OP07.05: Three‐dimensional ultrasound versus office hysteroscopy in assessment of pain and bleeding with intrauterine contraceptive device (IUCD)

Abstract

Objectives:To compare three-dimensional ultrasound (3D US) examination of uterus to office hysteroscopy as a method of diagnosing cause of pain and/or bleeding associated with IUCD. Methods: Patients attending the outpatient Gynecology Clinic at Cairo University Hospital and complaining of pain and/or bleeding after at least 4 months of insertion of IUCD were prospectively included in this study. All patients had full history taking, general and local examination. All patients had transvaginal 3D US of the uterus, and adnexa. Endometrial uniformity, texture of myometrium, site and position of the IUCD as well as any adnexal lesions was recorded. Patients were then referred for office hysteroscopy, after control of any bleeding or infection. Results: Ninety patients were included in this prospective study. Mean age of patients was 32.6 ± 7.2, mean parity was 3.1 ± 1.3 and mean duration of IUD insertion was 30 months. Thirty-six were complaining of bleeding (40%), 30 were complaining of pelvic pain (33.3%) and 24 had both (26.6%). By 3D US; 14 IUCDs (15.5%) were found displaced; 2 laterally, 12 downward. Sensitivity, specificity, NPV, PPV and accuracy of 3D US in diagnosing displaced IUCD compared to hysteroscopy were: 96. 1, 77.8, 67.5, 97.7 & 83.7 Objectives: To evaluate the influence of the position of the IUCD on the bleeding pattern after levonorgestrel intrauterine system (LNG-IUS) insertion. Methods: A prospective cohort of 331 women in whom a Mirena was inserted. At the day of insertion a questionnaire was handed to them to record the bleeding pattern in the following 3 days and at 4 to 6 weeks after insertion. At routine follow-up ultrasound 6 weeks after insertion the position of the Mirena was assessed with 2D-and 3D-imaging. The ultrasound examiner was blinded as to the answers to the questionnaire. The reported bleeding pattern was compared to the ultrasound findings. Results: In the first 3 days following Mirena insertion, 5% of patients reported heavy bleeding, 42% moderate bleeding, 39% spotting and 14% no bleeding. Four to 6 weeks after insertion, 3% reported heavy bleeding, 27% moderate bleeding, 33% spotting and 37% no bleeding. Of those who bled between 4 and 6 weeks after insertion, 46% reported a bleeding episode exceeding 7 days and 54% intermittent bleeding. Of the women who had a Mirena before insertion of this new one, 58% had complete amenorrhea at 4-6 weeks, as compared with 37% for those who had a Mirena inserted for the first time (P < 0.001). An abnormal position of the LNG-IUS stem and arms was associated with moderate or heavy bleeding in the first 3 days in 57% and 80%, respectively as compared to 44% and 45% in case of normal position (P-values 0.41 and 0.18). At 4 to 6 weeks 50% and 40% of women with an abnormally positioned IUCD reported moderate or heavy bleeding as compared to 30% and 32% in women with a normal Mirena position (P-values 0.14 and 0.65). Conclusions: Women should be informed that prolonged bleeding is often seen after Mirena insertion. An abnormal position...