What we have learned from recent IUD studies: A researcher's perspective

Chi, I‐cheng

doi:10.1016/0010-7824(93)90001-n

Cited by 41 publications

(7 citation statements)

References 103 publications

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“…Insertion of a Cu-IUD into the uterine cavity is associated with local inflammatory reaction and recruitment of large numbers of neutrophils and macrophages from the stroma ( 358 , 359 ). The Cu-IUD was shown to increase the concentration of granulocyte-macrophage colony-stimulating factor, soluble IL-2 receptor (soluble CD25), IL-1 β , TNF- α , IL-6, and other cytokines/chemokines in the FGT fluid ( 360 – 362 ).…”

Section: Additional Controversies or Research Gapsmentioning

confidence: 99%

Hormonal Contraception and HIV-1 Acquisition: Biological Mechanisms

2018

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Access to effective affordable contraception is critical for individual and public health. A wide range of hormonal contraceptives (HCs), which differ in composition, concentration of the progestin component, frequency of dosage, and method of administration, is currently available globally. However, the options are rather limited in settings with restricted economic resources that frequently overlap with areas of high HIV-1 prevalence. The predominant contraceptive used in sub-Saharan Africa is the progestin-only three-monthly injectable depot medroxyprogesterone acetate. Determination of whether HCs affect HIV-1 acquisition has been hampered by behavioral differences potentially confounding clinical observational data. Meta-analysis of these studies shows a significant association between depot medroxyprogesterone acetate use and increased risk of HIV-1 acquisition, raising important concerns. No association was found for combined oral contraceptives containing levonorgestrel, nor for the two-monthly injectable contraceptive norethisterone enanthate, although data for norethisterone enanthate are limited. Susceptibility to HIV-1 and other sexually transmitted infections may, however, be dependent on the type of progestin present in the formulation. Several underlying biological mechanisms that may mediate the effect of HCs on HIV-1 and other sexually transmitted infection acquisition have been identified in clinical, animal, and ex vivo studies. A substantial gap exists in the translation of basic research into clinical practice and public health policy. To bridge this gap, we review the current knowledge of underlying mechanisms and biological effects of commonly used progestins. The review sheds light on issues critical for an informed choice of progestins for the identification of safe, effective, acceptable, and affordable contraceptive methods.

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Section: Additional Controversies or Research Gapsmentioning

confidence: 99%

Hormonal Contraception and HIV-1 Acquisition: Biological Mechanisms

2018

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“…Copper IUDs are more effective in the older woman mainly because of declining fertility (Chi 1993). The differences in the effectiveness of the various devices may be less obvious in women over 40 years with declining fertility (Bhathena and Guillebaud 2006).…”

Section: Mechanism Of Action Effectiveness and Advantagesmentioning

confidence: 99%

Intrauterine contraception: an update

Bhathena¹,

Guillebaud²

2008

Journal of Obstetrics and Gynaecology

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“…The risk is 0.2% per 100 users. 8 If the operator realizes that there is a problem at the time of insertion, then a gentle attempt at retrieval may be made. Very rarely there may be trans-location of a device with spontaneous migration into the myometrium some time after insertion.…”

Section: Complicationsmentioning

confidence: 99%

“…In countries where devices are inserted under appropriate sterile conditions, the risk of pelvic infection is only increased for 20 days after insertion. 8 When infection does occur, it is thought that the pathogens enter the uterus via the strings of the device and, hence, pass to the peritoneal cavity.…”

Section: Complicationsmentioning

confidence: 99%

“…Around 1-7% are expelled in the first year, usually within the first 3 months of use. 8 If the threads have retracted into the uterus then the threads may be retrieved with an IUCD thread retriever. It is important that the patient is able to palpate the threads in order to confirm that the device is normally sited.…”

Section: Management Of Patients With Lost Threadsmentioning

confidence: 99%

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