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| Double Uterus Shown on Ultrasound |
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| Unicornuate Uterus |
If your uterus is abnormal because you were born with something other than the naturally occurring egg shape you might need an operation called a Metroplasty. Metroplasty is a repair of the uterus named for Johannes Peter Müllee who was actually a famed ichthyologist of the 1800s. Women with bleeding, pain, or miscarriages should have the shave and cavity of their uterus evaluated.
If abnormally shaped they may be candidates for surgical repairs of their uterus. First step is diagnosis. Often the diagnosis of an odd shaped uterus is done with an ultrasound and one of a heart shaped uterus is shown above. x-ray image testing called hysterosalpingograms, with or without saline infusions, are helpful too. Hysterosalpingograpy with the use of ultrasound can be accurate enough for a diagnosis, or some physicians prefer a cat scan or MRI imagining before actually preforming surgery on the most complex uteri that exist. But video hysteroscopy is important as a diagnostic tool as well. Surgical repair of women born with abnormal shaped uterus, also called congenital uterine anomalies, is primarily directed toward those women with uterine problems that can be surgically fixed, including those with uterine septa (a short or longer wall down the middle), bicornuate uteri (two sectioned uterus), and obstructed hemi-uteri (very odd shape which essentially a half uterus), or a double uterus (called uterine didelphys) Usually these congenital uterine problems (anomalies) are repaired surgically only if these women have had symptoms, miscarriages, premature deliveries, poor growth during your pregnancy, breech pregnancies or medical problems such as very heavy periods. Women with the rarer one-sided uteri like unicornuate or arcuate uteri are generally not candidates for reconstructive procedures because surgery does not improve pregnancy outcome, but if infections or pain is your medical problem, get a consultation with your gyno you may need surgery! For women wanting an IUD it is possible to get one with these odd uterine shapes, but they are not as likely stay retained, and only the frameless IUDs not available in USA are really suited to be used with the uterine abnormalities. If you have had a surgical repair of a rare condition and a successful pregnancy, write us with your story!
Dr. Trupin, I'm going to be getting an IUD next week and I was wondering if you've heard of GyneFix. I don't think its available in the US yet, but it seems pretty great. http://www.contrel.be/GYNEFIX%20SPECIALISTS/gynefix.htm
ReplyDeleteI heard about it on this website: http://www.livejournal.com/tools/memories.bml?user=iud_divas&keyword=Gynefix&filter=all which is an amazing resource for any woman considering an IUD.
We don't have GyneFix yet in the US. Most women can be accommodated by the two IUDs we have here in the USA, ParaGard and Mirena. It is an interesting concept and they've been working on variations of frameless IUDs for at least a couple of decades that I have been aware of. They are easy to insert, they should be low cost. The "Fix" means adhere to the uterine wall, not to "change" the wall as I was discussing, but excellent point Thanks for that interesting comment. Any additional contraceptive alternatives are a welcome addition for women it will be good research to watch.
ReplyDeleteI know this post isn't about GyneFix, but I've been reading TONS about it and really wish it were available in the US. Do you know if it's an in-the-works thing at this point? It's been around a long time in Europe, so I would think so, but there doesn't seem to be much information out there about the possibility.
ReplyDeleteDefinitely coming back to your blog, btw. So much useful information!
I haven't heard if GyneFix is going to come into the US, but it's tough to bust into our market. The FDA makes drug and device development so difficult that a company has to want to invest a lot and be fairly sure of their investment to go ahead with development. Not many companies have women's health as their priority, and several drugs have been completely tabled as Big Pharmas have merged, like Lunelle. I was in some of the research trials of Lunelle, and it was very popular. There were a few manufacturing issues, and then one company was bought out by the other, and it was tabled. Oddly enough as I was writing this I happened to google to see if there was any recent Lunelle chatter and there was...so here's the link for anyone who might be interested!
ReplyDeletehttp://www.livestrong.com/article/13798-lunelle/
Thank you for the wonderful blog. If I may comment on your observation: "Not many companies have women's health as thier priority."
ReplyDeleteThis is also true for the FDA, especially when you consider how many products and medical devices have been approved for male-enhancement since 1999. That is how long it has been since GyneFix submitted their medical device for FDA approval. http://popline.org/docs/1290/140776.html
It's been more than 10 years. How long does it take the FDA to approve a modern, time-tested and medically proven device?
Meanwhile, GyneFix continues to grow in popularity among women overseas and Canada as a modern, safe and effective alternative for reversible, non-hormonal contraceptive device.
Currently, US women seeking such have only one choice (the ParaGard, which is most ideally suited for women who have given birth, although there are physicians who will consent to insert in women who have not).
GyneFix has been proven to have less side effects, less expulsion rate and to be as effective as oral contraceptives which is comfort and piece of mind to me.
-Jennifer S.
United States
Interestingly the journal Contraception just published a new article on the GyneFix:
ReplyDeletehttp://www.contraceptionjournal.org/article/S0010-7824(09)00046-8/abstract.
It was an excellent study of over 2000 women comparing the frameless IUD (GyneFix is essentially copper tubes hanging on a string) to a copper T type plastic device over 8 years. In the first year the frameless IUD had over a 5% rate of being expelled which was over double the copper T, they also had more insertion failures. In the second through the 8th year they were retained about the same and rates of pregnancies were almost double for the frameless (a bit over 1%) the copper T, the rates of pregnancies did rise for the next few years. But the rates of tubal pregnancies and pain were lower for the frameless IUDs although the rates were low for both. The information is very good, does show that it may be an important choice, but the device did not beat out the ParaGard in all categories!
But contraceptive alternatives are important for women and we need to keep up our dialog!
Thank you for your informative response. As a women seeking alternatives to hormone contraceptives, I truly appreciate this information as it will help me feel better about making a decision for the ParaGard. Perhaps my doubts and concerns about this device is that it is the ONLY option, which I still find disturbing. In your opinion, if you can provide one, is there a medical device monopoly being played out here?
ReplyDeleteIf there is, I'd probably be willing to make a trip to another country just to have a better device placed rather than hold my breath here. Or is the ParaGard the only ONE that is worthy of FDA approval for significant reasons?
Again, thank you for your time and your blog!
Jennifer S.
ParaGard has been a ground breaker, it's very difficult to get an IUD to the US market. It was first in practice one by one companies dropped IUDs until there were actually none offered in the US as larger companies were overly burdened by the cost/difficulty/issues of the continuing legal defenses that were necessary. Speculation regarding why research goes in a particular direction can be endless, and certainly economics are a big part of it. Since contraceptive pills have so many non-contraceptive benefits, there's been a lot of reason to focus research in that direction. It will be interesting to see if another IUD can make it to the US market! Maybe if patients are outspoken enough it will!
ReplyDeleteThe incidence of regret after sterilization has remained at approximately 1/5, do alternatives such as reversal of tubal ligations are important. For women over the age of 35 it's important to consider the option of in vitro fertiliation, or IVF, as for this age group success rates may be better at take home babies than tubal reversals. And first step for all considering making a baby, see your Gyno for a check up to make sure you would be ready to go once you take the steps that correct infertility!
ReplyDeleteNice post, i drop here as in search of 'Metroplasty'. Thanks for sharing such a valuable information.
ReplyDeleteI would like to share here information about:
Tubal reversal or tubal sterilization reversal or tubal ligation reversal is a surgical procedure in which fertility is restored to women after a tubal ligation. In this procedure separated segments of fallopian tube are rejoined, in simple words tubal reversal gives women the chance to become pregnant again naturally. This delicate surgery is best performed by a reproductive surgeon with specialized training and experience in the techniques of tubal ligation reversal.
Dr. Morice is one of the world's best tubal reversal experts. At ATCHAFALAYA(Dr. Morice’s Tubal Reversal center), Advanced tubal reversal surgery is performed with Microsurgical Tubal Reanastomosis (MTR).
mybabydoc.com
Just in response to the Gynefix Vs Paragard conversation, i would like to make a comment as i have experience of both.
ReplyDeleteI live in the US but was born in Europe. I was recommended the Gynefix by a friend who swore by it and i have to tell you she was right. It was so easy to deal with, granted slightly uncomfortable while bein inserted, but it was plain sailing after that. It has to be removed/renewed after 5 years and as i was still not wishing to concieve at this time, I chose to have another fitted. Then I moved to the US.
Unfortunately, after 2 years, this Gynefix expelled itself. It was easily noticed so I wasnt under any danger of getting pregnant because i was aware of it. I would've liked another Gynefix but was made aware it wasnt available in the US and so i opted for the Paragard as i prefer hormone-free birth control.
I now have the paragard for the last 8 months and i cannot wait to have it removed. The only reason I haven't yet is the lack of alternative options. The amount of cramps/bleeding/mood swings is 10 fold to that of the gynefix. My body feels like its constantly trying to expel something and its affecting my eveyday mood. While i realise this might only by my body's reaction, there are numerous blogs on this subject which, of course, I only found after.
The women in the US are really missing out by noy having the option of the Gynefix. Is it not about choices?
The more choices we have the better. We always advise our patients with the symptoms that you have including pain, cramps, bleeding and mood swings to get medical evaluation. There are a number of potential treatments even while keeping the IUD.
ReplyDeletePhysicians never endorse buying medication online as you do not get proper diagnosis, dosage, treatment monitoring, in addition to not knowing what you are getting.
ReplyDeleteVery nice and informative post.
ReplyDeleteHi Dr. Trupin,
ReplyDeleteI am planning to get a copper IUD inserted and I was wondering if you knew whether copper IUDs (after insertion) are detected by airport metal detectors. I plan to be traveling with my ultra-conservative family in the near future and would like to avoid explaining to them why I set off their alarm...
Many thanks!
With regards to whether airport metal detectors can pick up the copper IUD we spoke with Takisha at ParaGard (877/727-2427). According to their data from the TSA, the imaging scanners (full body or hand held scanners) used at the airport do not detect medical implants beneath the surface of the body. ParaGard has not done any testing to verify. Typically women who go through the metal detectors do have zippered clothing and eyeglasses with metal in their frames and that usually doesn't fire the alarms, and both do contain more metal than in the Paragard, which is very little. I suspect the whole body scanners which are like "seeing naked" would show an IUD, but no one but the TSA agent would see that, not parents accompanying an individual. Have safe and wonderful travels!
ReplyDeleteThat's great news. Thank you very much for the quick reply!
ReplyDeleteAll the times when i see this blog a name blinked in my mind that is Dr Morice..
ReplyDeleteHe is the man much more experienced in women issues..
i think all the women must visit mybabydoc.com to learn the solution of their problems..
I realize this is an old post, but I wanted to add my experience with Gynefix! As a resident of the US, I flew to Vancouver to have mine inserted. I have had it about a week short of a year. As a nulligravid woman, I felt it was my best option, and I have been thrilled with my decision. I have extremely heavy bleeding, but never the first cramp, and insertion wasn't much more than uncomfortable.
ReplyDeleteIf anyone has come across this page looking for more info on Gynefix, there is a lot to read on the livejournal community IUD_Divas.
It is possible for women to get IUDs in other countries when they want an IUD that is not available here. Regulations make it very difficult for a physician to import a non-approved device for use. It may also be more difficult to get insurance coverage for devices that are not approved for use here. The Gynefix IUD is a frameless one, and it's inserted and theoretically will dissolve over time and not need removal. The ParaGard IUD is an excellent alternative for women who want a non-medicated IUD since the Gynefix IUD is only available in other countries, and most women can be fitted for this IUD. ParaGard IUDs are also able to be easily removed. To my knowledge there are not even any clinical trials of it in the USA or plans to bring Gynefix IUD here.Interesting that women are having good experiences with these devices.
ReplyDeleteI had a GyneFix fitted yesterday (I live in the UK) and so far there have been very few cramps and little bleeding, despite a difficult insertion (my muscles were too tight for the sound, and took lots of... convincing). I'm nulliparous, have a smallish uterus, cannot take hormonal contraception and have menorrhagia already: the GyneFix is the only IUD I would have considered so readily. The ParaGard would have been totally disasterous for me, however well it worked for someone else.
ReplyDeleteIt's astonishing for anyone outside of America to learn how limited the range of available IUDs are there: even the newer, smaller framed IUDs (like the Flexi-T) which are absolutely standard in England are not available in the US. Every woman is different and IUDs are not one-size-fits-all. A Paragard may be fine in itself, but it won't work for lots of women: some will get on better with a Flexi-T, some with a GyneFix... women need, and deserve, access to as wide a range of devices as is possible, so that they can make their own decisions about their body. If it is safe and correctly tested then it should be available.
As the reader in this comment thread so importantly points out is it is important to ave a variety of safe and effective contraceptive choices, and I understand there is a smaller version of Mirena which is in the final stages of testing and approval in the US. One thing I try to remind the providers at WomensHealthPractice.com is that contraception eduction of our patients is important and that many women do not know the variety of choices that we have. Thank you to the reader for that message.
ReplyDelete