The following information is taken from the 20^th edition of Contraceptive Technology:

Intrauterine Contraceptives by Gillian Dean, MD, MPH and Eleanor Bimla Schwarz, MD, MS

Cancer Protection

Both IUCs are associated with a reduction in the risk of endometrial cancer.  Although the mechanism of action in the copper IUC is unknown, it may relate to alterations in the endometrium.  Similarly, progestin-releasing intrauterine contraception has also been shown to protect against endometrial cancer, as is true of contraceptives that deliver a progestin systemically.  Indeed, the LNg IUC has been used to prevent development of endometrial hyperplasia in women using estrogen therapy in the peri-and postmenopause.  While the TCu380A is generally preferred for women with recent breast cancer, the LNg IUC is used at times for women treated with tamoxifen to protect the endometrium.  Moreover, the LNg IUC has been used for the treatment of nonatypical endometrial hyperplasia.  It may also be effective for atypical hyperplasic and grade 1 endometrial cancer.                           

Non-contraceptive Health Benefits of the LNg IUC Topical delivery of progestin to the uterine cavity has exciting therapeutic uses aside from contraception. Some are well established and approved indications, while others are still being explored. The LNg IUC reduces dysmenorrhea and menstrual blood loss from a variety of causes. Overall blood loss drops about 90%, and at least 20% of women stop bleeding altogether. This translates into clinically important increases in hemoglobin and iron stores. The reduction in menstrual blood loss occurs both in women with normal coagulation parameters and in those with bleeding diatheses, including those using anticoagulant therapy. Some evidence supports a benefit in treating heavy bleeding associated with adenomyosis and leiomyomas with the LNg IUC. Trials have compared this approach to treatment with an oral progestin, a nonsteroidal anti-inflammatory drug, or mefenamic acid (which is not available in the United States) and found the LNg IUC superior to the other alternatives. In addition, the LNg IUC is an acceptable and cost effective alternative to endometrial ablation or hysterectomy. The LNg IUC may also decrease the risk of pelvic inflammatory disease (PID), similar to other progestin-containing contraceptives. By thickening cervical mucus, progestin may provide a barrier to ascending infection. 

IUDs May Protect Against Cervical Cancer

By NICHOLAS BAKALAR Published: September 19, 2011

Intrauterine devices may offer some protection against cervical cancer, a large review of studies has found.

Related

·         Health Guide: Cervical Cancer

·         More Vital Signs Columns

The studies were conducted from 1985 to 2007 in Europe, Asia and South America and involved nearly 20,000 women. After controlling for many health and behavioral factors, the researchers found that using an IUD reduced the risk of cervical cancer by 45 percent, compared with never using one. The review, published online last week in Lancet Oncology, said the protective effect was apparent in the first year of use and continued for as many as 10 years.

Women who choose to have IUDs inserted are more likely to have been screened for cervical cancer, but the researchers found that screening was not a factor in the reduced risk. And women with IUDs were no more or less likely than women without them to be infected with human papillomavirus, the main cause of cervical cancer. Rather, the researchers suggest, the insertion of an IUD might provoke an immune response to HPV.

The data underscore two important points, according to the lead author, Dr. Xavier Castellsagué, an epidemiologist at the Catalan Institute of Oncology in Barcelona, Spain. First, having an IUD does not change the risk for HPV infection. And second, IUD use is associated with a reduction of almost 50 percent in the risk for cervical cancer.

Robert A. Hatcher MD, MPH

Professor of Gynecology and Obstetrics

Emory University School of Medicine

Atlanta, GA 

Reference:

Dean G, Schwarz EB. Intrauterine contraceptives (IUCs) IN Hatcher RA, Trussell J, Nelson AL, Cates Jr. W, Kowal D, Policar MS. et al Contraceptive Technology 20^th edition, pages 152 and 153: Ardent Media Inc. 2011

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What is your body telling you?

One day a good friend and colleague walked me out to the parking area next to the building where we both worked. It was across the street from Grady Memorial Hospital where I have worked since 1963 save for two years of active duty in the Public Health Service and one year at the University of California in Berkeley.

I was seated in the driver’s seat and had rolled down the window.  Our conversation went on for about five minutes. My friend was standing right next to the open window.

Then without raising her voice and in the exactly the same matter of fact tone in which she had been speaking, she said “Oh, Bob, I just ovulated in my right ovary.”

I roared! She told me that occasionally she could feel a slight twinge of pain as she ovulated.  This is what had happened that afternoon.  About 15% of women occasionally do feel something in the pelvic area as ovulation happens.  It can happen on the right or the left as ovulation can occur in either ovary.  When there is any discomfort from rupture of an egg out of the ovary it usually happens about 2 weeks after the first day of the previous menstrual period. This month my friend’s ovulation happened in the right ovary. 

Sometimes the pain of ovulation is quite severe (and must be distinguished from pain associated with pain from appendicitis and other causes). In the vast majority of women ovulation causes no symptoms at all.

Since my friend and I were working in the area of fertility control a recurrent symptom right at the time of ovulation, we realized, could have interesting implications for a woman both in terms of trying to become pregnant and trying to avoid pregnancy.

Well, those are probably more details about ovulation than you expected to hear about from reading today’s issue of the Clayton Tribune!

Next month when I am lecturing to 100 students at a women’s health course at the University of Michigan in Ann Arbor, I will have to tell them of this happening some 30 years ago and go into more details about the implications of that little moment of slight pain in the 15% of them who have experienced it.

So what does this moment of my life some 40 years ago possibly mean to the average reader of this paper? It reminds us that our bodies are speaking to us all the time and that if we are aware and attentive we can pick up signals that could be helpful to us.

Each of us is the captain of his or her own health team.  And it is my strong belief that each of us must be listening and looking for clues as to how our bodies are functioning.  This means looking closely at our habits as well as at the ways our bodies are responding to life and to our habits.

The challenge is to be interested and involved detectives without becoming paranoid or overly self-absorbed. 

Here a suggestion: take a few very, very deep breaths right now. It feels good, doesn’t it?  Now if you haven’t felt this good feeling recently take a number of deep breaths in the day ahead. Deep breathing is such a stress reducer and nothing is better for our health than stress reduction!

Robert A. Hatcher MD, MPH
Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, Georgia

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