Duration Of Intrauterine Device Use Research Articles

Descriptive study of the real-world, long-term cost estimates and duration of use for hormonal and nonhormonal intrauterine devices using US commercial insurance claims.

Intrauterine devices (IUDs) have comparable efficacy to permanent surgical contraceptive methods; however, long-term costs are infrequently considered. Existing estimates inconsistently account for costs outside of IUD insertion or removal, actual duration of use, or differences between hormonal and nonhormonal IUDs. To describe health care resource utilization and commercial payer costs that arise throughout hormonal and nonhormonal IUD use. In this retrospective cohort study, paid claims data (Merative, MarketScan) from a large US commercial claims database were evaluated between 2013 and 2019. Claims were included from individuals aged 12 to 45 years who had an IUD inserted in 2014, continuous insurance coverage for 1 year prior to insertion and throughout follow-up, and no insertion, removal, or reinsertion in the previous year. Procedures and services that could be IUD-related were identified using Current Procedural Terminology and International Classification of Diseases, Ninth and Tenth Edition codes. Duration of IUD use was evaluated by Kaplan-Meier analysis of time to IUD removal. Event rates were determined for identified procedures and services; costs were calculated as the sum of payer reimbursements per enrolled individual. All IUD types available during the study period were described: 2 hormonal IUDs (52-mg and 13.5-mg levonorgestrel-releasing [LNG]) and the nonhormonal (380-mm2 copper) IUD. Of 195,009 individuals meeting the age requirement and receiving an IUD in 2014, 63,386 met the inclusion criteria and 53,744 had their IUD type on record-42,777 (67.5%) 52-mg LNG, 2,932 (4.6%) 13.5-mg LNG, and 8,035 (12.7%) nonhormonal IUD users. Despite differences in their indicated duration (13.5-mg LNG, 3 years; 52-mg LNG, 5 years; and nonhormonal, 10 years), most individuals had their IUD removed before its indicated full duration of use (13.5-mg LNG, 56.1%; 52-mg LNG, 61.3%; nonhormonal [at 5 years], 54.6%). The event rate per 100 individuals during the follow-up period was highest for abnormal uterine bleeding (16.2), ovarian cysts (9.3), and surgical management of uterine perforations (4.5). IUD insertion costs (mean ± SE) per enrolled individual for the 13.5-mg LNG, 52-mg LNG, and nonhormonal IUDs were $931 ± $9, $1,107 ± $4, and $897 ± $6, respectively. Cumulative mean ± SE 5-year postinsertion costs for the 13.5-mg LNG, 52-mg LNG, and nonhormonal IUDs were $2,892 ± $232, $1,514 ± $31, and $1,389 ± $97, respectively, among the remaining enrolled individuals. In this descriptive study of commercially insured IUD users, at least half had their IUD removed before its indicated duration. IUD improvements that reduce the frequency of abnormal uterine bleeding, ovarian cysts, and uterine perforations may help reduce long-term IUD costs.

The management of the malposition of intrauterine devices at the tertiary center

Aims: The malposition of intrauterine devices (IUD) is a major problem in contraception and this study aims to evaluate the surgical procedures used in the management of these cases. Methods: Patients who were operated on for malposition of copper T IUD between 2018-2021 were evaluated retrospectively. The cases were analyzed in 4 groups as followed; instrumental removal, hysteroscopic (H/S), laparoscopic (L/S), and laparotomic (LPT) procedure. The groups were compared in age, obstetric history, IUD insertion time, and intraoperative outcomes. Results: There were a total of 39 cases and the groups consisted of instrumental removal (n=8), H/S (n=24), L/S (n=6), and LPT (n=1) procedure. In the H/S group, mean age (44 ±10) and duration of IUD use (10.1 ±7.5 years) were found to be significantly higher than the other groups (p=0.03 and p=0.001 ). Six cases (25%) in the H/S group IUD was in the uterine cavity while in 5 (20.8%) it was embedded in the endometrium and myometrium. In the L/S group, the duration of IUD use was shorter (1.3 ± 0.8 years) and the mean age (29±10) was lower and all cases were managed laparoscopically except in one case that was extracted after conversion to laparotomy. Conclusion: Advanced age and prolonged IUD use are risk factors for embedded of the IUD in the uterine cavity in the hysteroscopy group, however, IUDs that reach the abdomen by ruptured uterus are detected at younger ages and earlier in IUD use, and minimally invasive methods are eligible surgical procedures for these cases.

The effect of copper intrauterine device use duration on uterine and ovarian blood flow parameters: A prospective cross‐sectional study

This prospective cross-sectional study aimed to compare uterine and ovarian arterial Doppler signals in regularly menstruating patients who had been using copper intrauterine devices (IUD) for different durations. Four groups of participants were formed (n = 30 for each) depending on the duration of copper IUD use: less than 1 year (group 1), 1 to 3 years (group 2), and over 3 years (group 3). Women without IUDs formed the control group. All participants were called in on the fifth-eighth days of their menstrual cycle for Doppler blood flow assessment. The pulsatility index (PI) and resistance index (RI) values were recorded in uterine and ovarian arteries. The groups 2 and 3 had significantly higher uterine artery PI and RI values than groups 1 and 4. Furthermore, group 2 had uterine and ovarian artery PI and RI values similar to those of group 3. There was a positive relationship between uterine and ovarian arteries' PI and RI values with the duration of IUD use. The presence of an IUD for over a year seems to cause changes in the uterine artery PI and RI values assessed by Doppler ultrasonography.

The effect of intrauterine device presence and other factors in medical treatment success of tuboovarian abscess

BackgroundTo identify the epidemiologic and clinical risk factors associated with failed response to medical treatment in tuboovarian abscess (TOA) patients and whether there is a relationship between the presence of intrauterine device (IUD), duration of use and medical treatment success or not. MethodsFor this study, the medical records of patients diagnosed with TOA and hospitalized in an 8-year period were analyzed retrospectively. The presence of TOA and IUD was confirmed ultrasonographically in all patients. Parenteral antibiotic treatment was initiated as the first step. Patients who did not improve with this medical treatment underwent surgery. Patients who recovered with medical treatment were defined as the successful group, while those who underwent surgery after medical treatment failure were recorded as the failed group. ResultsThere were 37 patients in successful group and 87 patients in failed group. The mean age, parity, white blood count, TOA size, duration of IUD use, rate of multigravida and multiparity were higher in the failed group. Logistic regression analysis revealed that presence of multiparity, TOA size and the duration of IUD use were significant independent factors in predicting medical treatment success of TOA. The best cut-off value for TOA size was 4.5 cm and for duration of IUD use was 5.5 years in the Receiver Operating Characteristic curve analysis. ConclusionThe presence of long-term IUD use, increased TOA size, and multiparity were found to be risk factors related to the failure of medical treatment in TOA cases.

Intrauterine Device Use in Adolescents With Disabilities

Intrauterine devices (IUDs) are increasingly being used in adolescents and nulliparous women for contraception. Levonorgestrel IUDs also have beneficial effects on bleeding and pain. Although they are recommended for menstrual suppression in adolescents with disabilities, there are limited data on their use in this population. Our objective is to describe the characteristics and experiences of levonorgestrel IUD use in nulliparous children, adolescents, and young adults with physical, intellectual, and developmental disabilities. A retrospective chart review was conducted for all nulliparous patients ages ≤22 with physical, intellectual, or developmental disabilities who had levonorgestrel IUDs placed between July 1, 2004, and June 30, 2014, at a tertiary-care children's hospital. Descriptive statistical analysis and survival analysis were performed. In total, 185 levonorgestrel IUDs were placed in 159 patients with disabilities. The mean age was 16.3 (3.3; range of 9-22) years. Only 4% had ever been sexually active; 96% of IUDs were inserted in the operating room. IUD continuation rate at 1 year was 95% (95% confidence interval: 93%-100%) and at 5 years was 73% (95% confidence interval: 66%-83%). The amenorrhea rate was ∼60% throughout the duration of IUD use among those with available follow-up data. Side effects and complications were ≤3%. In this study, we provide evidence for the therapeutic benefit and safety of levonorgestrel IUD use in adolescents and young adults with physical, intellectual, and developmental disabilities. It should be considered as a menstrual management and contraceptive option for this population.

Bacterial colonization of Intrauterine Device samples from patients without a history of Pelvic Inflammatory Disease

Aim: In this research, we aim to evaluate microbiological colonization of intrauterine devices (IUDs) in patients without the diagnosis of Pelvic Inflammatory Disease (PID) whether it has relationship with the duration of IUD usage. Material and Methods: Our study included patients at the Obstetrics and Gynecology Polyclinic of second degree state hospital between January 1, 2015 and January 1, 2016, who requested the removal of an IUD. A total of 176 patients were recruited for our study. Age, parity, and duration of IUD use were recorded for all patients, who sought treatment at the outpatient clinic. None of the patients had a clinical or laboratory finding of PID. IUD samples, which were collected in the sterile containers, were sent to the microbiology laboratory.Results: The mean age of the patients recruited in our study was 34.5 years. 36 IUD cultures (20.4%) were positive. There were no statistically significant differences between the groups of patients with microorganisms cultured and those with none of the microorganisms cultured; in terms of age, parity, and duration of IUD use.Conclusion: In this study, aerobic bacterial growth occurred in 36 patients, 20.4% of the cultures of the IUDs. In addition, our study adds data to the literature, with the statistical analysis of the groups comparing age, parity, and the duration of IUD use with positive and negative cultures of microorganisms in the IUD samples, as was not done in previous studies.

User Profile and Factors Correlating to Duration of Intrauterine Device Use

Objective: To determine the demographic and clinical profile of intrauterine
 device (IUD) users and factors correlating to duration of
 IUD use.
 
 Method: We conducted a prospective observational study of 867 patients
 who underwent IUD insertion in Raden Saleh Outpatient Clinic
 during the period of January - December 2011. All patients were followed
 for 1 year to ascertain any complaint of discharge after insertion.
 Spearman correlation test was conducted to inves- tigate the
 strength of correlation and significance between age, parity, and discharge,
 with duration of IUD use.
 
 Result: During year 2011, 867 patients (median of age=34
 [range=14-49]; median parity=2 [range=0-7]) underwent IUD
 insertion in Raden Saleh Clinic. The majority of subjects were aged
 between 31-35 years old and were willing to use IUD for 4 years.
 Bivariate analysis revealed a significant correlation between age,
 parity, and vaginal discharge with duration of IUD use. The strongest
 correlation was identified between age and duration of use (r=0.25,
 p0.002 for parity and
 duration of use; r=0.05 p=0.045 for discharge and duration of use).
 
 Conclusion: Most IUD users were aged 31-35 years, who were
 willing to use IUD for 4 years. Factors that correlated with duration
 of IUD use were age, parity, and vaginal discharge.
 
 Keywords: contraceptive, duration of use, family planning, intrauterine
 device

How long is long acting? Recent trends in mean duration of intrauterine device use

Objectives: Intrauterine device (IUD) use has increased fivefold since 2002, yet little is known about how women are using IUDs, including the typical duration of use. Methods: Drawing on 2006–2010 and 2011–2013 National Survey of Family Growth data, we calculated women’s mean completed duration of IUD use by survey wave, age group and method dissatisfaction. Results: The mean completed duration of IUD use declined from 47 months in 2006–2010 to 31 months in 2011–2013 (p<.05). Among women aged 25–44, mean use declined from 51 months in 2006–2010 to 34 months in 2011–2013 (p=.09). Among younger women (aged 15–24), mean use declined from 23 months in 2006–2010 to 13 months in 2011–2013 (p=.07). The proportion of women with a mean duration of use less than 12 months increased, from 24% in 2006–2010 to 36% in 2011–2013 (p=.08). Women who discontinued their IUD due to dissatisfaction had shorter mean periods of use: For example, 22 months versus 40 months among those who did not discontinue due to dissatisfaction in 2011–2013 (p<.05). Conclusions: As more women have chosen IUDs, mean duration of use has decreased. This may reflect more women “testing the waters” with IUDs, owing to increased insurance coverage and provider skills, targeted counseling, same-day insertion protocols and growing patient awareness; as well as a shift toward hormonal IUDs, with a shorter maximum duration of use. These results suggest the need for patient-centered counseling approaches and the mitigation of policy, payer and procedural barriers to facilitate desired and timely IUD removal and contraceptive method switching.

Contraceptive methods and ovarian cancer risk among Chinese women: A report from the Shanghai Women's Health Study.

Oral contraceptive use is associated with reduced ovarian cancer risk; however, associations with other contraceptive methods, such as intrauterine device (IUD) and tubal ligation, are less clear. Women in China differ from western women in regard to mechanisms and duration of use of contraception. This study was undertaken to evaluate associations between contraceptive methods and ovarian cancer risk using data from the prospective Shanghai Women's Health Study. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by Cox proportional hazards regression. A total of 174 epithelial ovarian cancer cases were found to occur among 70,259 women who were followed-up for a total of 888,258 person-years. The majority of women had ever used any contraception (77.0%), including IUD (55.6%), oral contraceptive (20.4%), tubal ligation (14.7%) or contraceptive shots (2.6%). Ever use of any contraception was associated with a nonsignificant reduction in ovarian cancer risk (HR: 0.86, 95% CI: 0.60-1.24). Longer duration of IUD use was associated with lower ovarian cancer risk (p-value for trend = 0.04). Compared with never users, women with durations of IUD use longer than the median (20 years) were 38% less likely to develop ovarian cancer (HR: 0.62, 95% CI: 0.40-0.97). Based on the high prevalence and long duration of IUD use among Chinese women, we estimate a preventive fraction of 9.3%, corresponding to approximately 16 ovarian cancer cases. High prevalence of long-term IUD use may, therefore, contribute to the low incidence of ovarian cancer observed in China.

Determinants of intrauterine contraceptive device discontinuation among Indian women.

To determine intrauterine contraceptive device (IUCD) discontinuation rate and its causes and related factors among women attending the OPD/family planning clinic in Mahila Chikitasalaya, SMS Medical College, Jaipur from January 2012 to December 2012. 387 women who had an intrauterine device (IUD) inserted during the last 1-5years were interviewed during their visits to the OPD/family planning clinic. Sociodemographic characteristics for all women were described using frequency distribution. Life tables were used to describe the proportion of women who discontinued IUD at various time intervals. The main outcome measure was IUD discontinuation. The incidence of IUD discontinuation in the first year following insertion was 16.79%. Approximately 31% of the study sample continued using their devices after 5years. The average duration of IUD use was 36months. Of the 387 women, 56% discontinued IUD use because of a desire to conceive, 27.7% because of side effects, 15.36% because of opposition from the woman's family, and 1.5% because they were sexually inactive. The most common side effects reported as the reasons for discontinuation were bleeding, infection, and pain. Discontinuation was inversely related to the age at insertion, the number of living children, and the sex of children. Previous contraceptive users were significantly less likely to discontinue IUD use. The crude cumulative rate of IUD discontinuation was 16.79% during the first year, suggesting a need to tackle the problem of discontinuation through effective educational strategies and counseling techniques. Desire to have a male child still predominates among Indian families. The average duration of IUD use in majority of the females was about 36months (45%), thereby fulfilling its objective of spacing between children as laid down by the WHO (2years spacing between pregnancies). About 31% of the women continued using IUCD even after 5years. It is crucial to correct misconceptions and identify the lack of correct and complete information both among the providers and the acceptors, to improve the effectiveness of family planning programs.

Interest in and experience with IUD self-removal

ObjectivesIn the United States, the popularity of intrauterine devices (IUDs) is low despite many positive attributes such as high effectiveness and ease of use. The requirement that a clinician remove the IUD may limit US women's interest in the method. Our objective was to describe women's experience with self-removal and its effect on attitudes toward the method. Study designWe assessed interest in attempting and success in IUD self-removal among women seeking IUD discontinuation from five US health centers. Women were given the option of attempting self-removal of the IUD. Participants were asked to complete two surveys about their reasons for desiring IUD removal, attitudes toward IUD use and experience with self-removal and/or clinician removal. ResultsThree hundred twenty-six racially diverse women participated (mean age, 28 years; body mass index, 27; duration of IUD use, 3 years); more than half were willing to try self-removal [95% confidence interval (CI): 45–65%], and among those who tried, one in five was successful (95% CI: 14–25%). More than half of participants (54%) reported they were more likely to recommend IUD use to a friend now that they know that it might be possible to remove one's own IUD; 6% reported they were less likely to recommend the IUD to a friend. African American women were particularly interested in the option of IUD self-removal. ConclusionsMany women are interested in the concept of IUD self-removal, although relatively few women currently succeed in removing their own IUD. ImplicationsHealth educators, providers and advocates who inform women of this option potentially increase IUD use, reducing rates of undesired pregnancy.

Abstract B60: Contraceptive methods and ovarian cancer risk among Chinese women: A report from the Shanghai Women Health Study

Abstract Background: Oral contraceptive (OC) use is known to be associated with reduced ovarian cancer risk; associations with other contraceptive methods, such as intrauterine devices (IUD) and tubal ligation (TL), are less clear. The majority of studies conducted to date have used case-control designs; fewer cohort studies have been conducted, especially among Asian women. As contraception use is popular among Chinese women, and the use of different contraceptive methods differs from Western countries, differences in associations with ovarian cancer risk may exist. Methods: Data from the prospective Shanghai Women's Health Study (SWHS) was used to evaluate associations between different contraceptive methods and risk of ovarian cancer. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by Cox proportional hazards regression; models included adjustment for age, education, years of ovulation, body mass index (BMI), first-degree family history of cancer (yes/no), and regular physical activity within 5 years (yes/no). Results: A total of 164 ovarian cancer cases occurred among 70,349 women after an average follow-up time of 11.74 years. The majority of women had ever used any contraception (77.0%), including OC use (20.4%), contraceptive shots (2.6%), IUD use (55.6%) and TL (14.7%). Ever use of any contraception method was associated with a non-significant reduction in ovarian cancer risk (HR: 0.83, 95% CI: 0.58-1.19). Similarly, among users of contraception, women with durations of OC use longer than the median (≥2 years) tended to have lower ovarian cancer risk (HR: 0.60, 95% CI: 0.26-1.39), while women with durations of IUD use longer than the median (≥23 years) had significantly decreased ovarian cancer risk (HR: 0.48, 95% CI: 0.30-0.75). Conclusion: Longer durations of IUD use had beneficial effects on ovarian cancer risk among Chinese women. Due to the high prevalence and long duration of IUD use among Chinese women, and the protective association seen in this study, we estimate that approximately 20 ovarian cancer cases (12.0%) were prevented in this study population. Therefore, patterns of use of different contraceptive methods in China may contribute to the lower incidence of ovarian cancer observed in this country. Citation Format: Zhezhou Huang, Alicia Beeghly-Fadiel, Honglan Li, Wanqing Wen, Yutang Gao, Wei Zheng, Xiao-Ou Shu. Contraceptive methods and ovarian cancer risk among Chinese women: A report from the Shanghai Women Health Study. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr B60.

Fertility in older women following removal of long-term intrauterine devices in the wake of a natural disaster

BackgroundIn order to evaluate the effect of long-term intrauterine device (IUD) use on female fertility, we interviewed 2301 women who lost children in the 2008 Wenchuan earthquake in China, which prompted IUD removal. Study DesignA clinical retrospective survey. ResultFive hundred and twenty-four women were lost to follow-up, and data from the remaining 1770 women were analyzed. The completed questionnaires revealed that 80.11% (1418/1770) became pregnant following IUD removal and about 88% (1256) of whom conceived within 1 year. Among women with different durations of IUD use, pregnancy rates and miscarriage rates were as follows: <5 years, 89.77% and 4.27%; 6–10 years, 81.10% and 10.19%; and >10 years, 75.20% and 12.98%, respectively. Age, duration of IUD use, a history of a previous miscarriage and abnormal menstruation before the earthquake were independently associated with reduced fertility, but a higher gravidity pre-earthquake was associated with a higher conception rate. ConclusionLong-term IUD use in older women had a high rate of pregnancy after removal of IUD, but with an increased risk of fertility problems.

An intrauterine device as a possible cause of change in the microbial flora of the female genital system

An intrauterine device (IUD), used by millions of women worldwide, is one of the most efficient methods of contraception. The goal of our study was to compare a group of women using the IUD to a control group. The survey included 236 women of fertile age from gynaecological practices in the area of Split and Dalmatia County, Croatia. The subjects were divided into two groups: IUD users and a control group (women not using any contraception methods). Sampling, transportation, sample processing in the laboratory and interpretation of results were conducted using standard microbiological procedures and methods. Opportunistic bacteria were statistically more frequently isolated among IUD users (P < 0.001). The most frequently isolated bacteria in both groups were Escherichia coli and Ureaplasma urealyticum with significantly higher rates in IUD users (P < 0.001). Both colonization and infection had higher rates in IUD users (P < 0.001). There were no significant differences either in the frequency of bacteria isolation regarding different IUD types (P = 0.93), or in relation to duration of IUD use (P = 0.67). Based on the data in our study IUD users have an increased chance of developing a cervical infection caused by the bacteria Escherichia coli and Ureaplasma urealyticum. Therefore, before IUD insertion women should be screened and treated for asymptomatic vaginal or cervical infections to prevent possible serious IUD-associated infections.

Use of oral contraceptives, intrauterine devices and tubal sterilization and cancer risk in a large prospective study, from 1996 to 2006

The association of contraceptive methods, including oral contraceptives (OC), intrauterine devices (IUD) and tubal sterilization (TS), with overall and site-specific cancer were prospectively investigated in a cohort of 66,661 Chinese women in Shanghai, 76.7% of whom used contraception. During a median follow-up time of 7.5 years, 2,250 women were diagnosed with cancer. Ever-use of any contraceptive method was not associated with overall cancer risk [adjusted hazard ratio (HR(adj)) = 1.02, 95% CI, 0.92-1.12]. Use of any contraceptive method was associated with increased risk of rectal cancer (HR(adj) = 1.68, 95% CI, 1.08-2.62) and reduced risk of thyroid cancer (HR(adj) = 0.63, 95% CI, 0.38-1.04). Risk of gallbladder cancer increased with ever use of OC (HR(adj) = 2.38, 95% CI, 1.26-4.49). IUD use was associated with a possible reduced risk of thyroid cancer (HR(adj) = 0.64, 95% CI, 0.38-1.07). Longer duration of IUD use decreased risk for breast, thyroid and lung cancers. Ever having a TS was associated with increased uterine body cancer (HR(adj) = 2.50, 95% CI, 1.47-4.25) and decreased risk of stomach cancer (HR(adj) = 0.59, 95% CI, 0.39-0.91). We did not find any contraceptive method to be related to the risk of ovarian cancer but the analyses were based on few events. Although chance findings are a likely explanation for some of the associations found in our study, these findings suggest that various contraceptive methods or reproductive patterns may play a role in the etiology of cancer.

The Impact of Age and Intrauterine Contraception on the Clinical Course of Pelvic Inflammatory Disease

Background: The aim of the study was to investigate the clinical course of pelvic inflammatory disease (PID) and factors that could predict failed conservative treatment of PID. Additionally, the study aimed to examine the role of age and intrauterine device (IUD) use on the severity of PID. Method: Fifty-one women admitted to hospital with the diagnosis of acute PID were recruited. Of those, 17 patients were subsequently operated because of failed conservative treatment. All women underwent careful examination and completed a questionnaire at admission. Their clinical course was followed and the clinician responsible for the patient completed forms at admission and at discharge. Two groups were established retrospectively, those who were treated conservatively and those who underwent surgery. The outcome results were analyzed with regard to IUD use, duration of IUD use (≧5 or <5 years), and with regard to age below or above 35 years. All data were analyzed using the statistical package SAS. A p value <0.05 was considered significant. Results: Women who subsequently underwent surgical treatment were significantly older and significantly more frequently, current IUD users. There was no significant difference with regard to other socio-demographic characteristics. Women who subsequently underwent surgery had significantly more frequent complaints of severe abdominal pain, elevated body temperature, symptoms of peritoneal irritation, and appearance of adnexal mass. No differences were found between groups with regard to anaerobic microbiological findings, nor with regard to the finding of Actinomyces. IUD use and age ≧35 were found to be highly significant risk factors for surgery in patients with PID. Conclusion: Age over 35 years and IUD use, independently of each other, were factors strongly associated with an increased risk of surgery for PID as a result of failed conservative treatment.

‘Older’ age is a risk factor for pelvic inflammatory disease in intrauterine device users

To asses the role of a copper intrauterine device (IUD) per se in the development of pelvic inflammatory disease (PID) and complicated PID in women considered at low risk of PID. Cases were 51 women admitted to hospital with a diagnosis of acute PID, and controls were 50 healthy women attending an outpatient clinic for routine gynecological check-up. The women were 25-45 years old. Data were analyzed and compared between groups using the statistical program package sas. IUD use was not associated with an increased risk of PID in general, but in women > or =35 years, IUD use was associated with a risk of PID [odds ratio (OR) = 4.2, confidence interval (CI) 1.1-16.3]. When adjusting for smoking, educational level, employment, and microbial findings in women with PID, IUD use was associated with complicated PID in women > or =35 years (OR = 33.9, CI 1.2-959.6), but not in younger women. When adjusting age and IUD use duration for each other in IUD users, age > or =35 years was a significant risk factor for PID (OR = 4.9, CI 1.3-19.2), but not long (> or =5 years) duration. In IUD users with PID, age > or =35 years was a risk factor for a PID to be complicated in both the unadjusted and adjusted analysis (OR = 12.7, CI 1.6-102.3; OR = 12.1, CI 1.4-104.7), whereas long duration of IUD use was not. When adjusting for significant endocervical microbial findings, long duration of IUD use and age, only age > or =35 years, remained significantly associated with both PID and complicated PID (OR = 5, CI 1.1-21.9; OR = 36, CI - 1.9-670). IUD use was not associated with PID in low-risk younger women, but in women > or =35 years, IUD use was associated with an increased risk of PID. The study also demonstrates an association between IUD use and complicated PID in women > or =35 years.

Pelvic abscess in intrauterine device users

Objective To assess the causality between pelvic abscess formation and intrauterine device (IUD) use through a clinical study in a hospital.Method Sixty-two pelvic abscesses were retrospectively evaluated over a 7-year period. Patient records retrieved for the women enrolled in this study consisted of demographic characteristics, duration of IUD use and clinical management details.Results All the women were monogamous Muslim women without any suspicious sexual contacts, immunosupressive states, or drug use at the time of IUD insertion. In 10 cases (16.1%), a history of pelvic surgery was present. The mean age of the women was 36.1 ± 2.3 years (range 19–50 years). Of the 62 women, 14 (22.6%) were current IUD users. The mean time interval for women using IUD prior to the diagnosis of pelvic abscess was 5.7 ± 1.2 years (range 1–14 years). In all cases, a pelvic mass and abdominal pain constituted the referral signs and symptoms. All women received an initial antibiotic regimen comprising penicillin (24 mU/day), clindamycin (900 mg/day) and gentamycin (240 mg/day) in divided doses. In 38 cases (61.3%), medical treatment yielded a satisfactory clinical outcome, defined as a decreas in mass volume together with pain relief and a decrease in leukocytosis. Twenty-four cases (38.7%) underwent a subsequent surgical procedure, either laparotomy (n = 19) or laparoscopy (n = 5). The type of surgery ranged from abscess drainage to more radical approaches such as total abdominal hysterectomy and/or unilateral or bilateral salpingo-oophorectomy. There were no differences between those women responding to medical therapy and those who did not respond in terms of mean age, percentage of past pelvic surgery, gravidity, parity and the size of pelvic abscess.Conclusions A substantial number of women with an IUD were diagnosed as having a pelvic abscess within a 7-year period at the university clinic. Despite current knowledge that pelvic inflammatory disease and pelvic abscess are rarely encountered in long-term IUD users, the presence of an IUD should be investigated in cases with an initial diagnosis of pelvic abscess based on clinical and ultrasonographic evaluation, demonstrating mostly acquisition via sexually transmitted disease.

Microbiology Profile in Women With Pelvic Inflammatory Disease in Relation to IUD Use

Objective.To study the microbial characteristics of patients with pelvic inflammatory disease (PID) and the possible impact of an intrauterine device (IUD) on the microbial environment in women presenting with PID.Methods.Case-control study, investigating 51 women with acute PID and 50 healthy women. Endocervical specimens for microbiological investigation were obtained at gynaecological examination.Results.IUD users with PID had significantly moreFusobacteriaspp. andPeptostreptococcusspp. than non-IUD users with PID. The finding of combinations of several anaerobic or aerobic microbes was associated with a significantly increased risk of PID and with complicated PID. In IUD users, the combinations of several anaerobic/aerobic microbes were associated with an increased risk of PID, irrespective of duration of IUD use. Long-term IUD use appeared to be associated with an increased risk of a PID being complicated.Conclusion.The finding of several anaerobic or aerobic microbes appears to be associated with PID in users of IUD.

Microbiology profile in women with pelvic inflammatory disease in relation to IUD use.

OBJECTIVE: To study the microbial characteristics of patients with pelvic inflammatory disease (PID) and the possible impact of an intrauterine device (IUD) on the microbial environment in women presenting with PID. METHODS: Case-control study, investigating 51 women with acute PID and 50 healthy women. Endocervical specimens for microbiological investigation were obtained at gynaecological examination. RESULTS: IUD users with PID had significantly more Fusobacteria spp. and Peptostreptococcus spp. than non-IUD users with PID. The finding of combinations of several anaerobic or aerobic microbes was associated with a significantly increased risk of PID and with complicated PID. In IUD users, the combinations of several anaerobic/aerobic microbes were associated with an increased risk of PID, irrespective of duration of IUD use. Long-term IUD use appeared to be associated with an increased risk of a PID being complicated. CONCLUSION: The finding of several anaerobic or aerobic microbes appears to be associated with PID in users of IUD.