IUDs and PID: a comparative trial of strings versus stringless devices

Abstract

An international multicentered clinical trial was designed to determine the possible role of intrauterine device (IUD) marker strings in the etiology of pelvic inflammatory disease (PID). A total of 1265 women were admitted and randomly allocated to receive either a standard TCu200 IUD or a TCu200 IUD without marker strings. These patients were followed-up through 12 months postinsertion. No statistically significant differences were found between the two groups of IUD users with respect to the incidence of PID or other types of infection or inflammation. The 12-month life table termination rates and overall continuation rates were also similar for users of the respective devices, with the exception of removal rates for bleeding/pain, which were significantly higher in the strings group than in the stringless group. However, the number of bleeding/pain complaints ever reported during the study were not statistically different in the two study groups. The study results indicate that the IUD string does not play an important role in the etiology of PID associated with the use of IUDs.

A bill of health for the IUD: Where do we go from here?

“…One such example is the question of whether there is an association between IUD tails and PID. While Batar et al [59] suspected that the IUD tails may play an important role in the etiology of PID, Ports et al [60], in a study of 1265 women randomly fitted with a Copper T-200 IUD either with or without marker strings, reported no significant difference in the incidences of PID between the two groups. If the tail facilitates transport of bacteria to the upper genital tract, this effect should persist over the lifespan of the IUD [61].…”

Copper IUDs, infection and infertility

“…Of copper devices, those with threads carry no added risk of PID compared to those without threads,17 , 18 while those containing above 300mm of copper appear to carry the lowest risk of PID (e.g. 0.0 per 1000 women-years with Multiload 375 vs. 3.26 with Multiload 250) 16…”

Genital tract infections associated with the intrauterine contraceptive device can be reduced by inserting the threads into the uterine cavity

“…A recent similar study was conducted on 1265 women, randomly allocated to receive either a conventional TCu200 device or one from which the tail had been removed (Potts et al 1991). There were virtually no differences between the groups although a similar number of complaints of pain and bleeding encouraged significantly more removals of the conventional device.…”