TITLE:
Change in Vaginal Flora as Indicated by Pap Smear (Schröder’s Classification) in Women Using Levonorgestrel-Releasing Intrauterine System “Mirena”—Prospective Cohort Study
AUTHORS:
Malames M. Faisal, Magdy M. Abdel-Gawad, Ragia A. Fahmy, Mona S. Nour, Marwa M. Shakweer, Ahmed H. Abdel-Hakim
KEYWORDS:
IUD, Bacterial Vaginosis, Lactobacilli, Vulvovaginitis, Mirena, Contraception
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.9 No.5,
May
15,
2019
ABSTRACT: Background: The use of intrauterine device alters the normal balance
between vaginal flora. It might change cervicovaginal environment, which was suggested
to increase the risk for vulvovaginitis. It was found that up to 85% of levonorgestrel-releasing intrauterine system users become amenorrheic
4 months after insertion, or bleed only sporadically. It was hypothesized that this would have a beneficial
effect on vaginal flora maintaining normal balance. Objectives: The aim of
this study was to detect the effect of hormonal intrauterine system (“Mirena”: 20
microgram/24 hours intrauterine delivery system Levonorgestrel) on vaginal flora
by using pap smear before and 6 months after insertion. Study design: A prospective cohort study was carried out in a university
maternity hospital. 210 subjects were included with pap smear taken at time of insertion
of IUS “Mirena” and another one taken 6 months later to detect percentage of incidence
of infection in IUS users. Vaginal flora was studied, and lactobacilli were graded according to Schr?der’s
classification. A comparison was made to allow detection of changes in vaginal flora
caused by presence of hormonal IUS “Mirena”. Results: Over half of cases
(57.2%) showed worse vaginal flora after hormonal IUS “Mirena” insertion than before.
There was a highly statistically significant difference between Schr?der’s Grades
before and after insertion (P value Conclusion: Insertion of hormonal
IUS “Mirena” results
in significant change in microbial flora towards pathological bacteria.