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Microsoft word - bft_a4_factfile_1.doc

T h i s p a g e a n d i t s c o n t e n t s M I R E N A C O I L F O R H E A V Y P E R I O D S t h e B r i t i s h F i b r o i d T r u s t Dr Nicki On, PhD, MRPharmS. Pharmacist Dr Rajesh Varma, MA, PhD, MRCOG. Consultant Obstetrician & Gynaecologist. Website address: www.britishfibroidtrust.org.uk 1. An IUS (intrauterine system), commonly know as a coil, is a small T-shaped plastic device which slowly releases a progestogen hormone. This is similar to the natural progesterone 2. In UK, the IUS is available as Mirena. In fact, contraceptive pills. The hormone is housed Mirena has also been shown to be effective in polydimethylsiloxane. This is surrounded by a managing symptoms of other gynaecological conditions, such as fibroids, endometriosis, adenomyosis, endometrial hyperplasia and released from IUS at an initial rate of 20 premenstrual syndrome. However, Mirena is presently not licensed to be used as a treatment 3. The T-shaped frame also contains barium sulphate so that it can be seen on x-rays. 4. There are two fine threads, made of iron oxide and polyethylene, attached to the bottom of the frame. The fine threads allow easy removal and allow you or your gynaecologist to check heavy menstrual bleeding by controlling the monthly development of the lining of your The hormone in the coil prevents pregnancy Contraception: This is the main use, which is an effective, long term and reversible method of contraception. Once Mirena coil is placed cervix, which makes it difficult for the hormone levonorgestrel over a period of 5 Heavy menstrual bleeding (Menorrhagia): It overstimulation in women who have a uterus (womb) and wish to use Oestrogen replacement therapy HRT There is strong scientific evidence showing that Acne (usually less common after 3 months of it reduces the monthly blood loss in 90% of treatment, and may improve if acne already women who use the system. In 20% of women fitted with Mirena, periods may stop altogether with the reduction in blood loss being gradual Headaches or migraines (although headaches may lessen in many users; in others, they Generally, you see reduction in blood loss in 3 to may increase in number or become worse). 6 months after insertion. There is evidence showing about 86% reduction in blood flow at 3 months and 97% reduction at 12 months after emotional disturbances, it may be more likely fitting. You may have an increase in bleeding. for you to have a recurrence while using the however, usually in the first 2-3months, before a reduction in blood loss is achieved. If a significant reduction in blood loss in not Some develop small fluid-filled cysts on the ovaries. Often, these cysts do not cause Many gynaecologists now believe that Mirena is an important alternative to a hysterectomy and pelvic pains. These cysts are not dangerous and usually do not need to be treated and disappear without treatment. Women using the Mirena coil are more likely to develop benign ‘simple’ ovarian cysts. The most It is very effective in reducing menstrual blood abdominal pain that does not resolve with Once fitted, it lasts 5 years. Women who are in disappear without treatment in 2–3 months their forties will require one or two Mirena IUS Pelvic infection. The Mirena coil is designed to minimise the risk of infection, but there is still a slight risk of developing a pelvic infection while using the coil, particularly in the first 3 weeks after fitting. Such infections are usually related to sexually transmitted diseases, and you are more likely to develop an infection if you or your partner has several women will develop an infection with 5 years use of the coil. You can reduce your risk of developing an infection by using a condom Typically, about half of the women who suffer with heavy bleeding also complain of painful significantly improves period pains in over 96% should be removed. Embedment can result in of users, in addition to reducing the monthly difficult removal and, in some cases surgical removal may be necessary. Decreased libido (sex drive). This is not officially reported but was raised by a number of women on health's forum. During 20 days after fitting, there is a small chance of getting an infection. It is advisable to make sure there is no existing infection You can not have an IUS if you have or in the The IUS can be expelled (pushed) out by your womb or can move. This is more likely to happen soon after fitting, You may not be aware of it. It is important you learn how to While fitting, there is low risk of perforation (puncture) of your womb or cervix. The risk of perforation may be increased in lactating uteri, and during the postpartum period. The A heart attack or stroke or infection of risk is low when the coil is fitted by an experienced gynaecologist or gynaecology practice nurse. Perforation can cause pain There is a small risk of ectopic pregnancy if you fall pregnant while you are on the IUS. Levonorgestrel may affect glucose tolerance, and the blood glucose concentration should be There are alternative medical or surgical options. Mirena can be removed at any time. Ideally it should be removed during the time of a period, or another reliable form of contraception used for seven days leading up to the time of the Mirena removal. This ensures that there is no Hysterectomy to remove the fibroids and womb. Usually, fitting is arranged within 7 days after Before putting it in the gynaecologist or Visit your gynaecologist. You should visit having the Mirena coil inserted, and every 12 Check in place. In about 5-6% of women, the You may be given antibiotics at the same muscular contractions of the womb push the coil out of place or expel it from the uterus. A pain killer or local anaesthetic may be This is most likely to occur in the first few given to make you feel comfortable during The procedure takes about 15-20 minutes. Seek immediate medical attention if any of the because you may accidentally pull out the coil. Signs of a blood clot in the leg (sudden unexplained pain in the leg, especially in Signs of a blood clot in the lungs (sudden or unexplained shortness of breath; chest You may be able to feel the lower end of the Mirena can be felt (this often feels shortness of breath; nausea; cold sweats; Signs of a stroke (such as sudden slurring the expulsion initially, but later you will bleeding pattern and eventually a return If this is problematic, see your gynaecologist. He/she may tuck the strings behind the cervix, If dislodgement or expulsion happens, contact cut the strings shorter, or in more extreme your gynaecologist immediately. In the absence cases cut the strings to level with the cervix. of the coil, you loose the protection against The disadvantages of cutting the strings even pregnancy and it is advisable to use another with the cervix include your difficulty in method of contraception until you see your checking the IUS in correct placement, and the subsequent complicated removal at the later There is a small risk of you becoming pregnant If you experience any of the following, check with (less than 0.2%). However, if you do, there is a your gynaecologist/doctor to see if you should small increased risk of you having an ectopic pregnancy (development of fertilised egg outside the uterus) and your gynaecologist will have to (regular or irregular cycle lengths) or inter- remove the coil whether you want to continue bleeding, which persists after 6 months of If you think you might be pregnant or have a sudden or unusual pain in your lower abdomen, seek medical advice immediately. This might be the warning signs of an ectopic pregnancy. Recurrent inflammation of the lining of the The following medications may interact with Anti-epileptics: Lamotrigine (Lamictal), Generally, IUS removal is easiest if it is done gynaecologist or gynaecology practice nurse uses a pair of forceps to take hold of the IUS's If for some reasons, the coil is "lost" because the thread can not be felt or seen on speculum various thread collector devices or simple pressure medicines): bosentan (Tracleer). forceps to try to grasp the IUS device through Anti-neoplastics (anticancer):bexarotene the cervix. When this fails, which is rare, an ultrasound scan may be arranged to check the position of the coil and exclude its perforation through into the abdominal cavity or its unrecognised previous expulsion. Hysteroscopy If you develop a pelvic infection, it must be After removal, normal fertility returns within 3-6 immediately if you begin experiencing persistent weeks. Nearly 80% of women are able to conceive within 12 months. This might not be the case for intercourse or abnormal bleeding as these you because the presence of fibroids may further symptoms may indicate a pelvic infection. If you develop a pelvic infection, the coil should be So far, the normal practice has been to remove Varma R, Sinha D, and Gupta JK. Eur J Obstet guidelines. This conservative approach has not been based on any robust scientific evidence. recent investigation by Smeets et al.(Ref. 3). The final decision whether to remove the coil A J Smeets, R J Nijenhuis, P F Boekkooi, H before UAE procedure or not rests solely on Vervest, W Jan van Rooij, and P N Lohle. J Vasc your interventional radiologist who will carry out the UAE/UFE, taking into consideration your symptoms, the sizes and locations of The following is a list of medical terms used in this factfile, accompanied by a brief definition. Endometrial hyperplasia results in thickening of NICE. National Institute for Health and Clinical the lining of the womb by using energy source to block the blood supply to the fibroids. or in the muscle layer of the uterus (womb). This FACTFILE provides primarily information which is intended for educational purpose only. All contents within this factfile should not be treated as a substitute for the medical advice of your own doctor or gynaecologist or any other health care professional. s is not responsible or liable for any diagnosis made by a user based on the content

Source: http://www.britishfibroidtrust.org.uk/Factfiles/Mirena_BFT_A4_Factfile_1.pdf

Microsoft word - saraceno_2006_archive

Benedetto Saraceno, MD Director Department of Mental Health and Substance Abuse World Health Organization 20, avenue Appia 1211 Geneva, Switzerland Phone: +41 22 791 3603/3634 Fax: +41 22 791 4160 Subject: Important Archives Of Psychiat article ALLIANCE FOR HUMAN RESEARCH PROTECTION (AHRP) Promoting Openness, Full Disclosure, and Accountability http://www.ahrp.org Shankar Vedantam of The Washingto

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