Risk Of Pelvic Inflammatory Disease Research Articles

Association between Intrauterine Device and Pelvic Inflammatory Disease

The Women's Health Study, a concurrent case-control study at 16 hospitals in 9 cities across the United States, examined the relationship between use of an intrauterine contraceptive device (IUD) and pelvic inflammatory disease (PID) severe enough to require hospitalization. After final classification, 1447 patients were eligible as PID subjects and 3453 patients were eligible as controls. For all current IUD users, the estimated relative risk of hospitalization with the diagnosis of PID was 1.6. However, the relative risk was about twofold when only individuals experiencing their first episode of the disorder were considered. The study also demonstrated an increased association for women aged 25 years or less and for nonblack women. Recent insertion or reinsertion of an IUD was associated with increased risk for PID, but total duration of use was not. Furthermore, the effect of IUD use on the development of PID persisted for several months after the IUD had been removed. The study also confirmed previous findings that the type of device does not markedly influence risk, and that the relative risk of PID is higher when IUD use is compared with use of other contraceptives or use of no contraceptives. Finally, the study suggests that users of nonpermanent forms of contraception other than the IUD have some form of protection against the development of PID.

Contraception and Pelvic Inflammatory Disease

Studies on the relationship between contraception and pelvic inflammatory diseases have consistently showed a 1.5 to 4-fold greater risk of pelvic inflammatory disease for IUD users as compared with nonusers and a greater prevalence in women under 30 years of age as compared to older women. It is not known however whether the greater prevalence in women under 30 years of age is due to age itself or to social and behavioral factors which increase opportunities for exposure to or susceptibility to causative organisms of the disease. The effect of parity in the IUD-pelvic disease relationship has not been established. Studies on the relationship have yielded conflicting results which may be attributed to selection bias in control group inappropriate analytic methods and differences in types of IUD devices used by parous/nulliparous women. The protective effect of oral contraceptives and other types of contraceptives (condoms and diaphragms used with spermicidal chemicals) against pelvic disease has been demonstrated by numerous studies which showed a relative risk of pelvic disease of 0.3-0.9 (30-90% of risk) for users of oral pills as compared with nonusers; the risk of pelvic disease for users of hormonal contraceptives has also been shown to be half that for nonusers. The above fact is important as the decreased risk for users of oral pills tends to artificially increase the risk observed in IUD users. The mechanism of the protective effect of oral pills against the pelvic disease is speculative but studies have suggested that it is physiologically plausible for oral pills to decrease the risk of pelvic disease. Socioeconomic status has also been reported as a risk factor for pelvic inflammatory disease with estimated incidence of the disease among low income IUD users more than 3 times that among high-income women. Explanations offered include accessibility to health care sexual habits and numbers of sexual partners and others. Although the risk of pelvic inflammatory disease should be considered in choosing or prescribing a contraceptive method other factors should also be considered including age parity socioeconomic status availability of health care and priorities and concerns of various population groups.

Long-term clinical experience with the Cu-7-IUD. Evaluation of a prospective study

In a prospective Swedish three-center study, totally 1446 women wearing a Cu-7-IUD were carefully followed for a minimum 2 years. Smaller subgroups have been followed for 4 years (n = 278) or for even longer periods up to 8 years (n = 48) with the same Cu-7-IUD in situ . Data are given concerning continuation rate, efficiency, expulsion, removals, pain, bleeding and risk for pelvic inflammatory disease. Prolonged use of the Cu-7-IUD beyond 2 years up to 4 years seems to be associated with fewer side effects and a lower incidence of accidental pregnancies than during the first 2 years of use. The computerized data confirm our earlier impression that the Cu-7-IUD provides a substantial efficacy and is associated with a relatively low rate of adverse effects.

Intrauterine device use and the risk of pelvic inflammatory disease

A number of studies have shown an association between use of the intrauterine device (IUD) and the development of pelvic inflammatory disease. In the nine studies reviewed, the estimated risk varied between 1.6 and 9.3. A number of interacting variables are operant, in addition to IUD use. Further, the use of nonpermanent forms of contraception other than the IUD may exert a protective effect against the development of PID.

Risk of pelvic inflammatory disease among users of intrauterine devices, irrespective of previous pregnancy

The use of an intrauterine device (IUD) in 690 patients hospitalized for acute salpingitis (pelvic inflammatory disease) was compared with IUD use in a sexually active age-matched control group. Two hundred and twenty (31.9%) of the patients and 114 (16.5%) of the controls were wearing IUDs. Thus, the relative risk of developing acute salpingitis was 2 among IUD users. No significant difference was found in IUD use in the two groups between nulligravid women and women who had been pregnant. It was shown furthermore that the use of oral contraceptives decreases the risk of salpingitis by two thirds. A lower frequency of gonorrhea among PID patients who were IUD users was revealed also.

Pelvic inflammatory disease and the intrauterine device: a causal relationship?

IUD use in the U.S. has been declining in the past 5 years partly because of the adverse publicity given to the increased risk of pelvic inflammatory disease (PID) of IUD users. In 1977, the U.S. Food and Drug Administration recommended, on the basis of results from epidemiologic studies, that IUD labeling include the statement that "IUD use is associated with a 3-5 fold increase in infection rate." A review of the major results and some of the features of epidemiologic studies in which the contraceptive practices of PID cases were compared with controls (those without PID) showed that there is indeed an increased risk of PID among IUD users. The studies, except that of Vessey et al. however, do not provide any estimate of the magnitude of increased risk of PID to the IUD users nor ascertain whether there is a cause-and-effect relationship between IUD use and PID. Vessey found that the increased incidence of PID among IUD users was only 1.65/1000 woman-years and when compared with nonusers, the IUD user was at a 3.5-fold increased risk of PID. There is yet no evidence that any one type of IUD is associated with a higher rate of PID. Overall, although available evidence suggests that there is an increased risk of PID among IUD users compared to nonusers, the magnitude of the risk is small. It is possible that a woman's lifestyle has a greater influence on the risk of PID than the IUD per se.

IUD Users May Have Higher Risk of Contracting PID, Studies Find; Pill May Have Protective Effect

The incidence of pelvic inflammatory disease (PID), which can lead to serious reproductive impairment, infertility, or ectopic pregnancy, is increasing worldwide. About 500,000 women in their childbearing years contract PID for the first time each year in the U.S., and the incidence among young women appears to be increasing. Sexually transmitted diseases are responsible for many PID cases worldwide, while in developing countries postpartum and postabortion sepsis and endemic diseases such as filariasis and schistosomiasis may also be implicated. Some increase of PID is associated with legal abortion and IUD insertion, while pill use appears to protect women from PID. A worldwide review of medical literature indicates that the risk of PID is 3.5 times greater for IUD users than for nonusers, although several variables other than IUD use affect PID risk, such as age, race, socioeconomic status, and sexual activity. The risk for never pregnant IUD users in a Swedish study was 11.8 per 100 woman years, compared to 3.4 for ever-pregnant IUD users. There was no difference in relative risk for users of the pill or barrier methods, or for non-contraceptors. Another study reported a higher relative risk of PID related to duration of IUD use.

Risk of Pelvic Inflammatory Disease among Intrauterine Device Users Irrespective of Previous Pregnancy

Risk of Pelvic Inflammatory Disease among Intrauterine Device Users Irrespective of Previous Pregnancy

Intrauterine contraceptive device use and pelvic inflammatory disease

We examined the relationship between use of IUD's and PID, based on 44 women who were admitted to hospitals with first episodes of PID and 259 hospital control subjects. All the women used either IUD's or oral contraceptives. The age-adjusted relative risk for those using IUD's at the time of admission was 6.5 (95% confidence interval, 3.2 to 13.0). The association remained when several variables, and particularly parity, were taken into account. There was a suggestion that users who had had an IUD in place for at least 5 years had a higher risk of PID than did users of shorter duration. The data also suggest that copper-containing IUD's may be safer than other devices.

Low risk of pelvic inflammatory disease in young never-pregnant women using Gravigard R

The present four-center investigation involves 516 never-pregnant women in whom a copper-7-intrauterine device (Cu-7-IUD) was inserted. Out of these patients 173 were teenagers at the time of insertion. A “small-sized” Cu-7-IUD (Cu-7-Nullip) — designed for nulliparous women — was randomely used instead of the commercially available Cu-7-IUD (Gravigard R) in 76 — 44 of whom were teenagers — out of the 516 women. The incidence of pelvic inflammatory disease (PID) of 9,080 woman-months was reviewed. In the present study the incidence of PID varied from one center to another between 0.9 and 1.4 per cent/ year in women wearing Cu-IUDs. When comparing these figures with the estimated incidence (1.2%) in the population of fertile-aged women, it was concluded that the risk for PID was not increased in neverpregnant women using Cu-IUDs, including teenagers as well as women of 20 years of age or more. No difference in the incidence of PID was observed between the Gravigard R and the Cu-7-Nullip.

Oral and intrauterine contraception: A 1978 risk assessment

This report reviews the current literature on the various risks associated with the use of oral contraceptives and intrauterine contraceptive devices. Reports on oral contraceptives from large prospective studies are now beginning to supplement the detailed reports resulting from earlier case-control studies. These studies suggest that in Western societies there is an increase in the incidence of a variety of circulatory diseases, with an increased risk of death. With intrauterine contraceptive devices it now has been fairly well documented that there is an increased risk of pelvic inflammatory disease. After reviewing and assessing the risks of both methods in some detail and comparing these risks to the benefits, the resultant conclusion is that the benefits continue to outweigh the risks for both methods, except for older women who choose oral contraceptives and also are heavy smokers.

Pathogenesis of acute pelvic inflammatory disease: Role of contraception and other risk factors

In a case-control study of matched pairs, the risk of acute pelvic inflammatory disease (PID) was 4.4 times higher in intrauterine contraceptive device (IUD) users than in nonusers (p < 0.001). Of approximately 500,000 cases of acute PID occurring annually in the United States, an estimated 110,000 are attributable to IUD's, costing over forty-four million dollars per year. PID was attributable to the IUD in 77 per cent of IUD users. No particular type of IUD was implicated. The relative risk of acute PID in IUD users over nonusers was higher in nulligravid women than in previously pregnant women and was directly related to socioeconomic status (SES), but the total annual risk of PID in IUD users appear inversely related to SES. IUD use significantly increased the risk of nongonococcal PID. Fever occurred in 13 (21 per cent) of 61 IUD users and 59 (41 per cent) of 143 nonusers (p < 0.025). Among women with nongonococcal PID, and adnexal mass ≥ 6 cm. was noted in 14 (40 per cent) of 35 IUD users and in only 12 (15 per cent) of 78 nonusers (p < 0.01). An increased risk of gonococcal PID was found among non-Caucasians and women not using contraception, while the risk of nongonococcal PID was increased among women with a past history of gonorrhea. Oral contraceptive use may protect women with gonorrhea from developing PID. Menstruation precipitates the onset of symptoms of gonococcal PID.