الفهرس 
Anatomical and MicrobiologicalOnly 14 pages are availabe for public view
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Abstract
Nowadays the IUD is the most commonly used method of reversible contraception worldwide. Hormonal IUD is one of the recently introduced methods of contraception. It is of great effectiveness and has excellent patients’ tolerance. It has initial high cost, but over years it is one of the most cost-effective methods of contraception. It is an ideal contraceptive method for women with underlying medical troubles as diabetes mellitus, women having HIV or in women at increased risk of bleeding due to either inherited bleeding disorders or use of anticoagulation.
There are different brands of the hormonal IUD available all over the world. Jaydess is the Levonorgestrel 13.5 mg intrauterine delivery system. Mirena is the Levonorgestrel 52 mg intrauterine delivery system. Levosert was only introduced to Britain in 2015 which contains 52 mg of Levonorgestrel as well. The main difference between it and the older product is that Levosert is only licensed for three years’ use. Locally manufactured hormonal IUS is also present at Ain Shams University Maternity Hospital with competitive results.
In this study Pap smear was taken prior to insertion of hormonal IUS and another one taken 6 months later to detect changes in vaginal flora. Vaginal flora is classified according to the lactobacillary grading set by Schroder and further refined by Donders.
Participants should have fulfilled the inclusion criteria. Proper history taking, examination and informed consent with complete confidentiality were applied.
210 participants were included in the study having pap smear prior to insertion of hormonal IUS with 9 of them lost during follow up and 201 had a follow up visit 6 months later with another pap smear for study of change of vaginal flora.
It has been revealed in this study that a significant worsening in the vaginal flora has occured following LNG-IUS insertion and this was shown as increased incidence of vulvovaginitis 6 months after insertion of hormonal IUS. This study showed that more than half (57.2%) of the studied cases developed worse changes. Thus, a significant worsening in the vaginal flora was found after LNG-IUS insertion.
Conclusion:
Significant worsening in the vaginal flora was found 6 months after LNG-IUS insertion. This study has showed that 7% of cases had abnormal Pap smear findings before LNG-IUS insertion and it became 52.7% after six month from insertion. Most of this abnormal smear is of grade III (38.8%) followed by grade IIb (13.9%).
Also, the percentage of change in Pap smear which reflect the change of vaginal microflora towards the pathological one showed that more than half (57.2%) of the studied cases developed worse changes.
Recommendation:
Thus, each woman having IUS inserted should be counselled carefully about the risk of vulvovaginitis and health education regarding early detection of evoloving infection or any change in nature of vaginal discharge. Also good practice of self-hygiene should be educated and well applied. Hormonal IUS users may also be candidate for Pap smear for early detection of changes in vaginal flora.