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Acta Obstet Gynecol Scand. 2009;88(6):680-4. doi: 10.1080/00016340902893678.

Prolonged use of intrauterine contraceptive device as a risk factor for tubo-ovarian abscess.

Author information

1
Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden. georgios.charonis@vgregion.se

Abstract

OBJECTIVE:

The intrauterine contraceptive device (IUCD) is the most preferred method of reversible contraception in the world today. The Swedish Medical Products Agency currently recommends that women who had a copper IUCD inserted around age 40 do not need to have it extracted until one year after the menopause.

DESIGN:

Retrospective study.

SETTING:

Skovde Central Hospital, Sweden.

POPULATION:

All 114 women receiving in-patient treatment for pelvic inflammatory disease (PID) over five years between January 2001 and December 2005.

METHODS:

Comparison between cases of tubo-ovarian abscesses and salpingitis with focus on the effects of IUCDs used continually for >5 years after insertion.

MAIN OUTCOME MEASURES:

Age-adjusted risk of PID within or after five years of use, microbiological findings in blood, intraabdominal pus, cervical secretions or on extracted IUCDs.

RESULTS:

There were 31 cases of tubo-ovarian abscesses, 63 of salpingitis, four of endometritis, and 16 of mild genital infection. When comparing women with the same IUCD > 5 years to women having the same IUCD <or= 5 years, the risk of tubo-ovarian abscess was higher than the risk of salpingitis (OR 19.7; 95% CI 4.5-87.2). The risk remained significant after adjustment for age, both on multiple regression analysis (OR 13.5; 95% CI 2.5-72.9) and in stratified analysis for the age group 35-50 years (OR 12.0; 95% CI 1.8-81.7). Blood or abdominal cultures from patients operated upon were positive in 47.7% of the sampled cases. Intestinal tract microbes and upper respiratory tract microbes were more common than sexually transmitted infection microbes.

CONCLUSIONS:

The current Medical Products Agency recommendation that a woman nearing the end of her reproductive phase can safely use the same IUCD for a period exceeding five years is challenged.

PMID:
19412803
DOI:
10.1080/00016340902893678
[Indexed for MEDLINE]

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