Pelvic inflammatory disease in intrauterine device users

Abstract

Pelvic inflammatory disease (PID) has been associated with the use of intrauterine devices (IUDs) ever since they were introduced. In several mostly retrospective studies the incidence of PID was suggested to be as high as three- to ninefold in IUD users compared to non-users. Later epidemiological prospective studies showed a considerably lower risk comparing different types of contraception. Compared to non-contraceptive users the relative risk ranged from 1.8 in patients with copper-containing IUDs to 3.3 in patients using the older insert IUDs like the Dalkon Shield. More recent studies indicate that PID among IUD users is strongly related to the insertion process and to background risk of sexually transmissible disease. The incidence rate of PID decreases from 9.66 per 1000 woman years during the first 20 days following insertion to 1.38 per 1000 woman years beyond the first 20 days. This incidence is similar to the incidence in non-IUD users. PID is more prevalent in younger single women with different sexual partners. Nulliparous women with stable monogamous relationships are not at higher risk of PID than parous women. In conclusion, IUD users, selected for low risk of sexually transmissible disease, do not have excess PID. Proper counselling and selection is of the utmost importance. As there is a higher risk shortly after insertion, limiting IUD replacements will help diminish PID incidence.

Characteristics of women at low risk of STI presenting with pelvic inflammatory disease

“…Also, in our study, pelvic pain was the most common presenting symptom at first PID episode, which is usually reported to be the key symptom of for the provisional diagnosis of PID 4,5,11,24,[26][27][28][29] .…”

“…One of the muchdebated issues is whether IUD use as such increases a woman's risk of PID, independently of other risk factors for developing the disease. Whereas many studies in the past suggested that IUD use was an independent risk factor for PID development, more recent studies have claimed that this is not the case, except at the time immediately (21 days) following IUD insertion 24 .…”

Contraception and pregnancy in women affected by glycogen storage diseases

“…In a review of 28 clinical studies including 25,674 women of whom 42.5% were nulliparous, Struthers reported a PID rate of 1.49 PID/ 100 women-year [25]. The risk of PID was later estimated to be 1.8 fold more important for Cu-IUD users than for non-contraceptive users, with a maximum incidence in the first 20 days [4]. Because of this risk, the use of UID in nulliparous women is controversial, even if stable monogamous relationships seem to protect from PID.…”

Correlation of PID and multiparity: a case control study

“…A study done by Beerthuizen found that nulliparous women are not at higher risk of PID than multiparous women. 12 A longitudinal study conducted by Wright demonstrated no relationship between the parity and the development of PID. 13 In itself delivery is not a risk factor for PID but delivery in untrained hands is a risk factor.…”