One rationale that IUD use was discouraged in nulliparous women must do with concern over the possibility of pelvic inflammatory disease (PID) and infertility. This relies on the presumption that women or teenagers who haven’t had children and aren’t married may have had many sexual partners, placing them at a higher risk for a sexually transmitted infection (STI).
Furthermore, IUD research in the 1970s and 1980s was confusing and misleading. These studies deterred women from using IUDs since they claimed that PID risk increased by 60% in women who used IUDs. Nevertheless these studies didn’t have appropriate comparison groups (for example, they didn’t account for PID history, other birth control procedures or those women who may be at greater risk for developing PID). In addition they used crude analysis methods.
Better designed study that utilizes more sophisticated data analysis methods has discovered that there’s no significant increase in the risk of PID with IUD use.
IUDs and PID
Pelvic inflammatory disease (PID) refers to an infection which causes inflammation of the uterus lining, fallopian tubes or ovaries. The most common causes of PID are the sexually transmitted bacteria chlamydia and gonorrhea. With a condom (male or female) during sexual intercourse can help safeguard against catching a disease.
Research reveals that the prevalence of PID among women using IUDs is very low and consistent with estimates of their PID prevalence in the overall population.
That said, there seems to be some association between IUD use and pelvic inflammatory disease as compared to women who do not use any contraception.
Proof in the literature, however, explains that this greater risk of PID is not associated with real IUD use; instead, it has to do with bacteria being current at the time of the IUD insertion. After the first month of usage (about 20 times ), the risk of PID is not any greater than that in women who aren’t using IUDs. Research has thus concluded that bacterial contamination related to the IUD insertion process is the cause of infection, not the IUD itself.
Though data are somewhat inconsistent, it appears that use of this Mirena IUD (as compared to the ParaGard IUD) may actually lower the risk of PID. It’s believed that the progestin levonorgestrel in this IUD causes thicker cervical mucus, endometrial changes and reduced retrograde menstruation (if the menstrual blood flows into the fallopian tubes) and these conditions might create a protective effect against disease.
IUDs and Infertility
One of the common causes of infertility would be a tubal blockage. Roughly 1 million infertility cases are due to tubal disease. If left untreated, PID may cause redness and permanent blocking of the fallopian tubes. There is apparently no signs that IUD use is associated with infertility.
Research suggests that the former use or present use of an IUD isn’t related to an increased risk of tubal blockage. Results from an unmatched, case-control analysis of 1,895 women with primary tubal infertility (using many control groups to minimize bias — including women with infertility due to tubal blockage, infertile women who did not possess tubal blockage and women who had been pregnant for the first time), suggested:
- Previous use of copper IUDs (like ParaGard), when compared with women with no previous contraception use, wasn’t related to an increased risk of tubal blockage.
- Women whose sexual partners used condoms had a 50% lower risk of a gastrointestinal blockage compared to those who used no contraception.
- An extended duration of IUD use, the removal of the IUD because of unwanted effects or a history of symptoms during IUD use were not associated with an increased risk of tubal blockage.
In their Scientific Group assessment, the World Health Organization was concerned with worries in the general populace that IUD use was linked to a possible increased risk of PID and tubal infertility. Their conclusion agrees with present literature that methodological problems in previous research have caused the IUD-associated risk of PID to be overestimated. WHO also asserts there is no increased risk of infertility among IUD users who are in stable, monogamous sexual relationships.
In fact, what the study does show is that infertility (because of tubal blockage) is likely to be an outcome from an STI and not from IUDs. Studies reveal the presence of chlamydia antibodies in women are associated with tubal blockage. The body makes antibodies when subjected to the chlamydia bacteria to help combat this infection. The antibodies remain in the bloodstream even once the infection is cleared. Studies have found that the presence of the chlamydia antibody correctly predicts the existence of tubal blockage 62% of their time, whereas the lack of the chlamydia antibody predicts the absence of tubal damage 90% of the time. It can be concluded that infertility which occurs after IUD use has nothing to do with the IUD — which infertility is likely to have been caused by an untreated STI.
ACOG Guidelines on IUDs and STIs
It’s suggested that nulliparous women at high risk for STIs (i.e., 25 years old and/or having multiple sexual partners) should have an STI screening performed on precisely the same day as an IUD insertion. If test results are positive, treatment should be provided along with the IUD can be left in place if the woman is asymptomatic. A Category 2 rating (i.e., the advantages of working with this contraceptive method generally outweigh the dangers ) is given to a girl with an increased risk for STIs or for continuing IUD usage in a woman found to have a chlamydia or gonorrhea infection and then treated with antibiotic treatment.
A Category 3 classification (i.e., theoretical or proven risks usually outweigh the advantages of using the procedure ) is applied to girls who have a very high individual risk of exposure to gonorrhea or chlamydia. Girls that have a chlamydia or gonorrhea disease at the time of IUD insertion are more likely to develop PID than girls without an STI. Yet even in girls with an untreated STI in the time of insertion, this threat still appears small. The absolute risk of developing PID was low for both groups (0-5percent for those with STIs once the IUD is inserted, and 0-2% for those without disease ).
Women who have abnormal vaginal discharge or with confirmed cases of chlamydia or gonorrhea should be treated before an IUD is inserted. For women who received a diagnosis of chlamydia or gonorrhea, ACOG and the Centers for Disease Control and Prevention recommend repeat testing at three to six months prior to an IUD insertion.