The Effect of Intrauterine Contraceptive Devices on Ovarian and Menstrual Function in the Human

Abstract

The effects of IUCD's on ovarian and menstrual function were studied in 10 women throughout at least 2 menstrual cycles, one in which an IUCD was in place and the other was a control. Ovarian function was monitored and ovulation was dated by serial measurements of urinary estrogens and pregnanediol and of plasma progesterone. The steroid levels in all cycles showed the characteristic pattern of the ovulatory cycle with the values falling within the normal ranges. No significant differences in output of estrogens or pregnanediol could be detected between control and IUCD cycles and there was no evidence that the IUCD influenced follicular development, ovulation or the function of the corpus luteum. However, the lengths of the luteal phases, calculated as the interval between the mid-cycle estrogen peak and onset of menstrual bleeding, were shorter in the IUCD cycles than in their controls, the mean differences being 2.3 days which was highly significant (p < 0.001). Even so, the durations of the luteal phases in 70% of the IUCD cycles were still within the range found in normal fertile women and therefore the shortening could not itself explain the contraceptive action of the IUCD. The estrogen and pregnanediol values were significantly higher on the day before onset of bleeding in the IUCD cycles than in their controls. It was concluded that the shorter luteal phases in the IUCD cycles were not due to earlier hormone changes but were due to local effects of the IUCD which caused earlier shedding of the endometrium. (/ Clin Endocrinol Metab 36: 1125, 1973

Uterine histology and prostaglandin concentrations and utero-ovarian venous steroid and prostaglandin concentrations during the luteal phase of the menstrual cycle in baboons (Papio spp.) with or without an IUD

“…Decidualization per se may not be involved in the contraceptive effect of IUDs; indeed some decidua-like changes are seen in the luteal-phase uterus during the normal menstrual cycle (Edwards, 1980). The absence of any effect of the presence of the IUD on the peripheral steroid concentrations agrees with the observations of Breed et al (1972) on the baboon and Martin & Brown (1973), Nygren & Johansson (1973) and Haukkamaa, Luukkainen & Timonen (1974) on women. How¬ ever, the difference between the IUD-and non-IUD-bearing animals in the presence or absence of a deciduomal response to the same steroid concentrations indicates that the IUD has altered the sensitivity of the endometrium to the prevailing oestradiol-17ß and progesterone concentrations.…”

A study of returning fertility after childbirth and during lactation by measurement of urinary oestrogen and pregnanediol excretion and cervical mucus production

“…Return of ovarian function following childbirth in breast-feeding women showing the incidences of anovulatory cycles (ANOV), normal ovulatory cycles (OV) and ovulatory cycles with short luteal phases (SHORT) and deficient luteal phases (DEF), according to months from delivery and the number of bleeds (cycles) which had occurred. continuous profuse mucus discharge without any recognizable pattern and all her ovulatory cycles had short luteal phases as would be expected from the known asynchrony between hormonal and bleeding patterns caused by the device (Martin & Brown, 1973). The high incidence of anovulatory cycles and ovulatory cycles with short and deficient luteal phases which occurred before the early bleeds also contributed to the confusing mucus patterns.…”

“…This is explained by the frequency of vaginal infections such as monilia which were reported. The one woman who had an intrauterine contraceptive device had a continuous profuse mucus discharge without any recognizable pattern and all her ovulatory cycles had short luteal phases as would be expected from the known asynchrony between hormonal and bleeding patterns caused by the device (Martin & Brown, 1973). The high incidence of anovulatory cycles and ovulatory cycles with short and deficient luteal phases which occurred before the early bleeds also contributed to the confusing mucus patterns.…”