IUDs Safe And Effective In High-risk Patients, Study Finds

The findings may help physicians develop improved guidelines for providing intrauterine devices (IUDs) to patients.

The IUD is the most common form of reversible birth control used by women worldwide. While IUDs offer a high level of long-term contraceptive efficacy, they have been associated with health risks, including pelvic inflammatory disease and upper genital tract infections. Women who are at high risk for both sexually transmitted infections and pregnancy have been classified as poor candidates for this method of contraception.

In a study published in the August issue of the American Journal of Obstetrics and Gynecology, researchers concluded that IUDs were acceptable and not associated with a significant increase in occurrence of gynecologic infections in women who are at high risk for both sexually transmitted infections and pregnancy.

"We once thought that IUDs could only be used in married, monogamous women because of a perceived increase in the risk of pelvic infections," said lead investigator, Catherine A. Matthews, M.D., assistant professor in the Department of Obstetrics and Gynecology at VCU.

"From our study, we now know that IUDs are safe to use in all women who don't have an acute infection of the cervix. Therefore, young, unmarried, sexually active women can now be considered good candidates for this contraceptive option, which doesn't require taking a pill, patch, or injection," she said.

The team conducted a medical chart review of approximately 200 women who had IUDs inserted between 2000 and 2005. Researchers compared the efficacy and complication rates of the Paragard IUD and Mirena intrauterine system (IUS). Both are T-shaped devices placed in the uterus to prevent pregnancy, however, the Mirena IUS releases a hormone.

According to Matthews, a third of women who received an IUD had a history of STD prior to insertion. Additionally, 32 percent of women had a history of other gynecological infections such as bacterial vaginosis, and almost half were unmarried. Matthews said that the Mirena IUS had lower rates of complications and greater acceptability than the Paragard IUD.

Matthews collaborated with VCU colleagues Samuel J. Campbell, M.D., with the Department of Obstetrics and Gynecology; and Karen L. Cropsey, PsyD., with the L. Douglas Wilder School of Government and Public Affairs.