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Prolonged use of intrauterine contraceptive device as a risk factor for tubo-ovarian abscess
Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden / School of Life Sciences, University of Skövde, Skövde, Sweden / Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden / Department of Obstetrics and Gynecology, Kärnsjukhuset, 541 85 Skövde, Sweden.
University of Skövde, School of Life Sciences.
2009 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 88, no 6, 680-684 p.Article in journal (Refereed) Published
Abstract [en]

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. Skövde 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 ≤ 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.

Place, publisher, year, edition, pages
Informa Healthcare, 2009. Vol. 88, no 6, 680-684 p.
Keyword [en]
Salpingitis; tubo-ovarian abscess; intrauterine contraceptive device; pelvic inflammatory disease
National Category
Medical and Health Sciences
Research subject
Medical sciences
Identifiers
URN: urn:nbn:se:his:diva-3469DOI: 10.1080/00016340902893678ISI: 000267201800010PubMedID: 19412803Scopus ID: 2-s2.0-66149155042OAI: oai:DiVA.org:his-3469DiVA: diva2:274955
Available from: 2009-11-02 Created: 2009-11-02 Last updated: 2013-03-27Bibliographically approved

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CiteExportLink to record
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