[Steroid intra-uterine contraception: XXXX -releasing devices. II. Insertion, clinical problems and contraceptive dependability].

@entity1 @entity697 @entity1420 @entity548 @entity5 @entity190 @entity304 @entity158 @entity4134 @entity1867
The advantages and disadvantages of the @entity1420 -releasing intrauterine device (IUD), Progestasert, are investigated, relying on the published literature and the authors' own experiences. Insertion of the Progestasert presents very few problems except in certain cases, particularly in nulliparous @entity1 . A complete gynecologic examination is indispensible before insertion to guarantee the absence of contraindications (e.g., pregnancy, anatomically abnormal uterus, @entity5 , @entity4134 , @entity697 ). @entity158 or discomfort at insertion appears infrequently, except among nulliparas. Similarly, @entity158 after insertion is rare, but occurs most often in nulliparous @entity1 . Because of the insertion technique required for this IUD, cases of perforation of he uterus or cervix are virtually nonexistent. Expulsion of the Progestasert is very infrequent; it appears that incorrect insertion is the primary cause of expulsion. All studies verify a decrease in the expulsion rate after the 1st month of use. The incidence of @entity4134 in Progestasert users is significantly lower than in users of other IUDs. This may be due, in part, to the shape of the device, which does not have wide surface areas and has no sharp or pointed edges which can become embedded in the endometrial wall. Additionally, the nature of the insertion device, guaranteeing lack of contact between the transverse arm of the IUD and the vagina, assures the sterility of the IUD even at the moment of introduction into the uterus, limiting the transport of bacteria into the cavity. Lack of sufficient data on ectopic pregnancies in Progestasert users impedes a complete evaluation and definition of the problem with this particular device. One of the most frequent reasons for discontinuing use of the IUD is distrubance of the menstrual cycle. Increase in menstrual @entity190 , prolongation of the menstrual period, and @entity1867 are disturbances found in users of most IUDs. The Progestasert, however, appears to decrease @entity548 and shorten the menstrual period in all cases. The advantages of the Progestasert are indisputable in treating dysmennorhea. All studies agree on the attributes of topical release of @entity1420 in treating this illness. Studies report disappearance of symptoms in 35% of dysmennorheic @entity1 and a marked @entity304 in 65%. Not enough data exist to draw any conclusions about the teratogenic action of the Progestasert. In normal pregnancies, however, natural @entity1420 is found in much higher levels than that released by the IUD. Theoretically, the hormone released by the IUD should not interfere with normal fetal development. The failure rate of Progestasert is equal to or lower than that of other IUDs. Overall, the Progestasert represents a remarkable improvement over conventional IUDs.
