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


METHODS
Retrospective study.


METHODS
Skovde Central Hospital, Sweden.


METHODS
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.


METHODS
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.
Charonis
Georgios
G
Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden. georgios.charonis@vgregion.se
Larsson
Per-Göran
PG
D000038:Abscess / Q000209:etiology*; D000291:Adnexal Diseases / Q000209:etiology*; D000328:Adult; D005260:Female; D006801:Humans; D007434:Intrauterine Devices / Q000009:adverse effects*; D008875:Middle Aged; D000292:Pelvic Inflammatory Disease / Q000209:etiology; D010388:Pelvis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors