[Intrauterine device and pelvic inflammatory disease: Myth or reality?]

Area of Science:

• Reproductive Health
• Contraception
• Infectious Disease

Background:

• Intrauterine devices (IUDs) are effective, reversible contraceptives.
• Historical concerns link IUDs to pelvic inflammatory disease (PID), primarily due to the Dalkon Shield.
• Modern IUDs and improved medical practices have significantly altered this risk profile.

Purpose of the Study:

• To evaluate the current risk of PID associated with IUD use.
• To identify factors influencing PID risk in IUD users.
• To inform clinical practice regarding IUD recommendations.

Main Methods:

• A narrative review of 22 studies published between 2000 and 2016 from the PubMed database.
• Analysis focused on identifying risk factors and incidence rates of PID in IUD users.
• Meta-analysis was not feasible due to study heterogeneity.

Main Results:

• The overall risk of PID in IUD users is below 1%.
• Advanced maternal age and the presence of sexually transmitted infections are identified as significant risk factors for PID.
• Improved screening, patient follow-up, and PID management contribute to lower complication rates.

Conclusions:

• The fear of PID should not deter IUD usage.
• Modern IUDs are associated with a low risk of PID, especially when considering patient age and STI status.
• Enhanced screening and patient care have minimized PID risks associated with IUDs.