الفهرس 
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Abstract
IUDs that release copper or levonorgestrel are extremely effective contraceptives. The LNG-IUS also reduces menorrhagia and dysmenorrhoea. The major barrier to long-term effectiveness is the discontinuation rate, mainly for menstrual problems. Although IUDs are the most widely used reversible method of family planning in the world, utilization would be greater still if not for limitations in device and provider availability and misplaced concern about the risk of infection.
The LNG-IUS is a proven alternative to hysterectomy and endometrial ablation. Many surgical procedures are still performed without first evaluating the LNG-IUS or other medical treatments. Not only is the LNG-IUS highly effective in reducing MBL, it is well tolerated, has a high user satisfaction rate and is cost effective.
The symptoms most often responsible for IUD discontinuation are increased uterine bleeding and increased menstrual pain within one year, 5-10% of women discontinue IUD use because of these problems.
Smaller copper and progestin IUDs have reduced the incidence of pain and bleeding considerably. Because bleeding and pain is most severe in the first few months after IUD insertion, treatment with non steroidal anti-inflammatory drugs during the first several menstrual periods can reduce bleeding and cramping. Even persistent heavy menses can be effectively treated with NSAIDs.
IUDs use lead to increase menstrual blood loss. In developing countries with women who are already depleted in body iron stores may prove to be deleterious to their health.
Bleeding with IUDs is considered iatrogenic dysfunctional uterine bleeding. The bleeding associated with IUD use may either occur during menstruation (heavy and/or prolonged) or in the form of intermenstrual bleeding and spotting.
The IUD increases menstrual bleeding by its impact on several aspects of endometrial haemostasis. Some prostaglandins may cause increase vascularity and vascular permeability and some prostaglandins inhibit platelet activity, the increased production of prostaglandins may contribute to endometrial bleeding synthesis and release could be stimulated in IUD exposed endometrium. IUD induced menorrhagia might be correlated with poor contractility of spiral arterioles in spontaneous layer of the endometrium. Also the increased fibrinolysis with IUD is likely to arise as a result of damage to the capillary plexus causing increase and prolonged menstrual bleeding.
Also, three-dimensional ultrasound provides useful information on the location of the IUD following insertion. It enables imaging of the entire IUD, i.e. the shaft and the arms, simultaneously. Additional, the examination time can be kept to a minimum with this new technique.
Transvaginal color Doppler sonography can evaluate the hemodynamic changes in the uterine vascular bed after the insertion of a contraceptive intrauterine device (IUD) and to investigate whether those color Doppler findings could predict potential side effects, such as dysmenorrhe and abnormal bleeding.
This study includes 200 patients divided into study group (100women) and control group (100 women). The study group has abnormal uterine bleeding IUD and the control group has no abnormal uterine bleeding with IUD. The IUD-FD, IUD-MD, IUD-ED, IUD-IOD, endometrial thickness, uterine size and uterine doppler were measured in the two groups. The aim is to determine the possible relationship between the position of the IUD and abnormal uterine bleeding, there was no statistically significant difference regarding age, parity, duration of use, uterine size and endometrial thickness between the two groups. However, it was found that there is a statistically significant difference between the two groups considering IUD-F, IUD-M, IUD-E and IUD-IO distances giving a possible relationship between the position of the IUD and abnormal uterine bleeding.
It was found that abnormal uterine bleeding associating IUD is decreased when the IUD is nearer to the fundus and far from the internal os. There is direct relationship between the IUD-F, IUD-M, IUD-E distances and occurrence of abnormal uterine bleeding and pain, while there is reciprocal relationship between IUD-IO distance and occurrence of abnormal uterine bleeding and pain.
As regard to Doppler findings, it was noted that RI was significantly lower in group I in comparison to group II (P< 0.001) and Pulsitility index (PI) followed the same pattern as RI.
We can conclude that PI and RI were significantly lower in women with IUD-induced abnormal bleeding than in those using IUD without complaining of abnormal vaginal bleeding. The results of our study confirmed the hypothesis that there is increase in uterine artery blood flow (indicated by decreased PI and RI) in patients with IUD induced abnormal vaginal bleeding. In addition, detection of PI and RI in the uterine artery could be used to identify patients at risk of developing excessive bleeding after copper IUD insertion.