2/26/2017 Intrauterinecontraception:Managementofsideeffectsandcomplications

OfficialreprintfromUpToDate
www.uptodate.com2017UpToDate

Intrauterinecontraception:Managementofsideeffectsand
complications
Authors SectionEditor DeputyEditor
GillianDean,MD,MPH CourtneyASchreiber,MD,MPH KristenEckler,MD,FACOG
AlisaBGoldberg,MD,MPH

INTRODUCTION

Intrauterinecontraceptionisgenerallywelltolerated,butsideeffectsandcomplicationssometimesoccur.Thistopic
willreviewmanagementofthemostcommonproblemsrelatedtointrauterinecontraceptionwiththecopperT380A
intrauterinedevice(IUD)(calledTCu380A)andtheIUDcontaining52mglevonorgestrel(calledLNg20becauseofan
initialreleaserateoflevonorgestrel20mcgdaily).Atthistime,therearesparsedataonthenewerIUDcontaining13.5
mglevonorgestrel(calledLNg14becauseofaninitialreleaserateoflevonorgestrel14mcgdaily).

GeneralissuesrelatedtointrauterinecontraceptionandinsertionandremovalofIUDsarediscussedseparately.(See
"Intrauterinecontraception:Devices,candidates,andselection"and"Intrauterinecontraceptivedevice:Insertionand
removal".)

Severaltermsareusedtodescribeintrauterinecontraception,includingintrauterinedevice(IUD)andintrauterine
contraceptive(IUC)theLNg20isalsoreferredtoasanintrauterinesystem(IUS).Inthistopic,weusethetermIUD
foralltypesofintrauterinecontraception.

EXPULSION

Expulsionriskisgreatestinthefirstyearofuseanddecreasesthereafter[1].Inthefirstyearofuse,expulsionoccurs
in3to10percentofwomenwiththeTCu380Aand3to6percentofwomenwiththeLNg20IUD[15].Inalarge
retrospectivestudy,theriskofexpulsionwiththeTCu380AwasdoublethatoftheLNg20(6versus3percentat12
months)[1].ThemanufactureroftheLNg14IUDreportsanexpulsionrateof3.2percenthowever,dataarelimited.

Riskfactorsforexpulsionincludepriorexpulsion[1,6],menorrhagia,severedysmenorrhea[7],andinsertion
immediatelyafterasecondtrimesterabortionorpostpartum[8,9].Thereisnoincreasedriskofexpulsionwithinsertion
immediatelyafterfirsttrimesterabortioncomparedwithintervalinsertion[10].Nulliparitydoesnotappeartoincrease
theriskofIUDexpulsion,whiletheeffectofyoungage(lessthan20years)isunclear[1,2,7,11].Thelengthofthe
endometrialcavitydoesnotappeartobeariskfactorforexpulsionofmodernIUDs[12,13].

Subscribersloginhere

Tocontinuereadingthisarticle,youmustloginwithyourpersonal,hospital,orgrouppractice
subscription.Formoreinformationortopurchaseapersonalsubscription,clickbelowontheoption
thatbestdescribesyou:

Medical
Hospitalor
Professionalor GroupPractices
Institution
Student

Patientor
http://www.uptodate.com/contents/intrauterinecontraceptionmanagementofsideeffectsandcomplications#subscribeMessage 1/6
2/26/2017 Intrauterinecontraception:Managementofsideeffectsandcomplications

Patientor
Caregiver

Literaturereviewcurrentthrough:Jan2017.|Thistopiclastupdated:Dec13,2016.

ThecontentontheUpToDatewebsiteisnotintendednorrecommendedasasubstituteformedicaladvice,diagnosis,ortreatment.Alwaysseekthe
adviceofyourownphysicianorotherqualifiedhealthcareprofessionalregardinganymedicalquestionsorconditions.Theuseofthiswebsiteis
governedbytheUpToDateTermsofUse2017UpToDate,Inc.

References
Top

1.AounJ,DinesVA,StovallDW,etal.Effectsofage,parity,anddevicetypeoncomplicationsand
discontinuationofintrauterinedevices.ObstetGynecol2014123:585.
2.RiveraR,ChenMokM,McMullenS.Analysisofclientcharacteristicsthatmayaffectearlydiscontinuationof
theTCu380AIUD.Contraception199960:155.
3.Longtermreversiblecontraception.TwelveyearsofexperiencewiththeTCu380AandTCu220C.Contraception
199756:341.
4.SivinI,SchmidtF.EffectivenessofIUDs:areview.Contraception198736:55.
5.Mechanismofaction,safetyandefficacyofintrauterinedevices.ReportofaWHOScientificGroup.World
HealthOrganTechRepSer1987753:1.
6.BahamondesL,DazJ,MarchiNM,etal.Performanceofcopperintrauterinedeviceswheninsertedafteran
expulsion.HumReprod199510:2917.
7.ZhangJ,FeldblumPJ,ChiIC,FarrMG.RiskfactorsforcopperTIUDexpulsion:anepidemiologicanalysis.
Contraception199246:427.
8.GrimesDA,LopezLM,SchulzKF,StanwoodNL.Immediatepostabortalinsertionofintrauterinedevices.
CochraneDatabaseSystRev2010:CD001777.
9.GrimesDA,LopezLM,SchulzKF,etal.Immediatepostpartuminsertionofintrauterinedevices.Cochrane
DatabaseSystRev2010:CD003036.
10.JacobNS,MahnertN,LivingstonJB,etal.Comparisonofintrauterinedeviceexpulsionratesafteraspiration
abortionorintervalinsertion.ObstetGynecol2014123Suppl1:10S.
11.MaddenT,McNicholasC,ZhaoQ,etal.Associationofageandparitywithintrauterinedeviceexpulsion.Obstet
Gynecol2014124:718.
12.BahamondesMV,MonteiroI,CanteiroR,etal.Lengthoftheendometrialcavityandintrauterinecontraceptive
deviceexpulsion.IntJGynaecolObstet2011113:50.
13.LiangH,LiL,YuanW,etal.Dimensionsoftheendometrialcavityandintrauterinedeviceexpulsionorremoval
fordisplacement:anestedcasecontrolstudy.BJOG2014121:997.
14.elZeneinyAH,AmmarAR,BadawiSZ.ExpulsionoftheintrauterinedevicesLippesloopsize30mm.JEgypt
MedAssoc196952:46.
15.TepperNK,ZapataLB,JamiesonDJ,CurtisKM.Useofintrauterinedevicesinwomenwithuterineanatomic
abnormalities.IntJGynaecolObstet2010109:52.
16.ThonneauP,AlmontT,deLaRochebrochardE,MariaB.RiskfactorsforIUDfailure:resultsofalarge
multicentrecasecontrolstudy.HumReprod200621:2612.
17.BraatenKP,BensonCB,MaurerR,GoldbergAB.Malpositionedintrauterinecontraceptivedevices:riskfactors,
outcomes,andfuturepregnancies.ObstetGynecol2011118:1014.
18.PaloP.TransabdominalandtransvaginalultrasounddetectionoflevonorgestrelIUDintheuterus.ActaObstet
GynecolScand199776:244.
19.ReinerJS,BrindleKA,KhatiNJ.Multimodalityimagingofintrauterinedeviceswithanemphasisontheemerging
roleof3dimensionalultrasound.UltrasoundQ201228:251.

http://www.uptodate.com/contents/intrauterinecontraceptionmanagementofsideeffectsandcomplications#subscribeMessage 2/6
2/26/2017 Intrauterinecontraception:Managementofsideeffectsandcomplications

20.BenacerrafBR,ShippTD,BromleyB.Threedimensionalultrasounddetectionofabnormallylocatedintrauterine
contraceptivedeviceswhichareasourceofpelvicpainandabnormalbleeding.UltrasoundObstetGynecol
200934:110.
21.PakarinenP,LuukkainenT.Fiveyears'experiencewithasmallintracervical/intrauterinelevonorgestrelreleasing
device.Contraception200572:342.
22.DorisN,ShabibG,CorbettS,etal.DoesanintraabdominallyplacedLNGIUShaveanadverseeffecton
fertility?Acasereport.Contraception201489:63.
23.InalMM,ErtopuK,OzelmasI.Theevaluationof318intrauterinepregnancycaseswithanintrauterinedevice.
EurJContraceptReprodHealthCare200510:266.
24.AntebyE,RevelA,BenChetritA,etal.Intrauterinedevicefailure:relationtoitslocationwithintheuterine
cavity.ObstetGynecol199381:112.
25.PettaCA,FandesD,PimentelE,etal.TheuseofvaginalultrasoundtoidentifycopperTIUDsathighriskof
expulsion.Contraception199654:287.
26.MoralesRosellJ.SpontaneousupwardmovementoflowlyplacedTshapedIUDs.Contraception200572:430.
27.FaundesD,PerdigaoA,FaundesA,etal.TshapedIUDsaccomodatetotheirpositionduringthefirstthree
monthsafterinsertion.Contraception200062:165.
28.BerA,SeidmanDS.Managementofthemalpositionedlevonorgestrelreleasingintrauterinesystem.
Contraception201285:369.
29.PeriN,GrahamD,LevineD.Imagingofintrauterinecontraceptivedevices.JUltrasoundMed200726:1389.
30.MarchiNM,CastroS,HidalgoMM,etal.Managementofmissingstringsinusersofintrauterinecontraceptives.
Contraception201286:354.
31.MiziaK,RamsayP.TheeffectivenessandsafetyofultrasoundguidedremovalofaMirena()intrauterine
systemwhenthestringsarenotvisibleandconventionalofficeprocedureshavefailed.AustNZJObstet
Gynaecol201353:386.
32.GneyM,OralB,MunganT.Efficacyofintrauterinelidocaineforremovalofa"lost"intrauterinedevice:a
randomized,controlledtrial.ObstetGynecol2006108:119.
33.PrabhakaranS,ChuangA.Inofficeretrievalofintrauterinecontraceptivedeviceswithmissingstrings.
Contraception201183:102.
34.WilsonS,TanG,BaylsonM,SchreiberC.Controversiesinfamilyplanning:howtomanageafracturedIUD.
Contraception201388:599.
35.HeinemannK,ReedS,MoehnerS,MinhTD.Riskofuterineperforationwithlevonorgestrelreleasingandcopper
intrauterinedevicesintheEuropeanActiveSurveillanceStudyonIntrauterineDevices.Contraception2015
91:274.
36.HeinemannK,ReedS,MoehnerS,MinhTD.Comparativecontraceptiveeffectivenessoflevonorgestrel
releasingandcopperintrauterinedevices:theEuropeanActiveSurveillanceStudyforIntrauterineDevices.
Contraception201591:280.
37.KaislasuoJ,SuhonenS,GisslerM,etal.Uterineperforationcausedbyintrauterinedevices:clinicalcourseand
treatment.HumReprod201328:1546.
38.HatcherRA,TrussellJ,StewartF,etal.ContraceptiveTechnology,19thed,ArdentMedia,Inc.,NewYork2007.
39.ChenCP,HsuTC,WangW.IlealpenetrationbyaMultiloadCu375intrauterinecontraceptivedevice.Acase
reportwithreviewoftheliterature.Contraception199858:295.
40.AdoniA,BenChetritA.Themanagementofintrauterinedevicesfollowinguterineperforation.Contraception
199143:77.
41.ZakinD,SternWZ,RosenblattR.Completeandpartialuterineperforationandembeddingfollowinginsertionof
intrauterinedevices.II.Diagnosticmethods,prevention,andmanagement.ObstetGynecolSurv198136:401.
42.MarkovitchO,KleinZ,GidoniY,etal.ExtrauterinemislocatedIUD:issurgicalremovalmandatory?
Contraception200266:105.
43.VasquezP,SchreiberCA.ThemissingIUD.Contraception201082:126.
44.GillRS,MokD,HudsonM,etal.Laparoscopicremovalofanintraabdominalintrauterinedevice:caseand
systematicreview.Contraception201285:15.
45.AnderssonK,RydeBlomqvistE,LindellK,etal.Perforationswithintrauterinedevices.ReportfromaSwedish
survey.Contraception199857:251.
46.OzgunMT,BatukanC,SerinIS,etal.Surgicalmanagementofintraabdominalmislocatedintrauterinedevices.
Contraception200775:96.

http://www.uptodate.com/contents/intrauterinecontraceptionmanagementofsideeffectsandcomplications#subscribeMessage 3/6
2/26/2017 Intrauterinecontraception:Managementofsideeffectsandcomplications

47.SperoffL,DarneyP.AClinicalGuideforContraception,3rded,LippincottWilliams&Wilkins,Philadelphia2001.
48.DietrickDD,IssaMM,KabalinJN,BassettJB.Intravesicalmigrationofintrauterinedevice.JUrol1992
147:132.
49.ElHefnawyAS,ElNahasAR,OsmanY,BazeedMA.Urinarycomplicationsofmigratedintrauterine
contraceptivedevice.IntUrogynecolJPelvicFloorDysfunct200819:241.
50.SinghI.IntravesicalCuTemigration:anatypicalandinfrequentcauseofvesicalcalculus.IntUrolNephrol2007
39:457.
51.KhanZA,KhanSA,WilliamsA,MobbGE.Intravesicalmigrationoflevonorgestrelreleasingintrauterinesystem
(LNGIUS)withcalculusformation.EurJContraceptReprodHealthCare200611:243.
52.HeinbergEM,McCoyTW,PasicR.Theperforatedintrauterinedevice:endoscopicretrieval.JSLS200812:97.
53.NitkeS,RabinersonD,DekelA,etal.LostlevonorgestrelIUD:diagnosisandtherapy.Contraception2004
69:289.
54.HubacherD,ChenPL,ParkS.SideeffectsfromthecopperIUD:dotheydecreaseovertime?Contraception
200979:356.
55.SivinI,SternJ.Healthduringprolongeduseoflevonorgestrel20micrograms/dandthecopperTCu380Ag
intrauterinecontraceptivedevices:amulticenterstudy.InternationalCommitteeforContraceptionResearch
(ICCR).FertilSteril199461:70.
56.BavejaR,BichilleLK,CoyajiKJ,etal.Randomizedclinicaltrialwithintrauterinedevices(levonorgestrel
intrauterinedevice(LNG),CuT380Ag,CuT220CandCuT200B).A36monthstudy.IndianCouncilofMedical
ResearchTaskForceonIUD.Contraception198939:37.
57.MeirikO,RowePJ,PeregoudovA,etal.TheframelesscopperIUD(GyneFix)andtheTCu380AIUD:resultsof
an8yearmulticenterrandomizedcomparativetrial.Contraception200980:133.
58.JensenJT,NelsonAL,CostalesAC.Subjectandclinicianexperiencewiththelevonorgestrelreleasing
intrauterinesystem.Contraception200877:22.
59.LindhI,MilsomI.Theinfluenceofintrauterinecontraceptionontheprevalenceandseverityofdysmenorrhea:a
longitudinalpopulationstudy.HumReprod201328:1953.
60.GemzellDanielssonK,SchellschmidtI,ApterD.Arandomized,phaseIIstudydescribingtheefficacy,bleeding
profile,andsafetyoftwolowdoselevonorgestrelreleasingintrauterinecontraceptivesystemsandMirena.Fertil
Steril201297:616.
61.RnnerdagM,OdlindV.Latebleedingproblemswiththelevonorgestrelreleasingintrauterinesystem:evaluation
oftheendometrialcavity.Contraception200775:268.
62.NelsonAL,HatcherRA,ZiemanM,etal.ManagingContraception.Tiger,Georgia:BridgingtheGapFoundation,
2000.
63.GrimesDA,HubacherD,LopezLM,SchulzKF.Nonsteroidalantiinflammatorydrugsforheavybleedingorpain
associatedwithintrauterinedeviceuse.CochraneDatabaseSystRev2006:CD006034.
64.USSelectedPracticeRecommendationsforContraceptiveUse,2013.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6205a1.htm(AccessedonMarch04,2016).
65.HubacherD,ReyesV,LilloS,etal.Preventingcopperintrauterinedeviceremovalsduetosideeffectsamong
firsttimeusers:randomizedtrialtostudytheeffectofprophylacticibuprofen.HumReprod200621:1467.
66.GodfreyEM,FolgerSG,JengG,etal.Treatmentofbleedingirregularitiesinwomenwithcoppercontaining
IUDs:asystematicreview.Contraception201387:549.
67.MaddenT,ProehlS,AllsworthJE,etal.Naproxenorestradiolforbleedingandspottingwiththelevonorgestrel
intrauterinesystem:arandomizedcontrolledtrial.AmJObstetGynecol2012206:129.e1.
68.SordalT,InkiP,DraebyJ,etal.ManagementofInitialBleedingorSpottingAfterLevonorgestrelReleasing
IntrauterineSystemPlacement.ObstetGynecol2013121:934.
69.AbdelAleemH,d'ArcanguesC,VogelsongK,GlmezogluAM.Treatmentofvaginalbleedingirregularities
inducedbyprogestinonlycontraceptives.CochraneDatabaseSystRev2007:CD003449.
70.WeisbergE,HickeyM,PalmerD,etal.Apilotstudytoassesstheeffectofthreeshorttermtreatmentson
frequentand/orprolongedbleedingcomparedtoplaceboinwomenusingImplanon.HumReprod200621:295.
71.CheginiN,RhotonVlasakA,WilliamsRS.Expressionofmatrixmetalloproteinase26andtissueinhibitorof
matrixmetalloproteinase3and4inendometriumthroughoutthenormalmenstrualcycleandalterationinusers
oflevonorgestrelimplantswhoexperienceirregularuterinebleeding.FertilSteril200380:564.
72.VincentAJ,ZhangJ,OstorA,etal.Matrixmetalloproteinase1and3andmastcellsarepresentinthe
endometriumofwomenusingprogestinonlycontraceptives.HumReprod200015:123.

http://www.uptodate.com/contents/intrauterinecontraceptionmanagementofsideeffectsandcomplications#subscribeMessage 4/6
2/26/2017 Intrauterinecontraception:Managementofsideeffectsandcomplications

73.FarleyTM,RosenbergMJ,RowePJ,etal.Intrauterinedevicesandpelvicinflammatorydisease:aninternational
perspective.Lancet1992339:785.
74.LeeNC,RubinGL,BoruckiR.Theintrauterinedeviceandpelvicinflammatorydiseaserevisited:newresults
fromtheWomen'sHealthStudy.ObstetGynecol198872:1.
75.WalshT,GrimesD,FrezieresR,etal.Randomisedcontrolledtrialofprophylacticantibioticsbeforeinsertionof
intrauterinedevices.IUDStudyGroup.Lancet1998351:1005.
76.GrimesDA.Intrauterinedeviceanduppergenitaltractinfection.Lancet2000356:1013.
77.ToivonenJ,LuukkainenT,AllonenH.Protectiveeffectofintrauterinereleaseoflevonorgestrelonpelvic
infection:threeyears'comparativeexperienceoflevonorgestrelandcopperreleasingintrauterinedevices.
ObstetGynecol199177:261.
78.FeldblumPJ,CarawayJ,BahamondesL,etal.RandomizedassignmenttocopperIUDordepot
medroxyprogesteroneacetate:feasibilityofenrollment,continuationanddiseaseascertainment.Contraception
200572:187.
79.TepperNK,SteenlandMW,GaffieldME,etal.Retentionofintrauterinedevicesinwomenwhoacquirepelvic
inflammatorydisease:asystematicreview.Contraception201387:655.
80.MurrayS,HickeyJB,HouangE.Significantbacteremiaassociatedwithreplacementofintrauterine
contraceptivedevice.AmJObstetGynecol1987156:698.
81.ShoubnikovaM,HellbergD,NilssonS,MrdhPA.Contraceptiveuseinwomenwithbacterialvaginosis.
Contraception199755:355.
82.HodoglugilNN,AslanD,BertanM.Intrauterinedeviceuseandsomeissuesrelatedtosexuallytransmitted
diseasescreeningandoccurrence.Contraception200061:359.
83.PerssonE,HolmbergK,DahlgrenS,NilssonL.Actinomycesisraeliiinthegenitaltractofwomenwithand
withoutintrauterinecontraceptivedevices.ActaObstetGynecolScand198362:563.
84.FiorinoAS.IntrauterinecontraceptivedeviceassociatedactinomycoticabscessandActinomycesdetectionon
cervicalsmear.ObstetGynecol199687:142.
85.KeeblerC,ChatwaniA,SchwartzR.Actinomycosisinfectionassociatedwithintrauterinecontraceptivedevices.
AmJObstetGynecol1983145:596.
86.LippesJ.Pelvicactinomycosis:areviewandpreliminarylookatprevalence.AmJObstetGynecol1999
180:265.
87.WesthoffC.IUDsandcolonizationorinfectionwithActinomyces.Contraception200775:S48.
88.AgentsofActinomycosis.In:PrinciplesandPracticeofInfectiousDiseases,6thed,MandellGL,BennettJE,
DolinR(Eds),Elsevier,Oxford2004.p.2929.
89.SudhakarSS,RossJJ.Shorttermtreatmentofactinomycosis:twocasesandareview.ClinInfectDis2004
38:444.
90.MerkiFeldGS,LebedaE,HoggB,KellerPJ.TheincidenceofactinomyceslikeorganismsinPapanicolaou
stainedsmearsofcopperandlevonorgestrelreleasingintrauterinedevices.Contraception200061:365.
91.KlugCD,KeayCR,GindeAA.Fataltoxicshocksyndromefromanintrauterinedevice.AnnEmergMed2009
54:701.
92.VenkataramanasettyR,AburawiA,PhillipH.Streptococcaltoxicshocksyndromefollowinginsertionofan
intrauterinedeviceacasereport.EurJContraceptReprodHealthCare200914:379.
93.GisserJM,FieldsMC,PickN,etal.Invasivegroupastreptococcusassociatedwithanintrauterinedeviceand
oralsex.SexTransmDis200229:483.
94.TurokDK,GurtcheffSE,GibsonK,etal.Operativemanagementofintrauterinedevicecomplications:acase
seriesreport.Contraception201082:354.
95.YegezJF,MartinezSA,SandsLR,HellingerMD.Pelvicactinomycosispresentingasmalignantlargebowel
obstruction:acasereportandareviewoftheliterature.AmSurg200066:85.
96.NugterenSK,OuwendijkRJ,JonkmanJG,etal.ColitisandlowerabdominalmassbyActinomycesisraeliiina
patientwithanIUD.NethJMed199649:73.
97.SivinI.UtilityanddrawbacksofcontinuoususeofacopperTIUDfor20years.Contraception200775:S70.
98.MoschosE,TwicklerDM.Intrauterinedevicesinearlypregnancy:findingsonultrasoundandclinicaloutcomes.
AmJObstetGynecol2011204:427.e1.
99.BrahmiD,SteenlandMW,RennerRM,etal.PregnancyoutcomeswithanIUDinsitu:asystematicreview.
Contraception201285:131.

http://www.uptodate.com/contents/intrauterinecontraceptionmanagementofsideeffectsandcomplications#subscribeMessage 5/6
2/26/2017 Intrauterinecontraception:Managementofsideeffectsandcomplications

100.WorldHealthOrganization.Selectedpracticerecommendationsforcontraceptiveuse.
http://www.who.int/reproductivehealth/publications/family_planning/9241562846index/en/index.html(Accessed
onJanuary13,2012).
101.SachsBP,GregoryK,McArdleC,PinshawA.Removalofretainedintrauterinecontraceptivedevicesin
pregnancy.AmJPerinatol19929:139.
102.SviggumO,SkjeldestadFE,TuvengJM.UltrasonicallyguidedretrievalofoccultIUDinearlypregnancy.Acta
ObstetGynecolScand199170:355.
103.OwenC,SoberS,SchreiberCA.Controversiesinfamilyplanning:desiredpregnancy,IUDinsituandnostrings
visible.Contraception201388:330.
104.AssafA,GoharM,SaadS,etal.Removalofintrauterinedeviceswithmissingtailsduringearlypregnancy.
Contraception199245:541.
105.LinJC,ChenYO,LinBL,ValleRF.Outcomeofremovalofintrauterinedeviceswithflexiblehysteroscopyin
earlypregnancy.JGynecolSurg19939:195.
106.HopkinsMR,AgudeloSuarezP,ElNasharSA,etal.Termpregnancywithintraperitoneallevonorgestrel
intrauterinesystem:acasereportandreviewoftheliterature.Contraception200979:323.
107.WeissmannBrennerA,LernerA,PelegD.Transverselimbreductionandintrauterinedevice:casereportand
reviewoftheliterature.EurJContraceptReprodHealthCare200712:294.
108.SchiesserM,LapaireO,TercanliS,HolzgreveW.Lostintrauterinedevicesduringpregnancy:maternalandfetal
outcomeafterultrasoundguidedextraction.Ananalysisof82cases.UltrasoundObstetGynecol200423:486.
109.StubblefieldPG,FullerAFJr,FosterSC.Ultrasoundguidedintrauterineremovalofintrauterinecontraceptive
devicesinpregnancy.ObstetGynecol198872:961.
110.KoetsawangS,RachawatD,PiyaAnantM.Outcomeofpregnancyinthepresenceofintrauterinedevice.Acta
ObstetGynecolScand197756:479.
111.SivinI,SternJ,CoutinhoE,etal.Prolongedintrauterinecontraception:asevenyearrandomizedstudyofthe
levonorgestrel20mcg/day(LNg20)andtheCopperT380AgIUDS.Contraception199144:473.
112.BackmanT,HuhtalaS,BlomT,etal.Lengthofuseandsymptomsassociatedwithprematureremovalofthe
levonorgestrelintrauterinesystem:anationwidestudyof17,360users.BJOG2000107:335.
113.AnderssonK,OdlindV,RyboG.Levonorgestrelreleasingandcopperreleasing(NovaT)IUDsduringfiveyears
ofuse:arandomizedcomparativetrial.Contraception199449:56.
114.FahmyK,IsmailH,SammourM,etal.Cervicalpathologywithintrauterinecontraceptivedevicesacytocolpo
pathologicalstudy.Contraception199041:317.
115.MisraJS,EngineerAD,TandonP.Cervicalcytologyassociatedwithlevonorgestrelcontraception.ActaCytol
199539:45.
116.KaplanB,OrvietoR,HirschM,etal.Theimpactofintrauterinecontraceptivedevicesoncytologicalfindings
fromroutinePapsmeartesting.EurJContraceptReprodHealthCare19983:75.
117.BaileyAP,DarracottMM.Loopelectrosurgicalexcisionprocedurewithanintrauterinedeviceinplace.AmJ
ObstetGynecol2010203:291.e1.

http://www.uptodate.com/contents/intrauterinecontraceptionmanagementofsideeffectsandcomplications#subscribeMessage 6/6