A three-year longitudinal evaluation of the forearm bone density of users of etonogestrel- and levonorgestrel-releasing contraceptive implants

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to evaluate bone mineral density (BMD) at baseline and at 18 and 36 months of use of etonogestrel (ENG)-and levonorgestrel (LNG)-releasing contraceptive implants. This is a continuation of a previous study in which BMD was evaluated at baseline and at 18 months of use.</p> <p>Methods</p> <p>A total of 111 women, 19–43 years of age, wererandomly allocated to use one of the two implants. At 36 months of follow-up, only 36 and 39 women were still using the ENG- and LNG-releasing implants, respectively. BMD was evaluated at the distal and at the ultra-distal radius of the non-dominant forearm using dual-energy X-ray absorptiometry.</p> <p>Results</p> <p>There was no difference in the BMD of users of either implant at 18 and at 36 months. BMD was significantly lower at 18 and at 36 months at the distal radius in both groups of users compared to pre-insertion values; however, no difference was found at the ultra-distal radius.</p> <p>Conclusion</p> <p>Women 19–43 years of age using either one of these two contraceptive implants for 36 months had lower BMD values at the distal radius compared to pre-insertion values; however, no difference was found at the ultra-distal radius.</p

Prospective study of the forearm bone mineral density of long-term users of the levonorgestrel-releasing intrauterine system

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)The levonorgestrel-releasing intrauterine system (LNG-IUS) induces amenorrhoea, and its effect on bone mineral density (BMD) may constitute a concern. This study evaluated BMD in long-term users of the LNG-IUS or intrauterine device (IUD). BMD was evaluated at the midshaft of the ulna and ultra-distal radius using dual-energy X-ray absorptiometry in 37 women at 7 or 10 years of use following placement of a second LNG-IUS. The groups were paired for duration of use, age, body mass index (BMI), ethnicity and number of pregnancies. The mean age of both LNG-IUS and IUD users at the 7th and 10th year was similar to 34 and 38 years, respectively. Mean BMI was similar to 25 in both groups, increasing to similar to 26 at the 10th year. Amenorrhoea occurred in 51.4 and 91.9% of LNG-IUS users at the 7th and 10th year, respectively. Estradiol levels in LNG-IUS users were normal at both evaluations. There were no differences in BMD (g/cm(2)) at the midshaft of the ulna nor ultra-distal radius between LNG-IUS and IUD users or between the 7th and 10th years of use in LNG-IUS users. A Z-score below -2SD at the ultra-distal radius was observed in only one LNG-IUS user and in none of the IUD users at the 10th year. Higher BMI and BMD at the seventh year and amenorrhoea were predictors of higher BMD at the 10th year. BMD at the midshaft of the ulna and ultra-distal radius in LNG-IUS users were similar to that of IUD users and remained unchanged between the 7th and the 10th years of use.25511581164Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)FAPESP [03/083917]CNPq [573747/2008-3

Ovarian cysts in users of Implanon (R) and Jadelle (R) subdermal contraceptive implants

Objective: To evaluate the prevalence of ovarian cysts in users of two contraceptive implants compared to users of intrauterine contraceptive (IUC). Materials and Methods: A total of 344 women were enrolled at 3 months of use of the elonogestrel-releasing implant (Implanonl (R)), the levonorgestrel-releasing implant (Jadelle (R)) or the TCu380A IUC. Bimanual pelvic examination and vaginal ultrasound were performed during routine 3-, 6- and 12-month visits of asymptomatic women. Women with ovarian cysts (or enlarged ovarian follicles >= 25 mm) were assessed weekly until disappearance or reduction of the image [including estradiol (E-2) and progesterone (P) measurement], and women with no ovarian enlargement underwent the same evaluation for the same period of time. Results: Ovarian cysts were detected in 5.2%, 13.0% and 1.9% of users of Implanon (R), Jadelle (R) and IUC, respectively, at 3 months. At 6 months of use, prevalence was 7.2%, 8.0% and 2.1%, whereas 12-month rates were 26.7%, 14.6% and 1.2% in the three groups, respectively. E2 levels were significantly higher among users with ovarian cysts than controls. The time until disappearance of the ovarian cyst was similar in all three groups. There were more cases of menorrhagia in users of implants who had ovarian cysts than in those with no ovarian enlargement. Conclusions: The finding of ovarian cysts or enlarged ovarian follicles during the first year of use of Implanon (R) and Jadelle (R) implants is common and transient and should not be interpreted as a pathologic ovarian cyst. No further medical interventions are necessary. (c) 2006 Elsevier Inc. All rights reserved.73553253

Length of the endometrial cavity as measured by uterine sounding and ultrasonography in women of different parities

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Background: In view of current controversies regarding the need for new, shorter intrauterine devices (IUDs) that would reduce expulsion rates in nulligravida, endometrial cavity length was measured in women of different parities using uterine sounding and ultrasonography. Study Design: A cross-sectional descriptive study was performed including 570 women of 17-52 years of age, 260 of whom were nulligravida and 310 parous. Results: The difference in mean length between measurements taken by uterine sounding and ultrasonography was 0.28 cm. Mean endometrial cavity length was 3.84 +/- 0.03 cm (mean +/- S.E.M.) in nulligravida and 4.25 +/- 0.03 cm in parous women according to uterine sounding (p3.6 cm, the length of the most common IUDs, the TCu380A and the levonorgestrel-releasing intrauterine system. Therefore, the issue appears controversial for developing new, shorter IUDs, since current models fit most women, including nulligravida, albeit one third of the women of our sample showed endometrial length shorter than 3.2 cm. (C) 2010 Elsevier Inc. All rights reserved816515519Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)National Research Council (CNN) [573747/2008-3]Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)FAPESP [2003108391-7]National Research Council (CNN) [573747/2008-3

Users' Perspectives On Bleeding Patterns After Two Years Of Levonorgestrel-releasing Intrauterine System Use

[No abstract available]36387391Wildemeersch, D., Schacht, E., Thiery, M., Intrauterine contraception in the year 2001: Can intrauterine device use be revived with new improved contraceptives technology? (2000) Eur. J. Contracept. Reprod. Health Care, 5, pp. 295-304Hubacher, D., Grimes, D.A., Noncontraceptive health benefits of intrauterine devices: A systematic review (2002) Obstet. Gynecol. Surv., 57, pp. 120-128Stewart, A., Cummins, C., Gold, L., The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: A systematic review (2001) Br. J. Obstet. Gynaecol., 108, pp. 74-86Monteiro, I., Bahamondes, L., Diaz, J., Therapeutic use of levonorgestrel-releasing intrauterine system in women with menorrhagia: A pilot study (2002) Contraception, 65, pp. 325-328Hidalgo, M., Bahamondes, L., Perrotti, M., Bleeding patterns and clinical performance of the levonorgestrel-releasing intrauterine system (Mirena) up to two years (2002) Contraception, 65, pp. 129-132Faundes, A., Alvarez, F., Diaz, J., A Latin American experience with levonorgestrel IUD (1993) Ann. Med., 25, pp. 149-153Diaz, J., Bahamondes, L., Monteiro, I., Acceptability and performance of the levonorgestrel-releasing intrauterine system (Mirena) in Campinas, Brazil (2000) Contraception, 62, pp. 59-61Dda Silva, M.O., Costa, M.M., Reason, myths and fantasies: Preliminary data and reflections about the Portuguese experience with LNG-IUS-induced hypomenorrhea (1999) Eur. J. Contracept. Reprod. Health Care, 4, pp. 21-25Backman, T., Huhtala, S., Blom, T., Length of use and symptoms associated with premature removal of the levonorgestrel intrauterine system: A nation-wide study of 17,360 users (2000) Br. J. Obstet. Gynaecol., 107, pp. 335-339Ronnerdag, M., Odlind, V., Health effects of long-term use of the intrauterine levonorgestrel-releasing system: A follow-up study over 12 years of continuous use (1999) Acta Obstet. Gynecol. Scand., 78, pp. 716-721Diaz, J., Faundes, A., Diaz, M., Evaluation of the clinical performance of a levonorgestrel-releasing IUD, up to seven years of use, in Campinas, Brazil (1993) Contraception, 47, pp. 169-175Suvisaari, J., Lahteenmaki, P., Detailed analysis of menstrual bleeding patterns after postmenstrual and postabortal insertion of a copper IUD or a levonorgestrel-releasing intrauterine system (1996) Contraception, 54, pp. 201-208Chi, I.C., Farr, G., The non-contraceptive effects of the levonorgestrel-releasing intrauterine device (1994) Adv. Contracept., 10, pp. 271-285Ortayli, N., User's perspectives on implantable contraceptives for women (2002) Contraception, 65, pp. 107-111Chimbira, T.H., Andrson, A., Turnbull, A.C., Relation between measured menstrual blood loss and patient's subjective assessment of loss, duration of bleeding, number of sanitary towels used, uterine weight and endometrial surface area (1980) Br. J. Obstet. Gynaecol., 87, pp. 603-609Backman, T., Huhtala, S., Luoto, R., Advance information improves user satisfaction with the levonorgestrel intrauterine system (2002) Obstet. Gynecol., 99, pp. 608-61

Enlarged ovarian follicles in users of a levonorgestrel-releasing intrauterine system and contraceptive implant

OBJECTIVE: To evaluate the prevalence of enlarged ovarian follicles among users of a 20mug/d levonorgestrel-releasing intrauterine system (Mirena(R), Leiras Oy, Turku, Finland), of subdermal contraceptive implants releasing Nestorone(R) (Population Council, New York, New York) and of the TCu 380A intrauterine device. STUDY DESIGN: A cohort study was conducted at the Universidade Estadual de Campinas, Brazil. Three hundred women were enrolled, with 100 participants in each group. Bimanual pelvic examination and vaginal ultrasound were performed during routine gynecologic examinations in women without complaints. In women with enlarged ovarian follicles (greater than or equal to25 min), estradiol and progesterone levels were assessed weekly until disappearance or reduction of the ovarian image. RESULTS: Enlarged ovarian follicles were detected in 19%, 10% and 5% of users of the levonorgestrel system, implants and intrauterine device, respectively. Most of the enlarged ovarian images disappeared after 2 weeks of follow-up. Progesterone levels showed that the intrauterine system and TCu 380A IUD (FEI, North Tonawanda, New York) users had presumably ovulated before the first ultrasound examination in contrast to the implant users. CONCLUSION: Physicians and users should be aware that findings of enlarged ovarian follicles during the use of progestin-only contraceptives are transient and that no medical interventions are necessary.48863764

A prospective study of the forearm bone density of users of etonorgestrel- and levonorgestrel-releasing contraceptive implants

BACKGROUND: The aim of the study was to compare bone mineral density (BMD) before insertion and at 18 months of use of etonorgestrel- and levonorgestrel-releasing contraceptive implants. METHODS: One hundred and eleven women, 19-43 years of age, were randomly allocated to two groups: 56 to etonorgestrel and 55 to levonorgestrel. BMD was evaluated at the midshaft of the ulna and at the distal radius of the non-dominant forearm using dual-energy X-ray absorptiometry before insertion and at 18 months of use. RESULTS: There was no difference in baseline demographic or anthropometric characteristics, or in BMD of users of either model of implant. BMD was significantly lower at 18 months of use at the midshaft of the ulna in both groups of users. However, no difference was found at the distal radius. Multiple linear regression analysis showed that the variables associated with BMD at 18 months of use in both implant groups were baseline BMD, body mass index (BMI) and difference in BMI (0 versus 18 months of use). CONCLUSIONS: Women of 19-43 years of age using either one of the implants showed lower BMD at 18 months of use at the midshaft of the ulna, however, without a difference at the distal radius.21246647

In vivo assessment of the human sperm acrosome reaction and the expression of glycodelin-A in human endometrium after levonorgestrel-emergency contraceptive pill administration

BACKGROUND: The objectives were firstly to assess acrosome reaction (AR) status of spermatozoa following uterine flushing, secondly to measure levonorgestrel (LNG) levels in serum and in uterine flushing fluid and finally to measure endometrial glycodelin-A expression after administration of LNG as a form of emergency contraception (EC). METHODS: Forty-eight experiments were conducted on 15 regularly menstruating women. Four groups were formed based on different intercourse to treatment interval and treatment to recovery of spermatozoa and the biopsies. RESULTS: Twenty-four and forty-eight hours after treatment, there were 14.5 +/- 3.9 x 106 and 17.3 +/- 6.8 x 106 sperm recovered from the uterus, respectively. There were no differences between the AR rate and the endometrial glycodelin-A staining intensity in an LNG or placebo treated cycles. The LNG in uterine flushing medium represented 1.38% of the values observed in serum 24 h after the LNG intake. CONCLUSIONS: Twenty-four and forty-eight hours after administration of EC, neither the proportion of AR sperm, nor the glycodelin-A level was influenced by 1.5 mg of LNG. LNG did not impair the cervical mucus either because viable spermatozoa were found in the genital tract 36-60 h after coitus and 24-48 h after LNG intake. The mechanism of action of LNG as EC remains unknown.2282190219