Reactions of human endometrium to the intrauterine foreign body II. Long-term effects on the endometrial histology and cytology

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The intrauterine device produces a foreign body reaction in an area crucial for the viability and metabolism of the unimplanted blastocyst and the ascending sperm. After intrauterine foreign body (IUFB) insertion, hysterectomy specimens from 167 patients and endometrial biopsies from 202 women were studied histologically. These tissue specimens were obtained at intervals ranging from a few hours until 5 years after IUFB insertion. Minor tissue damage of the endometrium which was usually limited to the superficial epithelium and stroma was noted in a minority of specimens. Neutrophils, mononuclear cells, and plasma cells were greatly increased in the endometrium during the first 6 months after insertion. Thereafter, mononuclear cells were moderately reduced in quantity, but tissue concentrations remained elevated throughout the course of study. Plasma cells were seen as a transient invader of endometrial tissue, disappearing in most patients 5 months after IUFB insertion. Intrauterine flushings contained increased numbers of inflammatory cells as well as a high content of protein. It is postulated that this sterile tissue reaction in the endometrial cavity is the main causative factor for the contraceptive effect of the IUFB in the human female. This study revealed no evidence of a carcinogenic effect on the endometrium in association with the IUFB.