Uterine perforations with Copper T IUDs.

This study assesses the possible impact of uterine perforations and cervical perforations on the wider use of IUDs. Clinical data in cases of cervical and uterine perforations with Cu T 200 reported from various Indian centres participating in these trials were collected and analyzed. 4357 women (82384 women months of use) were investigated over a 54 month period. Of these 5 cases of cervical and 5 cases of uterine perforations were discovered. Results indicate that cervical perforations occurred several months to years after insertion. These perforations were asymptomatic and were recognized during routine examination. Removal was easy and the cervical tissues healed readily. All of the uterine perforations occurred in women who delivered 8-10 weeks prior to insertion. All the women were lactating and were amenorrheic. In 4 cases the uterus was small hyperinvoluted and freely mobile during insertion. All the perforations may have occurred at the time of insertion. At the time of removal the Cu T was surrounded by dense inflammatory adhesions. It is recommended that: 1) the addition of a terminal rounded bead to the lower end of the vertical limb of Cu T might reduce or prevent perforations 2) it might be preferable to postpone insertion of an IUD in lactating women until the uterus regains its normal size and menstruation returns and 3) Cu IUDs should be removed as early as possible following diagnosis of perforation. Health consequences of untreated perforations with Cu IUDs are greater than with inert devices like Lippes Loop.