Intrauterine devices and pelvic inflammatory disease: recent developments

Area of Science:

• Reproductive Health
• Contraception
• Infectious Disease Epidemiology

Background:

• The relationship between intrauterine devices (IUDs) and pelvic inflammatory disease (PID) is a significant concern in modern contraception.
• Previous estimates of PID risk associated with IUD use have varied.
• Recent large-scale studies have provided more objective data on this association.

Purpose of the Study:

• To clarify the association between intrauterine device use and pelvic inflammatory disease.
• To provide updated risk estimates for PID in IUD users compared to non-users.
• To identify factors influencing the risk of IUD-associated PID.

Main Methods:

• Analysis of large, sophisticated studies published since the mid-1980s.
• Comparison of PID incidence among IUD users versus women using no contraception.
• Evaluation of PID risk associated with specific types of IUDs.

Main Results:

• Consistent finding of increased PID risk among IUD users.
• Objective studies indicate a relative risk of 1.5-2.6 compared to non-users, lower than prior estimates.
• The elevated PID risk is most pronounced in the initial months post-insertion.
• The Dalkon Shield shows a higher PID risk compared to Lippes Loop, Saf-T-Coil, or copper IUDs.

Conclusions:

• While IUD use is associated with a modest increase in PID risk, this risk is lower than previously estimated.
• The heightened risk is temporary, primarily occurring shortly after IUD insertion.
• Specific IUD types, like the Dalkon Shield, may carry a greater risk.
• Careful selection of candidates for IUDs can further mitigate the risk of PID.