified with 2D ultrasonography in 83 (64.8%) cases, and with 3D ultrasonography in 107 (83.6%) cases. The diagnostic accuracy of 3D ultrasonography was significantly better than was that of 2D ultrasonography (P<0.001).

CONCLUSION

The use of 2D ultrasonography is recommended for the follow-up of women who use IUDs as a contraceptive method. However, 3D ultrasonography should be used when malposition is suspected.

Understanding benefits and addressing misperceptions and barriers to intrauterine device access among populations in the United States

Three intrauterine devices (IUDs), one copper and two containing the progestin levonorgestrel, are available for use in the United States. IUDs offer higher rates of contraceptive efficacy than nonlong-acting methods, and several studies have demonstrated higher satisfaction rates and continuation rates of any birth control method. This efficacy is not affected by age or parity. The safety of IUDs is well studied, and the risks of pelvic inflammatory disease, perforation, expulsion, and ectopic pregnancy are all of very low incidence. Noncontraceptive benefits include decreased menstrual blood loss, improved dysmenorrhea, improved pelvic pain associated with endometriosis, and protection of the endometrium from hyperplasia. The use of IUDs is accepted in patients with multiple medical problems who may have contraindications to other birth control methods. Yet despite well-published data, concerns and misperceptions still persist, especially among younger populations and nulliparous women. Medical governing bodies advocate for use of IUDs in these populations, as safety and efficacy is unchanged, and IUDs have been shown to decrease unintended pregnancies. Dispersion of accurate information among patients and practitioners is needed to further increase the acceptability and use of IUDs.