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OBJECTIVES: Analysis of congenital adrenal hyperplasia (CAH) cases, gynaecological implications, referral reasons to gynaecologist and treatment. MATERIAL AND METHODS: Retrospective, longitudinal, single-centre study with female CAH paediatric patients ≥ 10 years-old, followed between 1998-2018 in gynaecology and endocrinology departments at a public university tertiary hospital. RESULTS: 47 patients, 34.0% (n = 16) with classic, 66.0% (n = 31) with non-classic forms (NCAH), CYP21 deficit and 46,XX karyotype. We found a normal median menarche age (11.5 IQR 2 [6-15] years-old), but significantly earlier in NCAH (p = 0.003). Precocious puberty occurred in 48.9%, n = 23. Primary amenorrhea occurred in salt-wasting form (21.4%, n = 3). Oligomenorrhea and hirsutism were significantly more prevalent in NCAH (p = 0.018, p = 0.014 respectively) and acanthosis nigricans and virilization signs in classic forms (p = 0.05, p = 0.000 respectively). Sixteen patients (34.0%) were referred to gynaecology, mostly due to menstrual irregularities (50.0%, n = 8). Medical treatment with isolated or combined corticoids, oestrogen and progestogen were chosen in all but one case. Gonadotropin-releasing hormone analogues were used in 19.0% (n = 9). Surgery was performed in 34.0% (n = 16) patients, median age 2.0 IQR 2.5 (0.6-90) years-old. CONCLUSIONS: This paper highlights the importance of a multidisciplinary approach. Early treatment contributes to a phenotypical feminine differentiation and normalization of the hypothalamus-pituitary-ovarian axis, which is essential given the gynaecologic and obstetric consequences of untreated cases.

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Background: In women with rheumatic diseases (RDs) menstruation-related disorders have never been investigated. The aim of this study was to evaluate gynecological symptoms/disorders in fertile age women with RDs. Materials and methods: All patients (n = 200) filled up a self-administered questionnaire on their gynecological history, menstrual cycle pattern, menstrual-related symptoms, and quality of life (QoL). The RD group was then compared to a control group of 305 age-matched fertile age women. Results: Among patients with RDs, 58% had arthritis, 40% connective tissue diseases (CTDs), and 1.5% systemic vasculitis. No differences were observed between CTDs and arthritis, except for a family history of HMB which was more common among women with CTDs (p < .01). When compared to controls, women with RDs reported more frequent heavy menstrual bleeding (HMB) during adolescence (51.7 and 25.4%, respectively; p = .0001) and adult life (37.7 and 25.9%, respectively; p = .0065). Also, dysmenorrhea in adolescence was significantly more common among cases (55.6 and 45.4%, respectively; p = .0338). Gynecological pain (dysmenorrhea, non-menstrual pelvic pain, dyspareunia, dysuria, and dyschezia) in patients with RDs was more frequent than in controls (p = .0001, .0001, .0001, .0001, .0002, respectively). Considering women who reported moderate and severe symptoms in RDs, dysmenorrhea and dyspareunia remain significantly more frequent in women with RDs than in controls (p = .0001; p = .0022; respectively). QoL scores were significantly reduced in women with RDs, either in physical (p = .0001) and mental domains (p = .0014) of short-form 12. Conclusion: Women affected by RDs frequently presented menstruation-related disorders; thus, female patients with RDs should be questioned about gynecological symptoms and referred to the gynecologist for an accurate evaluation.

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PURPOSE: This study was performed to identify the prevalence of menstrual disorders in Korean women based on body mass index (BMI) and lifestyle factors, by utilizing the Korean National Health Insurance Database. METHODS: A retrospective observational study design was used for the secondary data analysis. Data of women aged 15 to 49 years who were diagnosed with menstrual disorders were extracted from The National Health Insurance Service-National Health Screening Cohort in Korea from 2009 to 2016. The age-standardized prevalence rate of menstrual disorders was calculated using SAS version 9.4, and a Chi-square test and Cochran-Armitage test were performed. RESULTS: In total, 2,219,445 cases were extracted from the database. The prevalence of menstrual disorders significantly increased from 8.6% to 11.6% (Z=135.16, p for trend <.001) over the past eight years. In particular, it was higher in underweight women than in women with normal weight across all years (Z=-4.18~-14.72, p<.001). Moreover, statistically significant differences in the prevalence of menstrual disorders were found to be associated with drinking and smoking in all years and with physical activity levels in part (p<.05~.001). CONCLUSION: These findings present compelling evidence on the prevalence of menstrual disorders based on a national database. Since the prevalence of menstrual disorders has steadily increased and differs based on BMI and lifestyle factors, educational and clinical interventions are necessary to promote risk awareness and appropriate behavioral changes among Korean women.

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The aim of this research was to compare menstrual cycles, menstrual disorders, and the prevalence of premenstrual syndrome (PMS)and premenstrual dysphoric disorder (PMDD) in professional female gymnasts and their peers who donot practice any sport, and to identify factors causing a predisposition to premenstrual tension syndrome and premenstrual dysphoric disorders in both groups. The prospective study involved apopulation of 85 girls. The study group consisted of 45 professional female gymnasts (15-17 years of age) who lived inthe territory of Silesia, in the southern area of Poland. The control group consisted of 40 girls of the same age who lived in the same area but did not professionally practice any sport. The research tools included a questionnaire, a daily diary of PMS symptoms, a daily diary of PMDD symptoms, and a premenstrual symptom screening tool (PSST). The study showed that intensive physical activity undertaken by girls before their first menstruation is a menarche-delaying factor andthat competitive sport promotes premenstrual syndrome and premenstrual dysphoric disorder. The risk factors for PMS and PMDD were also identified, andincluded alcohol and coffee consumption.

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BACKGROUND: Polycystic ovarian syndrome is one of the most common endocrine disorders with a prevalence of 5-10% in women. This syndrome is one of the major causes for menstrual disorders and is treated by medicational and non-medicational methods. This study aimed to define the effect of auriculotherapy on menstruation disorders in girls with polycystic ovarian syndrome. MATERIALS AND METHODS: This is a clinical trial conducted on 60 single girls aged 18-35 years with clinical, laboratory, and sonography signs. The subjects were randomly assigned to two groups of auriculotherapy and medication, which underwent treatment for 2 and 3 months, respectively. Clinical signs were investigated in three steps in both groups. Data were collected through observation, laboratory tests, and sonography, and were analyzed by SPSS version 15. RESULTS: In 60 subjects, Chi-square test showed a significant difference in menstruation disorders in both groups 1 month after the start of intervention (P = 0.001); but 2 months after the start of intervention (P = 0.11) and immediately after the end of the intervention (P = 0.16), the difference was not significant. Three months after the end of the intervention, this variable showed a significant difference (P = 0.02). CONCLUSIONS: Medicational treatment and auriculotherapy are both effective on menstruation disorders, but auriculotherapy is more effective on reduction of menstruation disorders, compared to medicational therapy.

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Menstrual problems like menorrhagia, dysmenorrhea and premenstrual syndrome (PMS) are common in adolescent girls. However literature regarding association between menstrual and mental health problems is limited; hence the current study was planned. Methods: It is a cross-sectional study conducted in Sangli district (Maharashtra), India among the female students from three randomly selected graduation colleges. Calculated sample size was 605 and cluster random sampling technique was applied. The study duration was June 2013 - May 2014. Study instrument was self-administered questionnaire with inventories like PSST-A, DASS-21 and SPIN. Statistical analysis was done using chi-square test and binary logistic regression. Results: Of the 707 participants; 413 (58.4%) had menstrual problems with dysmenorrhoea being the commonest. Embarrassment due to menstruation was felt by 14.9%. Menstrual problems were associated with perceived body type, body image, stress and anxiety. Embarrassment due to menstruation was associated with social phobia, stress, anxiety and depression. On binary logistic regression; body image and embarrassment due to menstruation were significant predictors for menstrual problems. Conclusions: Menstrual problems contribute to the development of various Mental Health disturbances. Hence, girls should be encouraged to seek health advice for the menstrual problems. A full time Health counsellor in schools and colleges can justify addressing adolescent health problems.

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PURPOSE: This study compares the prevalence of pubertal menstrual disorders in type 1 diabetes mellitus (DM) patients with that in normal subjects. METHODS: A questionnaire was used to obtain data on pubertal development and menstrual history from 43 type 1 DM patients, who were diagnosed at the pediatrics department of Severance Children's Hospital, Yonsei University, and 56 normal control subjects. We evaluated the estrogen levels in all type 1 DM patients. RESULTS: The age at onset of puberty did not significantly differ between the 2 groups. However, the prevalence of oligomenorrhea in type 1 DM patients (21.21%) was significantly higher than that in the control group (2.08%; P<0.05). In addition, the incidence of amenorrhea in type 1 DM patients (20.59%) was significantly higher than that in the control group (2.08%; P<0.05). Pubertal development in type 1 DM patients was delayed due to elevated levels of glycosylated hemoglobin (HbA1c). The delay (9 months) in pubertal development in the patients diagnosed with type 1 DM at prepubertal ages was shorter than that (14.8 months) in the patients diagnosed with type 1 DM at postpubertal age (P<0.05). The level of LH, FSH were higher and E2 level was lower in DM patients compared to control group, especially in diabetics with amenorrhea (P<0.05). CONCLUSION: We observed a high frequency of delayed pubertal development and menstruation irregularities in patients who were diagnosed with type 1 DM at the prepubertal age or in type 1 DM patients with high levels of HbA1c. This finding can be attributed to the decreased plasma levels of E2 or due to the decreased E2 activity in patients with type 1 DM. Further evaluation of hormonal changes in type 1 DM patients is essential.

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Menarche is an important event and a primary indicator of the onset of sexual maturation during adolescent girls. During adolescence, severe gynecologic disorders are very rare but menstrual problems are common. Common menstrual disorders are amenorrhea, abnormal uterine bleeding, dysmenorrhea and premenstrual syndrome. Although most menstrual problems are caused by immaturity of the hypothalamic-pituitary-ovarian axis and can be normal during the first few years after menarche, organic pathology must always be considered. This article reviews the causes, diagnosis and treatment of above menstrual disorders in adolescence as well as normal menstrual cycle physiology.

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Study included 120 cases of genital tuberculosis proved by histopathology. Analysis of their menstrual history showed that the common menstrual disorder was oligohypomenorrhoea found in 54.0% cases, menorrhagia in 19.0% cases, and postmenopausal bleeding in 1.6% cases. History of amenorrhoea was present in 14.3% cases. There were 8 cases of secondary amenorrhoea and one case was of primary amenorrhoea. The pelvic examination showed cervical involvement in 43.1% of cases. Tubo-ovarian mass was present in 19.8% cases. Genital tract tuberculosis is a disease of varied symptomatology. A high degree of suspicion and efficient investigation are important for diagnosis.

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PIP: A 29-year-old woman presented to the gynecology outpatient clinic with abdominal discomfort following the insertion of a levonorgestrel intrauterine system (LNG-IUS). It was noted that although the patient remained amenorrheic since the insertion, there was a persistent left iliac fossa discomfort, which was constant in nature and not made worse by intercourse. On examination, there was a vague tenderness in the left iliac fossa, and a transvaginal ultrasound scan showed bright echoes outside the uterus suggestive of an extrauterine IUS. Thus, arrangements were made for an admission for hysteroscopy and laparoscopy, proceeding to laparotomy if required. Following the procedures, the patient reported disappearance of the discomfort, although the LNG-IUS had not yet been retrieved. X-ray revealed the device lying high in the abdomen and laparoscopy was conducted. The LNG-IUS itself was buried, but was easily retrieved with gentle counteraction on the omentum through a 5 mm laparoscopy portal. Overall, this case emphasizes the importance of an X-ray as well as an ultrasound investigation in such cases.^ieng

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The levonorgestrel-releasing intrauterine system (LNG-IUS) has been used in the treatment of both idiopathic menorrhagia and adenomyosis. An electronic search of the on-line medical literature revealed no reports of its use for menorrhagia secondary to uterine myomas. Presented here is the successful treatment of uterine myomas with menorrhagia in a woman with a renal transplant. There was a significant reduction in menorrhagia, dysmenorrhea, and uterine and myoma size with the use of the LNG-IUS. We believe that this system provides an alternative to conventional hysterectomy and gonadotrophin-releasing hormonal analog medical treatment for uterine myomas, with a possibly inhibitory effect on myoma growth.

PIP: This case report focuses on the effect of the levonorgestrel-releasing intrauterine system (LNG-IUS) on uterine myomas in a renal transplant patient. The successful treatment of uterine myomas with menorrhagia in a 43-year-old woman with a renal transplant is presented. Preinsertion, the uterine cavity was not distorted and it measured 12 cm. The LNG-IUS was inserted without difficulty. On follow-up, 3 months later, improvement was observed. Her cycles were regular with heavy flow only on the first 2 days. The uterus was 10 weeks¿ size on pelvic examination and her hemoglobin was 9.5 g/dl. One year after the initial insertion, she was asymptomatic with normal menstrual flow. The uterus was 6-8 weeks' size on pelvic examination and the uterine cavity was 6 cm. The largest intramural fibroid measured 10-15 mm. Hemoglobin was 10.8 g/dl without any hematinics. There was a significant reduction in menorrhagia, dysmenorrhea, and uterine and myoma size with the use of the LNG-IUS. Thus, the system provides an alternative to conventional hysterectomy and gonadotrophin-releasing hormonal analog medical treatment for uterine myomas, with a possibly inhibitory effect on myoma growth.

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This study addresses attitudes towards changes in menstrual bleeding patterns caused by oral contraceptives (OC) or hormone replacement therapy (HRT) and preferred changes in bleeding pattern with and without use of OC or HRT in relation to reproductive age group. Data were collected by means of telephone interviews with 325 women in each of four age groups (15-19, 25-34, 45-49, and 52-57 years). In total, 80.5% of currently menstruating women preferred one or more changes in bleeding pattern such as less painful, shorter, or less heavy periods, or amenorrhea. The majority of the menstruating women in all age groups preferred to have a bleeding frequency of less than once a month or never, whether the bleeding was spontaneous or induced by OC. In the case of HRT, amenorrhea was most preferred. These findings with respect to preferred bleeding frequency and OC may have important implications for health care providers and for future contraception development.

PIP: This study addresses attitudes toward changes in menstrual bleeding patterns caused by oral contraceptives (OCs) or hormone replacement therapy (HRT) and preferred changes in bleeding pattern with and without use of OCs or HRT in relation to reproductive age group. A survey on 325 Dutch women from each of four age categories (15-19, 25-34, 45-49, and 52-57 years) was conducted through telephone interviews. Results showed that OC users and menstruating women prefer one or more changes in bleeding characteristics such as less painful, shorter, or lighter periods. It was less significant in the non-OC users in all age groups (75.1% vs. 86.3%, p = 0.016, in women aged 15-19 years; 60.0% vs. 72.3%, p = 0.030, in women aged 25-34 years; 50.9% vs. 74.5%, p = 0.002, in women aged 45-49 years). Most women would prefer a bleeding frequency of less than once a month or never. The proportion of women who reported amenorrhea as a positive consequence of OC/HRT use increased with age. These findings provide significant implications for health care providers in future contraception development.

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PIP: A case report documents a Hispanic adolescent, 17 years of age, with pseudocyesis, who became amenorrheic using Depo-Provera to prevent a second pregnancy. Pseudocyesis includes classic symptoms of pregnancy such as nausea, breast enlargement and pigmentation, abdominal distention, and amenorrhea in nonpregnant women. It demonstrates the to control one's physical aspect at the level of hypothalamus. The involvement that contributed to her pseudocyesis--in this case, of her mother and boyfriend -- was not unusual. The abrupt resolution was brought on by normal menstrual period that began after she voluntarily missed her Depo-Provera injection. However, her ambivalence about a pregnancy became clear after she and her family received counseling. While the agenda had been to help her prevent a pregnancy, hers had not been as clear and uncomplicated. Her subsequent conception was a very positive one for her and her family, which helped to resolve the situation.^ieng

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Despite the low contraceptive prevalence among the Mayan population of Guatemala, past research has found interest in natural methods. A calendar rhythm method with a simple blanket rule would appear to be preferable to more complicated methods. Under a blanket rule, the number of days of abstinence is predetermined and all couples are instructed to abstain during the same interval of the menstrual cycle. However, regular menstrual cycles may be key to successful practice of a calendar method. A database of 880 cycles of 301 women of the Guatemalan highlands was analyzed to determine the length and regularity of menstrual cycles in this population.

PIP: This article reports on the irregular cycle incidence among Mayan women who reported regular cycles. Data from a research study of a blanket 9-19 calendar rhythm method were analyzed to assess the regularity of cycles among the subjects. The necklace method tested in this study is a natural family planning method utilizing the "blanket rule". Sexual abstinence starts on day 9 of the menstrual cycle until day 19. A necklace with 30 beads is used as a mnemonic device. Findings showed that the menstrual cycles of highland Guatemalan women may not be very regular, indicating that women interested in practicing a method with a standard rule of abstinence could be taking risks of getting pregnant. Pregnancies occurred during the course of the study, suggesting cycles of irregularity. Given these results, programs that teach fertility awareness methods should help Mayan women monitor the length of their cycles more closely.

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As stated by the Committee on Adolescence of the AAP, All pediatricians who choose to see teenagers should be able to provide counseling about sexual behavior, education on contraceptive methods and prevention of sexually transmitted diseases, and assistance with access to family planning services, preferably in the office or, if necessary, by referral. Expansion of skills and office capabilities to provide routine reproductive health care for adolescents, including pelvic examinations, annual Pap tests, diagnoses of pregnancy, diagnoses and treatment of sexually transmitted diseases, and the prescription of contraceptives, is also encouraged. Pediatricians who have longstanding relationships with their patients, and who are admired and trusted are ideal for providing this care.

PIP: This paper discusses adolescent gynecologic experiences in health care provider clinics. Pediatricians in this study deal with problems that are not encountered by their predecessors. Traditional pediatric practice 20-30 years ago differ from that in the modern adolescent practice. Medical practitioners providing care to adolescents need to ensure that their practices are able to meet the demands of the patient. Incorporating general pediatric setting implies a change in one's practice to be more receptive to adolescents. This involves having appropriate staff, philosophy, decor, expertise, and equipment. They should be prepared to handle multiple issues related to pubertal development, sexuality, self-esteem, and body image. Office services must choose comprehensive scope of services and develop policies or guidelines acceptable to all providers in the practice. Practitioners and staff must be able to possess and understand the importance of confidentiality and its limitations. It is necessary to have complete, useful, and essential office equipment and supplies. Lastly, it is also the role of pediatricians to educate and counsel adolescents and parents regarding adolescents' gynecologic health. Among the common gynecologic problems encountered are the following: menstrual disorders; vaginitis and vulvar disorders; breast disorders; sexually transmitted diseases; and adolescent pregnancy and contraception.

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PIP: This multinational clinical trial compared the efficacy and side effects of single doses of 600 mg, 50 mg, and 10 mg of mifepristone in emergency contraception when given within 120 hours (5 days) of unprotected coitus. A total of 1717 women from 11 family clinics in six countries (Australia, China, Finland, Georgia, UK, US) were enrolled and randomly assigned to the 3 treatment groups (559 to 600 mg, 560 to 50 mg, and 565 to 10 mg). The study revealed that mifepristone treatment prevents 85% of expected pregnancies. It was also found that proportions of pregnancies were similar in the 3 treatment groups; 1.3% in the 600-mg treatment group, 1.1% in the 50-mg group, and 1.2% in the 10-mg group. Delayed menstruation was seen as the most significant side effect of the treatment (P 0.01) and was more likely to occur in women receiving the 600-mg treatment (36%); it occurred in about 23% of the women receiving 50 mg and in 18% of the women receiving 10 mg of mifepristone. Moreover, bleeding within 5 days of treatment was found to be significantly associated with the treatment dosage. Overall, bleeding occurred in 15%, 31%, and 35% of women who received 10 mg, 50 mg, and 600 mg of mifepristone, respectively. Other dose-related reactions included fatigue, weakness, nausea, vomiting, headache, and dizziness.^ieng

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Adenomyosis is an important cause of menorrhagia. Besides hysterectomy, the treatment options for adenomyosis have been limited. Presented here is the successful treatment of adenomyosis in a woman presenting with menorrhagia, dysmenorrhea, and an enlarging uterus, for whom conservative therapy initiated with mefenamic acid was unsatisfactory. The patient had insertion of the levonorgestrel-releasing intrauterine system (LNG-IUS). A marked decrease in uterine size occurred within 12 months of insertion accompanied by resolution of the menorrhagia and dysmenorrhea. Thus, the LNG-IUS is a viable option and represents a real advance in the treatment of adenomyosis.

PIP: Adenomyosis is the major cause of menorrhagia, dysmenorrhea, and an enlarged uterus, which causes great distress to the patient. Surgical hysterectomy has been used in the past as a treatment option for adenomyosis, but acceptability of this intervention is minimal due to an increased risk in morbidity and mortality. This article presents the successful medical treatment of an enlarged adenomyotic uterus with the levonorgestrel-releasing intrauterine system (LNG-IUS) using a case report of a 42-year-old woman with adenomyosis who received the LNG-IUS as a long-term therapy for menorrhagia and dysmenorrhea. Regular menstruation without pain was reported after 3 months of treatment with a 27% decrease in uterine size after 9 months. The effectiveness of the LNG-IUS was hypothesized to be due to two factors: 1) decidualization and subsequent marked atrophy of the endometrium; 2) direct action of the hormone on the foci of the adenomyosis. A reported side effect of the LNG-IUS is the irregularity of bleeding during the initial treatment. The study suggests that use of the LNG-IUS is a viable option and could greatly advance the treatment of adenomyosis.

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The long-term effectiveness of the copper-bearing intrauterine device (IUD) has been documented. This paper reports 12-month results from a multiyear comparative study of the Copper T (TCu) 380A and Multiload (ML) 250 IUD in Bangkok, Thailand, among 1396 women. Continuation of the assigned IUD was relatively high after 12 months of use, with continuation rates of 90.17 and 87.54 per 100 women, respectively. Whereas the accidental pregnancy rate was higher for the ML 250 IUD than for the TCu 380A IUD (1.0 and 0.2 per 100 women, respectively), this difference was not considered statistically significant (p < 0.69). The rate of IUD expulsion was significantly higher among women using the ML 250 IUD than for women using the TCu 380A IUD (4.61 and 2.40 per 100 women, respectively, p = 0.05).

PIP: The performance of the Copper T 380A and Multiload 250 IUDs over a 4-year period were compared in a prospective study of 1396 women from Bangkok, Thailand, who were randomly assigned to be fitted with 1 of the 2 devices. This paper presents the findings from the first 12 months (1995-96) of the study. At insertion, 8-10% of women in both groups reported mild pelvic pain. After 12 months of use, the continuation rate was 90.2% for the Copper T 380A and 87.5% for the Multiload 250 device. Menstrual problems were the most common complaint during the follow-up period; such disturbances--primarily spotting and dysmenorrhea--were reported by 59.1% of Copper T 380A users and 44.4% of women in the Multiload 250 group. The accidental pregnancy rate after 12 months was higher, but nonsignificantly, among Multiload 250 users (1.0/100 women) than Copper T 380A acceptors (0.2/100 women). The IUD expulsion rate was significantly higher among Multiload 250 acceptors (4.61%) than users of the Copper T 380A (2.4%). The higher efficacy, lower risk of expulsion, and longer life span (10 years) of the Copper T 380A compared to the Multiload 250 IUD suggest this is an ideal method for women who desire long-term protection against pregnancy but do not wish to be sterilized.

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OBJECTIVE: The purpose of this study was to evaluate the prevalence of a sexual assault history among women with and without 3 common gynecologic complaints: dysmenorrhea, menorrhagia, and sexual dysfunction. STUDY DESIGN: Data came from 3 surveys of women randomly selected from general populations: 2 United States regional samples (n = 1428 and n = 1703) and 1 national sample (n = 963). Prevalence rates and adjusted odds ratios were calculated and combined across the 3 samples with a meta-analysis. RESULTS: The prevalence of an assault history ranged from 6% to 26% among women with 1 symptom to 13% to 40% among women with 3 symptoms. Symptoms were associated with increased odds of an assault history for women 18 to 34 years old (odds ratio 1.90, 95% confidence interval 1.56 to 2.32), 35 to 44 years old (odds ratio 1.99, 95% confidence interval 1.57 to 2.53), and >54 years old (odds ratio 1.37, 95% confidence interval 1.04 to 1.80). Symptoms were unrelated to sexual assault history for women in the perimenopausal (45 to 54 years) age group (odds ratio 0.94, 95% confidence interval 0.71 to 1.24). Symptom level was unrelated to having disclosed assaults to a physician (odds ratio 1.17, 95% confidence interval 0.85 to 1.62). CONCLUSIONS: Women in the general population with common gynecologic complaints are at a substantially increased risk of having a history of sexual assault.

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The objective of this paper was to compare the efficacy, acceptability, safety, and bleeding pattern of TCu 380A intrauterine device (IUD) and progesterone-releasing vaginal ring used by breastfeeding women. The study population included 97 breastfeeding women using IUD and 100 women using vaginal ring. Of the IUD users, no insertion failure, perforation, or accidental pregnancy occurred in 12 months. There was one IUD expulsion. There were no discontinuations of IUD due to medical reasons other than expulsion. The total discontinuation rate was 2.3%. In the ring group, no accidental pregnancy occurred. The major reasons for discontinuation were ring use-related problems and vaginal problems. The total discontinuation rate was 65.4% within 1 year. The frequency of any one complaint among the ring users was higher than that among the IUD users. There were no differences in the proportion of women having no sexual activity and in the weight of their babies between the two groups. Compared with the IUD users, the median number of bleeding/spotting (B/S) episodes and B/S days of the vaginal ring users were fewer; consequently, the mean length of B/S-free interval was longer in all four reference periods; the mean length of B/S episode and segment were the same; the occurrence of amenorrhea was more frequent; in contrast, the proportions of normal bleeding patterns were fewer. The frequencies of prolonged bleeding, frequent bleeding, and infrequent bleeding patterns did not differ between the two groups. The percentage of irregular bleeding was fewer only in the first two reference periods. It is concluded that the TCu 380A IUD and progesterone-releasing vaginal ring used by breastfeeding women are safe and effective. The higher discontinuation rate of the ring users was mainly because of use-related problems. Breastfeeding women with TCu 380A IUD had better tolerance and acceptability. The TCu 380A IUD does not, but the progesterone-releasing vaginal ring does, suppress the recovery of ovarian function. However, once return of menstruation occurred, there were no differences in bleeding patterns between the two contraceptive methods.

PIP: The efficacy, acceptability, and bleeding patterns associated with use of the Copper T 380A IUD and the progesterone-releasing vaginal ring during lactation were compared in a 12-month study conducted in Beijing City, China. Enrolled were 97 breast-feeding IUD users and 100 lactating vaginal ring acceptors. The devices were inserted 29-64 days postpartum. In the IUD group, there was one expulsion during the study period, but no cases of perforation, pelvic inflammatory disease, or pregnancy. The two IUD discontinuations (2.3/100 woman-years) were attributable to user rather than medical-related reasons. There were no accidental pregnancies in the ring group either. However, there were 50 medical-related and four user-related discontinuations among ring users, for a 12-month discontinuation rate of 65.4/100 woman-years. Three women discontinued ring use due to menstrual problems, 10 requested removal for vaginal problems such as increased discharge and vaginitis, seven experienced frequent ring expulsion, 12 left the device out for more than 48 hours, and 13 found the ring unpleasant to use. Significantly more ring than IUD users had at least one complaint at the 1-, 3-, and 6-month post-insertion visits. Menstruation diaries revealed bleeding/spotting immediately post-insertion in both groups, followed by a variable period of amenorrhea until resumption of menses. The median number of bleeding/spotting episodes and the occurrence of amenorrhea were more frequent in the vaginal ring group. Once menstruation resumed, there were no differences in bleeding patterns between the two contraceptive methods. The results indicated progesterone suppresses the recovery of ovulation in breast-feeding women but does not interrupt the regulation of menstruation.

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