OB/GYN Reports

OB/GYN related news - Powered By EZDoctor

IUD: Risks and Complications


The intrauterine device (IUD) is a method of birth control designed for insertion into a woman's uterus so that changes occur in the uterus that make it difficult for fertilization of an egg and implantation of a pregnancy. 

IUDs also have been referred to as "intrauterine contraception (IUC). IUDs approved for use in the U.S. contain medications that are released over time to facilitate the contraceptive effect.

The IUD is a small "T"-shaped device with a monofilament tail that is inserted into the uterus by a health care practitioner in the office setting. When inserted into the uterus, the arms of the "T" are folded down, but they then open out to form the top of the "T". The device rests inside the uterus with the base of the T just above the cervix and the arms of the T extending horizontally across the uterus. A short piece of monofilament string attached to the IUD extends through the cervix into the vagina. This string makes it possible to be sure that the IUD is still in the uterus.

Although IUDs are highly effective, no birth control method, except abstinence, is considered to be 100% effective.

How does an IUD work?

It is not fully understood how IUDs work. They are thought to prevent conception by causing a brief localized inflammation that begins about 24 hours after insertion. This causes an inflammatory reaction inside the uterus that attracts white blood cells. The white blood cells produce substances that are toxic or poisonous to sperm. The progesterone-releasing IUDs also cause a subtle change in the endometrial environment that impairs the implantation of the egg in the uterine wall. This type of IUD also alters the cervical mucus, which, in turn, inhibits sperm from passing through the cervix.

IUDs are only available by prescription and must be properly inserted by a health care professional. A pelvic exam is required to insert an IUD. The IUD is inserted into the uterus long as she is not pregnant.

The woman must check her IUD every month to be sure that it is still in place. The woman with an IUD in place will still have normal menstrual periods, although some women notice that flow is heavier. Other women, especially those with a hormone-releasing IUD, may have lighter flow. Sometimes, the uterus expels (pushes out) the IUD. Expulsions may not cause any specific symptoms and can be overlooked. In addition to the woman checking the IUD, the device must also be checked periodically by a health-care professional.

Risks and Complications

An IUD may not be appropriate for women who have heavy menstrual bleeding, had previous pelvic infections, have more than one sexual partner, or plan on getting pregnant. This is because IUDs do not protect against sexually transmitted infections (STDs) and should not be in place if a woman intends to become pregnant.

If women become pregnant with their IUDs in place, 50% of the pregnancies end in miscarriage. Any woman with an IUD who develops signs or symptoms of pregnancy, or has a positive pregnancy test, should see her health-care professional right away.

Women who use non-progesterone types of IUDs are less likely to have an ectopic pregnancy compared to women using no contraception. When a woman using an IUD does become pregnant, the pregnancy is more likely to be ectopic, but still ectopic pregnancy in a user of an IUD is a rare occurrence.

Serious complications due to infection (pelvic inflammatory disease) associated with an IUD may prevent a woman from being able to become pregnant in the future.

Also, with the progesterone-releasing IUDs (levonorgestrel IUDs), a reduction in menstrual flow and a decrease in painful menstrual cramping are often observed with continued use. This is because the progesterone hormone can cause thinning of the lining of the uterus. These menstrual changes are not dangerous in any way and do not mean that the contraceptive action of the IUD is diminished.

The IUD provides no protection against sexually transmitted diseases (STDs).

How is an IUD removed?

An IUD must be removed by a health care professional.

It is very important that a woman not attempt to remove an IUD on her own, as serious problems may result. IUD removal is carried out by determining the position of the uterus, then locating and grasping the stings of the IUD with a special forceps or clamp. The health care professional will then remove the IUD by gentle traction on the strings.

Occasionally, the strings of the IUD will not be located. In these situations, the strings have often slipped higher into the cervical canal. Your health care professional can use special instruments to locate the strings and/or remove the IUD. Complications of IUD removal are rare, and removal can take place at any time. Some studies have shown that removal is easier during the menstrual period, when a woman's cervix is typically softer, than during other times in the menstrual cycle.


Source: WebMd

Uterine Fibroids: Everything You Need To Know


Fibroids (leiomyomata uteri) are the most common benign tumors of the uterus. They usually come in a variety of shapes and sizes, as well as numbers, in the uterus. Very rarely do they turn to cancer – the exact incidence being less than 1% in a patient’s lifetime. Women who are at risk usually have a family history, are Black or Hispanic, and may have an elevated Body Mass Index (BMI). As a matter of fact, because we are seeing more women with an increase in BMI, Caucasian women are presenting with fibroids more frequently as well. While there is still a lot to understand about the development of fibroids, they grow for two reasons: hormones, in particular estrogen, and blood supply.

Fibroids can be located in different parts of the uterus. There are some fibroids that are located underneath the surface of the uterus, which are called subserosal; these generally do not cause bleeding but can cause pressure. There are those that are embedded in the muscle of the uterus, which are called intramural. Finally, there are those fibroids that affect the lining of the uterus, which are called submucosal, and these are the ones that usually present with excessive bleeding.

Symptoms and Tests

The most common symptoms of fibroids are heavy bleeding, pressure, increased frequency in urination and pelvic pain. Although most fibroids do not usually cause pain, if they outgrow their blood supply, it can cause pain due to degeneration (which means tissue breakdown). Fibroids are usually diagnosed with a pelvic exam and a pelvic sonogram. Transvaginal sonography is very good at detailing whether a fibroid is affecting the uterine lining or not.

Treatment

While the leading cause of hysterectomies is fibroids, there are many more conservative treatments that are available now. Birth control pills are one of these treatments; not only can they suppress bleeding, but they can also suppress the hormones that can control the growth of the fibroid. Decreasing weight also decreases the amount of exogenous estrogens that can control the growth as well. Uterine artery embolization can cut off the blood supply to the uterus, thus controlling growth and bleeding. In the case of submucosal fibroids, they can be resected hysteroscopically by going into the uterus and removing the fibroid through the vagina. Another procedure called a myomectomy just removes the fibroids, thus conserving the uterus. Lastly, you can also just watch them: If they don’t bother you, don’t bother them. Specific treatment modalities should be discussed with your physician to see what works best for you.

Types of Fibroids

All uterine fibroids are made of abnormal uterine muscle cells growing in a tight bundle or mass.

Uterine fibroids are sometimes classified by where they grow in the uterus:

  • Myometrial (intramural) fibroids are in the muscular wall of the uterus.
  • Submucosal fibroids grow just under the interior surface of the uterus, and may protrude into the uterus.
  • Subserosal fibroids grow on the outside wall of the uterus.
  • Pedunculated fibroids usually grow outside of the uterus, attached to the uterus by a base or stalk.

Uterine fibroids can range in size, from microscopic to several inches across and weighing tens of pounds.

Symptoms of Uterine Fibroids

Most often, uterine fibroids cause no symptoms at all -- so most women don’t realize they have them. When women do experience symptoms from uterine fibroids, they can include:

  • Prolonged menstrual periods (7 days or longer)
  • Heavy bleeding during periods
  • Bloating or fullness in the belly or pelvis
  • Pain in the lower belly or pelvis
  • Constipation
  • Pain with intercourse

Some experts believe that some uterine fibroids can occasionally interfere with fertility and pregnancy. Although it's rare, a uterine fibroid projecting into the uterus might either block an embryo from implanting there, or cause problems with the pregnancy later.

Effects on Pregnancy

One of the most common concerns that I am asked about in my clinical practice is whether the patient can become pregnant with a fibroid. Again, location is key. Depending on where it is, whether it affects the cavity where the baby grows or blocks the fallopian tube for fertilization, treatment will be dictated by these factors. If those issues are not present, women can become pregnant and have a normal pregnancy. All these issues should be discussed with your physician prior to pregnancy to determine your specific needs. Fibroids will grow during pregnancy, often experiencing the greatest growth during the first trimester.

Conclusion

Although intimidating at first, fibroids are not as scary as they sound. Not everyone must have them removed, and a solid relationship with your physician will help guide you as to the best treatment.

If you are ever in doubt, seek a second opinion. If your physician does not perform minimally invasive procedures, there are many specialists that do.

 

Source: DoctorOz, WebMD