Contraception and the etiology of pelvic inflammatory disease: new perspectives

The dramatic increase in use of contraception worldwide makes it imperative to understand the effects of contraceptives on the health of women using them. In this article, we review the literature on the relationships of modern nonsurgical contraception with pelvic inflammatory disease. Subsequently, we identify areas where further research is needed to better define the risks and benefits of these contraceptive methods in various settings. From our review, two new conclusions emerge. First, our reanalysis of published data on the risk of PID associated with intrauterine device (IUD) use compared with no contraceptive use shows, with one exception, less risk than the previous comparisons to all non-IUD use. Second, and probably most importantly, the studies, when taken together, strongly imply that oral contraceptives have a protective effect against PID. Only one study of 11 is equivocal on this point.