Georgios Charonis1, Per-Göran Larsson. 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.
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.
Authors: Herman F Wunderink; Eileen E L O Lashley; Mariëtte I E van Poelgeest; Katja N Gaarenstroom; Eric C J Claas; Ed J Kuijper Journal: J Clin Microbiol Date: 2010-11-10 Impact factor: 5.948