Contraceptives Offer Women No Protection From Pelvic Inflammatory Disease, Says University Of Pittsburgh-Led Study

"This study addresses the controversy surrounding the protective effect of hormonal and barrier methods of contraception against PID in women," says Principal Investigator Roberta Ness, M.D., M.P.H., associate professor of epidemiology, medicine and obstetrics/gynecology. "The risk of upper genital tract infection was not reduced by any contraceptive method among women in this study. In fact, inconsistent condom use actually increased the risk of infection in this group of women."

PID is a common condition in which microorganisms spread from the lower genital tract to infect and inflame the upper genital tract, including the endometrium, fallopian tubes, ovaries and peritoneum. Women with PID have elevated rates of infertility, ectopic pregnancy and chronic pelvic pain.

Previous studies testing the ability of various contraceptive methods to protect against PID showed inconsistent results, perhaps due to the inclusion of women both with and without symptoms, and the use of older, higher-dose oral contraceptives in the studies.

The University of Pittsburgh-led study looked at contraceptive use among 563 women who had signs and symptoms of PID and who were enrolled in the PID Evaluation and Clinical Health (PEACH) Study, a randomized clinical treatment trial. Participants were between the ages of 14 and 37 and were recruited from emergency departments, clinics and STD units at each of 13 clinical sites. Each participant was interviewed and examined, and each received an endometrial biopsy and upper genital tract isolate microbiologic evaluation. According to the women, condoms were the most common method of contraception they used, followed by oral contraceptives, contraceptive injections and other barrier methods.

Inconsistent use of condoms was associated with an increased risk of upper genital tract infection (UGTI). Specifically, condom use in less than 100 percent of sexual encounters was associated with a more than two-fold increase in risk. However, UGTI rates were unaffected by use of medroxyprogesterone or oral contraceptives. Endometritis (inflammation of the uterine lining) alone, without UGTI, appears to be related to use of contraceptive injections among women with PID symptoms.

While no method offered protection against UGTI, the analysis showed that consistent condom use, when compared with no contraception use at all, led to a slightly reduced risk of both UGTI and endometritis without UGTI. Also, while oral contraceptives were not associated with a decreased risk of further infection, they were related to decreased severity of PID symptoms.

"Based on our findings in the PEACH study, hormonal and barrier contraceptives appear to play no role in reducing the risk of upper genital tract disease in women," Dr. Ness said.

Other PEACH Study investigators include David Soper, M.D., Medical University of South Carolina, Charleston; Robert Holley, M.D., University of Alabama School of Medicine, Birmingham; Jeffrey Peipert, M.D., and Hugh Randall, M.D., Emory University, Atlanta; Richard Sweet, M.D., Magee-Womens Hospital of UPMC Health System, Pittsburgh; Steven Sondheimer, M.D., University of Pennsylvania, Philadelphia; Susan Hendrix, D.O., Wayne State University, Detroit; Antonio Amortegui, M.D., and Giuliana Trucco, M.D., University of Pittsburgh and Magee-Womens Hospital of UPMC Health System, Pittsburgh; Debra Bass, M.S., and Sheryl Kelsey, Ph.D., University of Pittsburgh.