Dean L. Moyer

The intrauterine device: A bacteriologic study of the endometrial cavity

Bacterial and histologic studies were performed on endometrium obtained by 2 methods in 2 different groups of patients wearing the IUD. The first group consisted of 75 patients schedules to have elective vaginal hysterectomies in association with culporrhaphy for symptomatic uterine and vaginal relaxation. The second group was made up of 253 patients who elected to use the IUD as a contraceptive. Cultures were obtained transfundally after hysterectomy in the first group and transcervically in the second. The incidence of sterile endometrial cultures was significantly greater when the transfundal method was employed. Using this method of obtaining cultures, it was found that positive endometrial cultures were obtained from all uteri in which the IUD had been inserted within the previous 24-hour period. The incidence of positive endometrial cultures rapidly diminished at the time after insertion increased, so that after 1 month had elapsed since insertion of the IUD, all the endometrial cavities examined were sterile . The results of the study confirm the statements of others that the occurrence of clinical infection of the upper genital tract in patients having the IUD with nylon threads protruding into the vagina is usually due to an unrelated cause such as coital infection. Even when the threads passes through contaminated endocervical mucus, sterile cultures were obtained from the portion of the threads within the endometrial cavity as well as from the loop itself.

Contraception by means of a silastic vaginal ring impregnated with medroxyprogesterone acetate.

Cylindrical rings, made of silicone rubber impregnated with medroxyprogesterone acetate were placed in the vaginas of 3 regularly menstruating women on the first cycle day. Silastic rings without medication were used in 3 controls. During the 28 days that the rings were in place, there was continuous systemic absorption of the progestogen as evidenced by elevation of the basal body temperature, shift in maturation index, abolition of the midcycle LH peak, and change in the endometrial histology. In the 3 controls, no significant alterations occurred in any of the parameters measured (BBT, vaginal cytology, endometrial biopsies and gonadotrophins) as compared with the cycles before and after insertion of the ring. After removal of the rings in the test group, the advent of withdrawal bleeding and a fall in the basal body temperature indicated a prompt termination of drug activity. Presumptive evidence of ovulation followed shortly thereafter. It is hoped that this method of administering a progestogen may be developed for family planning.

The Effect of Medroxyprogesterone Acetate on Endometriosis in the Human Female

The effect of Depo-Provera (medroxyprogesterone acetate) alone or w ith various estrogens was studied in 14 patients with endometriosis. A ll the paitents except 1 were followed for 13-62 months. Depo-Provera was administered in doses of 100 mg every 2 weeks for a total dosage of 1000-2000 mg. The drug had an effect lasting 4-7 months after the last injection. The effect on endometriotic tissue was striking and was similar in many respects to those conditions occurring during pregnancy. Except for spotting and breakthrough bleeding side effects were less frequent than those reported for oral progestins and estrogen-progestogen combinations. It is concluded that Depo-Provera is a potent long-lasting progestational agent which is highly useful as an adjunct to surgery in cases of advanced endometrial lesions.