الفهرس 
EndometriumOnly 14 pages are availabe for public view
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Abstract
Intrauterine devices (IUDs) are one of the world’s most popular methods of reversible birth control. The method is safe, rapidly reversible, inexpensive, highly effective, long-acting and non-hormonal; these attributes make it unique and desirable for many users (Sivin, 2007).
The mechanism of IUDs to control birth is still unclear, but whatever the mechanism, copper might enhance inflammatory response and might induce vascular changes of the endometrium and myometrium (Hsu et al., 1976).
The most important copper IUDs related side effects are uterine bleeding and/or menstrual pain. These side effects are responsible for a removal rate of 5% to 15% during the first year after IUD insertion. Probably there is a connection between IUD adverse effects and uterine vascularization. However, this association is neither well-known nor well-studied (Jiménez et al., 2006).
Color Doppler studies showed an increase in blood flow resistance in the uterus of patients with primary dysmenorrhea (Pirhonen and Pulkkinen, 1995). Other studies showed that there is no change in the uterine artery PI during the mid-luteal phase after the insertion of a copper IUD (Järvelä et al., 1998; Jiménez et al., 2006; Souza and Geber, 2006), but there was a decrease in PI after IUD insertion in patients with increased menstrual pain, suggesting increased blood flow to the uterus in those patients (Jensen, 2005; Souza and Geber, 2006). During menses (first or second cycle days), there was a significant increase in uterine artery blood flow in patients who presented with copper IUD side effects, as indicated by decreased PI and RI (Frajndlich et al., 2000).
In agreement with those studies, Jiménez (2006) have demonstrated that patients with copper-IUD-related side effects show an increase in subendometrial vascularization, suggesting that power Doppler analysis could identify some vascular abnormalities in the mid-luteal phase in those patients.
The aim of the present study is to use power Doppler analysis as well as resistance index (RI) and pulsatility index (PI) to quantify the subendometrial microvascularization and uterine artery blood flow in patients with IUD-induced side effects.
The current study was conducted at Ain Shams University Maternity Hospital during the period between June 2012 and July 2014. A total of 50 women planned to have an IUD inserted for contraception purpose were recruited in the current study.
The mean ± standard deviation (SD) of age was 29.6 ± 5.58 years and of body mass index (BMI) was 28.14 ± 4.78 kg/m2 and the median of parity was 2 and a range between 1 and 3.
In this study, the mean ± SD of the initial (pre-insertion) mid-luteal endometrial thickness was 10.82 ± 1.51 mm and subendometrial vascular RI and PI measured by Power Doppler ultrasonography was 0.83 ± 0.07 and 1.7 ± 0.14 respectively, while the 3-month-post-insertion mid-luteal endometrial thickness was 11.52 ± 1.59 mm and subendometrial vascular RI and PI was 0.76 ± 0.1 and 1.59 ± 0.2 respectively.
The post-insertion endometrial thickness was statistically significantly higher and the subendometrial RI and PI were statistically significantly lower when compared to pre-insertion values through paired analysis.
In this study, the recruited women were divided into two groups according to the occurrence of side effects; group I (positive for side effects; 14 women) and group II (negative for side effects; 36 women). There were no significant differences between women of both groups regarding the demographic data. There were no significant differences between women of both groups regarding the initial endometrial thickness, subendometrial RI or PI.
In the present study, there was no significant difference between women of both groups regarding the post-insertion endometrial thickness. The post-insertion subendometrial RI and PI were, however, significantly lower in women with IUD-related side effects (denoting a significantly higher subendometrial vascularization).
In the current study, binary logistic regression analysis revealed that the subendometrial RI Δ percentage was the only independent significant predictor of IUD-related side effects (pain and/or bleeding). Presence of major subendometrial RI Δ percentage area was significantly associated with development of IUD-related pain (almost 8-fold higher risk), bleeding (almost 32-fold higher risk), pain and bleeding (almost 21-fold higher risk) and side effects severe enough to have the IUD removed (almost 22-fold higher risk).