The Contradictive Findings between Ultrasound, Hysteroscopy and Cytokines in Women with Non-hormonal IUD'S Suffering from Metrorrhagia: A Prospective Study

Abstract

Abstract Purpose: The objective of this study is to assess the correlation between bleeding irregularities and the accurate placement of the IUD device in the uterine cavity, determined through transvaginal ultrasonography and hysteroscopy. Additionally, the study aims to examine the cytokine profile in the uterine cavity and serum of patients experiencing bleeding irregularities after the insertion of non-hormonal IUDs. Methods: A prospective cohort study was conducted at a single Tertiary medical center, wherein patients experiencing intermenstrual bleeding and spotting after the insertion of non-hormonal IUDs were enrolled. The study involved hysteroscopic and sonographic assessments of the uterine cavity and IUD placement, along with the analysis of blood and uterine cavity cytokine profiles. Results: During the period between July 2019 and February 2020, a total of eight patients who experienced intermenstrual bleeding and spotting after the insertion of non-hormonal IUDs were enrolled in the study. One case was excluded since a progestative device was detected by ultrasound. Out of the five cases that underwent a thorough ultrasonographic assessment, 3 cases (60%) showed an embedded IUD. However, these findings were excluded by the hysteroscopic evaluation. Conclusion: The results suggest that ultrasonographic assessment may lead to an overdiagnosis of IUD mispositioning compared to hysteroscopy. Additionally, both ultrasound and hysteroscopy have limitations in diagnosing the cause of bleeding in most cases. The role of local reactive inflammatory cytokines should be further studied.