Demet KOKANALI, Serap AKBAY, Müzeyyen Gülnur ÖZAKŞİT

Bakırlı ve levonorgestrelli rahim içi araçların servikal sitolojiye etkileri

Amaç: Bakırlı ve levonorgestrelli Rahim içi araç (RİA) uygulanan kadınlarda, RİA uygulaması öncesi ve sonrası servikal sitolojide herhangi bir değişiklik olup olmadığını araştırmakGereç ve Yöntemler: Bakırlı ve levonorgestrelli RİA uygulanan kadınların, RİA öncesi ve sonrası Pap smear sonuçları retrospektif olarak incelenmiştir. Çalışma preparatlarının tamamı konvansiyonel Pap smear örneklerinden oluşmuştur.Bulgular: Çalışmaya dahil edilen kadınların 52 tanesine bakırlı, 24 tanesine levonorgestrelli RİA uygulanmıştır. Tüm kadınlar RİA öncesi normal sitolojik inceleme sonucuna sahipti. RİA sonrası örneklerde, İki grupta da atipi ya da kanser olgusuna rastlanmadı. Bakırlı RİA grubunda 20 kadında (38.5%) non-spesifik inflamatuar değişiklik ve 6 kadında (11.5%) ASC-US mevcutken, levonorgestrelli RİA grubunda bu sayılar sırasıyla 10 (41.7%) ve 3 (12.5%) idi. İki grup arasında RİA uygulaması sonrası Pap smear sonuçları açısından istatistiksel olarak anlamlı bir fark yoktu. Sonuç: Bakırlı ve levonorgestrelli RİA kullanımı neoplazi gelişimine neden olmaz. Fakat endometrial ve servikal hücreler üzerinde bir takım benzer inflamatuar değişiklikler yapabilirler.

Anahtar Kelimeler:

bakır, levonorgestrel, rahim içi araç, smear

The effects of copper- and levonorgestrel-intrauterine devices on cervical cytology

Objective: To investigate whether there is any change in cervical cytology before and after Copper- and Levonorgestrel-Intrauterine device (IUD) insertion.Material and Methods: Pap smear results before and after Copper- and Levonorgestrel-IUD were evaluated retrospectively. All of the study specimens consisted of conventional Pap smear samples.Results: Among the women included in the study, 52 of them were inserted copper- and 24 levonorgestrel-IUD. All women had normal cytological examination results prior to IUD. There were no cases of atypia or cancer in the two groups after IUD. Non-specific inflammatory changes in 20 women (38.5%) and ASC-US in 6 women (11.5%) were found in the copper-IUD group, whereas 10 (41.7%) and 3 (12.5%) women were present in the levonorgestrel -UD group, respectively. There was no statistically significant difference between the two groups in terms of Pap smear results after IUD insertion. Conclusion: Copper- and levonorgestrel-IUD do not cause neoplasia. But they may lead to similar inflammatory changes on endometrial and cervical cells.

Keywords:

copper, levonorgestrel, intrauterine device, smear,

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Heinemann K, Reed S, Moehner S, Minh TD. Comparative contraceptive effectiveness of levonorgestrel-releasing and copper intrauterine devices: the European Active Surveillance Study for Intrauterine Devices. Contraception. 2015 Apr;91(4):280-3.doi: 10.1016/j.contraception.2015.01.011. Epub 2015 Jan 16.
Ajah LO, Chigbu CO, Ozumba BC, Oguanuo TC, Ezeonu PO. Association of Intrauterine Device (IUD) and Cervical Neoplasia - A Study in a Poor Nigerian Population. J Clin Diagn Res. 2016 Jun;10(6):QC05-8. doi: 10.7860/JCDR/2016/18328.8049. Epub 2016 Jun 1.
Pal N, Broaddus RR, Urbauer DL, Balakrishnan N, Milbourne A, Schmeler KM, et al. Treatment of Low-Risk Endometrial Cancer and Complex Atypical Hyperplasia With the Levonorgestrel-Releasing Intrauterine Device. Obstet Gynecol. 2018 Jan;131(1):109-116. doi: 10.1097/AOG.0000000000002390.
Pillay B, Gregory AR, Subbiah M. Cytopathologic changes associated with intrauterine contraceptive devices. A review of cervico-vaginal smears in 350 women. Med J Malaysia. 1994 Mar;49(1):74-7.
Solomon D, Davey D, Kurman R, Moriarty A, O'Connor D, Prey M et al. The 2001 Bethesda system terminology for reporting results of cervical cytology. JAMA 2002; 287:2114–9.
Misra JS, Engineer AD, Tandon P. Cervical cytology associated with levonorgestrel contraception. Acta Cytol 1995;39:45–9.
Lessard T, Simões JA, Discacciati MG, Hidalgo M, Bahamondes L. Cytological evaluation and investigation of the vaginal flora of long-term users of the levonorgestrel-releasing intrauterine system (LNG-IUS). Contraception. 2008 Jan;77(1):30-3. Epub 2007 Nov 26.
Bariş Iİ, Keleş AN. A review on the impact of IUD in cervical cytology: Mardin Region Data. Turk Patoloji Derg. 2013;29(1):51-7. doi: 10.5146/tjpath.2013.01148.
Erol O, Simavlı S, Derbent AU, Ayrım A, Kafalı H. The impact of copper-containing and levonorgestrel-releasing intrauterine contraceptives on cervicovaginal cytology and microbiological flora: a prospective study. Eur J Contracept Reprod Health Care. 2014 Jun;19(3):187-93. doi: 10.3109/13625187.2014.900532. Epub 2014 Apr 17.
Kazerooni T, Mosalaee A. Does contraceptive method change the Pap smear finding? Contraception 2002; 66:243-6.
Castellsagué X, Díaz M, Vaccarella S, de Sanjosé S, Muñoz N, Herrero R et al. Intrauterine device use, cervical infection with human papillomavirus, and risk of cervical cancer: a pooled analysis of 26 epidemiological studies. Lancet Oncol. 2011 Oct;12(11):1023-31. doi: 10.1016/S1470-2045(11)70223-6. Epub 2011 Sep 12.
Cortessis VK, Barrett M, Brown Wade N, Enebish T, Perrigo JL, Tobin J, et al. Intrauterine Device Use and Cervical Cancer Risk: A Systematic Review and Meta-analysis. Obstet Gynecol. 2017 Dec;130(6):1226-1236. doi: 10.1097/AOG.0000000000002307.
Hasçalık Ş, Çeli, Ö, Karadağ N, Aydın E. Rahim İçi Araç Kullanan Kadınlarda Servikal Sitolojik Değişiklikler. Turgut Özal Tıp Merkezi Dergisi 2000; 7(3):220-1.
Tao MH, Hong Xu W, Zheng W, Zhang ZF, Gao YT, Ruan ZX, et al. Oral contraceptive and IUD use and endometrial cancer: A population-based case–control study in Shanghai, China. Int. J Cancer 2006; 119:2142–7.
Guleria K, Agarwal N, Mishra K, Gulati R, Mehendiratta A. Evaluation of endometrial steroid receptors and cell mitotic activity in women using copper intrauterine device: Can Cu-T prevent endometrial cancer? J Obstet Gynaecol Res 2004, 30: 181–7
Ortiz ME, Croxatto HB. Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action. Contraception. 2007 Jun;75(6 Suppl):S16-30. Epub 2007 Mar 29.

Yayın Aralığı: Yıllık
Başlangıç: 2017
Yayıncı: Balıkesir Üniversitesi

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