IUDs, inflammation, and infection: Assessment after two decades of IUD use

Abstract

In the 1950s social and technological changes allowed experimental use of an inert plastic IUD which was successful and regarded as safe. The devices were pliable, chemically inert, sterilizable, disposable, and equipped with a small inserter so that cervical dilation was not needed for insertion. But many IUDs were withdrawn because they were found to cause endometritis and provide poor protection against pregnancy. In the 1970s there were cases of serious inflammatory and infectious diseases with pelvic inflammatory disease (PID) the most common. The Dalkon Shield has been associated with midtrimester septic abortions and with unilateral actinomycotic tube-ovarian abscesses and there is evidence to support a chemically caused IUD-related endometritis in the moderate inflammation associated with IUDs containing copper and with the Majzlin spring. The most common factor among IUD users with Actinomycetales infection is not the type of IUD but the duration of use; almost 85% of cases were in women who had worn IUDs over 3 years. Also the likelihood of an ectopic pregnancy is almost 3 times greater for longterm IUD users. It is hypothesized that with time the IUD is capable of inducing changes that can lead to infection and that changes can occur to the IUD itself. A surface coating on the IUD and the tail has been found which is composed of mucoid and cellular elements which consist of an inflammatory response; the IUD then becomes recognized as a foreign body to the host and may contribute to the development of PID. Other problems such as perforation, cramping, bleeding, and unwanted pregnancy may be at least indirectly related to IUD surface alterations. It is now agreed that all IUD-associated inflammatory and infectious disease can no longer be considered gonorrheal type PID and that the biodegradation of the nylon-6 tail of the Dalkon shield may also be a factor in PID. Some recommendations are to: 1) change IUDs every 2 years, 2) counsel women on IUD complications and examine IUDs upon removal, and 3) bring IUD technology up to date to develop an IUD that is thoroughly safe and effective.