NO RELATIONSHIP BETWEEN THE IUD POSITION EVALUATED BY ULTRASOUND AND COMPLAINTS OF BLEEDING AND PAIN

The objectives of this study were to define the ''normal'' position of the T-shaped intrauterine device (IUD) in the endometrial cavity, usi ng transvaginal ultrasound, and to compare the IUD's position in women with and without complaints of bleeding and/or pain. Vaginal ultrasou nd was carried out in women who had used a T-Cu 200 or T-Cu 380 for at least 6 months. Of these women, 236 registered bleeding complaints an d/or pain and 245 had no complaints. The distances, IUD-endometrium, I UD-myometrium, and IUD-fundus, were measured in each woman. Our result s showed that women with and without complaints presented no significa nt differences in age, parity, type of IUD, duration of use, previous contraceptive method used, hysterometry, uterine position, or period o f the cycle in which the ultrasound was performed. The values of the t hree distances in users without complaints were widely dispersed. The 90th percentile of the IUD-endometrium, IUD-myometrium, and IUD-fundus distances were 7, 11, and 27 mm, respectively. The curve of the value s for the three distances among women with complaints was similar to t hat of the subjects without complaints. Using the generally accepted m easurement of 20 or 25 mm as the limits of normality of the distance I UD-fundus, and the 90th percentile of the distance IUD-endometrium as the gold standard, 77% and 43% of the women were false positives for ' 'incorrect IUD position.'' Similar results were obtained when the 90th percentile of the distance IUD-myometrium was used as a gold standard . We concluded that the 90th percentiles of the distance IUD-endometri um, IUD-myometrium, and IUD-fundus were 7, 12, and 27 mm, respectively , among users without complaints. The ultrasonographic diagnosis of th e IUD position was unable to discriminate between women who did or did not have complaints of bleeding and/or pain. If ultrasound were to be performed in T-shaped IUD users, the IUD-myometrium distance is Likel y to be the most reliable measurement. (C) 1997 Elsevier Science Inc. All rights reserved.