MODIFICAZIONI MORFOLOGICHE ENDOMETRIALI NELLE PORTATRICI DI DISPOSITIVI INTRAUTERINI

The diminution of the number of births seems to stem from a widespread use of voluntary abortions and only partially from a correct use of contraceptive methods. The IUD is not without clinical complications, such as hemorrhage, pelvic or endometrial inflammation, possibly ectopic pregnancy, perforation of the uterus, and loss of the IUD itself. In several out-patient clinics in the province of Novara Italy the morphological and/or morpho-functional alterations of the endometrium were analyzed histologically and evaluated on a percentage basis after removal of the IUD and examination of adhering endocervical or endometrial tissue fragments. The total sample comprised 50 patients between the ages of 20 and 46. Removal of the IUD was performed between the 1st and 3rd theoretical date of the menstrual cycle. In 60\% of the patients sufficient endometrial material revealed, under the morphological aspect, that 50\% had superficial inflammation and pseudodeciduation, 46\% superficial dysplasia of the epithelium, 8\% papillary formation, 4\% superficial microthrombosis and 26\% granular tissue and/or exudative material. Under the functional aspect, the endometrium was in the regular menstrual phase, as expected, for 20\% of these patients, 18\% in the proliferative and 18\% in the secretory phase. The anomalous or phase-altering function and morphological alteration of the endometrium reacting to the presence of an extraneous device is probably one of the reasons for the contraceptive efficacy of the IUD. These well-documented endometrial and endocervical alterations do not contraindicate the use of the IUD but regular clinical and cytologic checkups are advised.