Is there a Relationship between Combined Oral Contraceptive Use and Intrauterine Device Use with Abnormal Smear Results and Cervical Atypia?

Abstract

Introduction: The relationship between the use of contraceptive method and the presence of Human Papilloma Virus (HPV) persistent infection and precancerous cervical lesions has not been fully established. Aim: To investigate the frequency of cervical atypia and risk factors affecting it in women using Combined Oral Contraceptive (COC) and Copper-Intrauterine Device Use (Cu-IUD). Materials and Methods: A retrospective study was conducted in a tertiary centre between 2017 to 2019, involving 835 patients using Cu-IUD and 538 patients using COC. Age, obstetric data, high-risk HPV type positivity, education level, location, occupation, Body Mass Index (BMI), smoking, cervical cytology results and colposcopic biopsy results were noted for each group. Statistical Package for the Social Sciences (SPSS) version 22.0 program was used to analyse the data. Pearson chi-square test and multivariate binary logistic regression test were performed. Model compatibility was good in binary logistics test (omnibus test p<0.001). The p<0.05 value was considered statistically significant. Results: The frequency of Cervical Intraepithelial Neoplasia l (CIN l) lesions increased in women using Cu-IUD (p=0.038), while the frequency of CIN II+ lesions increased in COC users. The use of COC increased the risk of CIN II+ (p=0.014). High-risk HPV type positivity was common in those using COC (p<0.05). In addition, age group 40-51 years, education level being primary, being multiparous, urban location, high risk HPV positivity were other risk factors for the presence of cervical atypia (p<0.05). Conclusion: The risk of CIN I increased in those using Cu-IUD, while the risk of CIN II+ increased in those using COC.