A clinicopathological study of IUD users with special reference to endometrial patterns and endometritis

A group of 65 IUD users was studied during a period of 165 years of use, with a mean of 2.6 +/- 1.7 years per woman. The main complaint which differed significantly from the 120 controls was the occurrence of spotting in 33.8% of IUD users. Normal endometrial mucosae were found in 36.9% of IUD users and 38.7% of controls. Chronic endometritis was evidenced in 35.4% of IUD users versus 12.5% of controls; the former were asymptomatic in 25.0% of the cases. 39.1% of them had normal endometrial synchrony. Chronic endometritis occurred 2.2 +/- 1.3 years after insertion of the device. Endometritis was always symptomatic in controls; only 13.3% of them exhibited endometrial synchrony. The fundamental mechanism(s) responsible for the contraceptive efficiency of intrauterine contraceptive devices (IUD) remains a subject of controversy and a field of investigation. The most recent studies are essentially directed towards the biochemical analysis of uterine fluid [1]. Nevertheless, the presence of an inflammatory process, either morphologically or biochemically detectable, seems to be one of the fundamental modifications induced by the IUD. Since a certain reluctance to use IUDs has been observed in some countries, which has been ascribed mainly to contradictory reports on the risk of pelvic inflammatory disease (PID) in women wearing such devices [2], we found it interesting to intend to objectivate and reevaluate the influence of IUD on chronic aspecific endometritis, a possible precursor state of salpingitis and PID.