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Hysterographic orientation of IUDs in relation to menstrual blood loss.


 To correlate the position and orientation of different models of MLCu IUDs in utero with incidence of side effects, 35 married, nonlactating, and sexually active women, 18-24 years of age and with regular menstrual periods were studied. All had been pregnant at least once and had had at least 3 menstrual periods after the last delivery or 2 periods after the last abortion. A physical and gynecological examination was performed. The women were divided into 4 groups: 30 women (3 groups of 10 patients) were fitted with standard MLCu 250, short MLCu 250, and MLCu 375 IUDs. The 4th group consisted of 5 women in whom MLCu 250 mini was inserted. Menstrual blood loss collected in cotton pads of constant weight provided by the investigator. The women were carefully instructed on how to collect their menstrual blood, and polyethylene bags were supplied to them. Menstrual blood loss was calculated. Follow-up visits were planned at monthly intervals, and questions about side effects were asked. In 30 women hysterography was done twice. Initially, it was performed following the 1st postinsertion menstruation. A 2nd hysterogram was performed following the 3rd postinsertion menstruation. The IUD was properly oriented in utero in 20 cases (67%). These were fitted with short MLCu 250 (8 cases), MLCu 375 (6 cases), Standard MLCu 250 (4 cases), and mini MLCu 250 (2 cases). The other 2 patients had small uterine cavities fitted with mini devices. Device displacement was noted in 10 cases among those fitted with MLCu 250, Standard (2 cases), MLCu 250 mini (3 cases), MLCu 375 (2 cases). Subjective increased menstrual blood loss was reported in 11 cases. There was no significant difference between pre- and postinsertion menstrual blood loss. Intermenstrual bleeding was reported in 3 cases, 1 fitted with a short MLCu 250 and 2 cases fitted with MLCu 375. Hysterographically the device was properly oriented in 2 cases with a large uterus. 5 cases had a moderate degree of dysmenorrhea, 1 case fitted with short MLCu 250, 3 cases with standard MLCu 250, and 1 case with MLCu 375. Hysterographically the device was displaced in utero in 2 cases, and most of the cases had a large size uterus. All these patients experienced no dysmenorrhea prior to IUD insertion. Moderate deep seated pelvic pain and low abdominal cramps were experienced in 3 cases, a case in each group of those fitted with different models of MLCu 250. Pain was not reported in patients fitted with MLCu 375.
