Manejo farmacológico del sangrado irregular no menstrual asociado al uso de implantes anticonceptivos subdérmicos / Pharmacological management of irregular non-menstrual bleeding associated with the use of subdermal contraceptive implants

El spottingo sangrado irregular no menstrual es uno de los principales efectos secundarios de los implantes anticonceptivos, situación que se recomienda discutir con la usuaria previo a la colocación, para evitar falsas expectativas o temores que lleven a la extracción temprana del dispositivo. A propósito de una paciente sin antecedentes relevantes que consultó al centro de salud por spotting desde la colocación del implante cuatro meses antes, decidimos revisar la evidencia sobre la efectividad de los distintos esquemas farmacológicos disponibles para el manejo de este evento adverso. Luego de realizar una búsqueda bibliográfica concluimos que, si bien existe sustento para indicar algunos de los esquemas farmacológicos, este es aún débil y son necesarios estudios clínicos adicionales que brinden evidencia sólida sobre qué esquema en particular utilizar, evaluando sus riesgos y beneficios. (AU)

Spotting or irregular non-menstrual bleeding is one of the main side effects of contraceptive implants, a situation that health professionals must discuss with the user prior to its placement in order to avoid false expectations or fears that lead to early removal of the implant. Regarding a patient with no relevant history who consulted the health center due to spotting four months after implant placement, we decided to review the evidence onthe effectiveness on different pharmacological schemes available for the management of this adverse event. After performing a literature search, we concluded that, although there is support for indicating some of the pharmacological schemes, this is still weak, and further clinical studies are needed to provide solid evidence on which particular scheme touse, assessing its risks and benefits. (AU)

Comparison of Postprandial Lipemia between Women who are on Oral Contraceptive Methods and Those who are not / Comparação da Lipemia Pós-Prandial de Mulheres que Utilizam e Não Utilizam Contraceptivo Oral

Background: Postprandial Lipemia (PPL) is a physiological process that reflects the ability of the body to metabolize lipids. Even though the influence of oral contraceptives (OC) on PPL is not known, it is a known fact that their use increases fasting lipid values. Objective: To compare the PPL between women who are on OC and those who are not. Methods: A prospective analytical study which assessed eutrophic women, aged between 18 and 28 years old, who were irregularly active and with fasting triglycerides ≤150 mg/dL. They were divided into two groups: oral contraceptive group (COG) and non-oral contraceptive group (NCOG). Volunteers were submitted to the PPL test, in which blood samples were collected in time 0 (12-hour fasting) and after the intake of lipids in times 180 and 240 minutes. In order to compare the triglyceride deltas, which reflect PPL, the two-tailed Mann-Whitney test was used for independent samples between fasting collections and 180 minutes (Δ1) and between fasting and 240 minutes (Δ2). Results: Forty women were assessed and equally divided between groups. In the fasting lipid profile, it was observed that HDL did not present significant differences and that triglycerides in COG were twice as high in comparison to NCOG. Medians of Δ1 and Δ2 presented significant differences in both comparisons (p ≤0.05). Conclusion: The results point out that women who are irregularly active and use OC present more PPL in relation to those who do not use OC, which suggests that in this population, its chronic use increases the risk of heart conditions. .

Fundamento: Lipemia pós-prandial (LPP) é um processo fisiológico que reflete a capacidade do organismo de metabolizar lipídeos. Embora não seja conhecida a influência dos contraceptivos orais (CO) na LPP, sabe-se que o seu uso eleva os valores lipídicos de jejum. Objetivo: Comparar LPP entre mulheres que utilizam e não utilizam CO. Métodos: Estudo analítico prospectivo, no qual foram avaliadas mulheres eutróficas, com idade entre 18 e 28 anos, irregularmente ativas e com triglicerídeos de jejum ≤150 mg/dL divididas em dois grupos: grupo contraceptivo (GCO) e grupo sem contraceptivo (GSCO). As voluntárias foram submetidas ao teste de LPP, no qual amostras sanguíneas foram coletadas no tempo 0 (jejum de 12 h) e após ingestão de lipídios nos tempos 180 e 240 minutos. Para comparação dos deltas dos triglicerídeos, que refletem a LPP, entre as coletas de jejum e 180 min (Δ1) e jejum e 240 min (Δ2), foi utilizado o teste de Mann-Whitney bidirecional para amostras independentes. Resultados: Foram avaliadas 40 mulheres divididas igualmente entre os grupos. No perfil lipídico de jejum, observou-se que a HDL não apresentou diferença significativa e que os triglicerídeos do GCO foram o dobro do GSCO. As medianas de Δ1 e Δ2 apresentaram diferença significativa nas duas comparações (p ≤0,05). Conclusão: Os resultados apontam que mulheres irregularmente ativas que utilizam CO apresentam LPP maior que aquelas que não utilizam CO, sugerindo que nessa população seu uso crônico aumenta o risco de doenças cardiovasculares. .

Condom and oral contraceptive use and risk of cervical intraepithelial neoplasia in Australian women / 부인종양

OBJECTIVE: To assess the association between condom use and oral contraceptive consumption and the risk of cervical intraepithelial neoplasia (CIN). METHODS: A cross-sectional study was conducted in Perth clinics. A total of 348 women responded to the structured questionnaire. Information sought included demographic and lifestyle characteristics such as the use of condom for contraception, consumption of oral contraceptive, and duration of oral contraceptive usage. Crude and adjusted odds ratio (OR) and associated 95% confidence interval (CI) were calculated using unconditional logistic regression models and reported as estimates of the relative risk. RESULTS: The prevalence of CIN was found to be 15.8%. The duration of oral contraceptive consumption among women with abnormal Papanicolaou (Pap) smear result indicating CIN was significantly shorter than those without abnormal Pap smear result (mean+/-SD, 5.6+/-5.2 years vs. 8.2+/-7.6 years; p=0.002). Comparing to or =10 years reduced the risk of CIN (p=0.012). However, use of condom for contraception might not be associated with a reduced risk of CIN after accounting for the effects of confounding factors (adjusted OR, 0.52; 95% CI, 0.05 to 5.11; p=0.577). CONCLUSION: Use of oral contraceptives, but not condoms, for contraception appeared to be inversely associated with CIN. Prolonged use of oral contraceptive demonstrated its benefits of reducing the risk of CIN.

Efecto del consumo de anticonceptivos orales en el flujo salival no estimulado, PH y capacidad buffer / Effect of oral contraceptive use in unstimulated salivary flow, pH and buffer capacity

La saliva, un elemento esencial en la preservación de salud oral, puede verse alterada por diversos factores, como el consumo de fármacos, en cuanto al flujo, pH o capacidad buffer, constituyendo un factor predisponente a diversas patologías (1). Comparar el flujo salival no estimulado, pH y capacidad buffer entre consumidoras y no consumidoras de anticonceptivos orales combinados. Cincuenta y seis mujeres sanas, entre 21 y 26 años de edad, con bajo riesgo cariogénico, dividida en dos grupos, consumidoras y no consumidoras de anticonceptivos orales. Para determinar el flujo salival no estimulado, se tomó una muestra de saliva durante 15 minutos. Para determinar los pH se utilizó un potenciómetro (PL-600Lab PH meter) y para determinar capacidad buffer se utilizó el método de Ericsson. Para analizar la significancia estadística de las diferentes pruebas se realizó la prueba U Mann-Whitney utilizando el software SPSS versión 14.0. El promedio de flujo salival no estimulado observado en este estudio, es mayor entre consumidoras de anticonceptivos orales, con un p<0.005. En cuanto a capacidad buffer, se obtuvieron valores levemente superiores en el grupo consumidor, mientras que los valores de pH resultaron similares entre ambos grupos. El flujo salival no estimulado se ve aumentado en las consumidoras de anticonceptivos orales combinados, mientras que la capacidad buffer presenta un incremento no significativo, mientras que el pH salival arroja valores similares para ambos grupos

Saliva is an essential element in oral health preservation and its pH, buffer capacity and flow rate, have a fundamental role. These factors may be altered by, among others, drug consumption which predisposes to several diseases (1). To compare the non-stimulated salivary flow rate, pH and buffer capacity between patients under Oral contraceptives medication and not taking any medication. Fifty six healthy women, aged 21 to 26 years, with low cariogenic risk, divided into two groups: under oral contraceptives medication and without medication. To determine the non-stimulated salivary flow rate, was taken a saliva sample during 15 minutes. To determine the pH, was used a potentiometer (PL 600Lab PH-meter) and buffer capacity was measured by Ericsson's method. Mann-Whitney test was performed using SPSS software version 14.0 to determine statistical significance. Mean of stimulated salivary flow rate is not statistically significantly in subjects under oral contraceptives medication (p <0.005). Buffer capacity showed slightly higher values in study group, while the pH values were similar in study and control groups. The stimulated salivary flow rate is not increased by consuming the Oral contracetives, the salivary pH shown similar values for both groups, and finally, the salivary buffer capacity, shown increased in the consumer group, however, it does not statistically significant

Estudio comparativo entre las características citológicas de los epitelios nasal, faríngeo y vaginal en mujeres adultas jóvenes / Comparative study of cytological characteristics of the nasal, pharygeal and vaginal epithelium in young adult women

Determinar y comparar las características citológicas de los epitelios nasal, faríngeo y vaginal en mujeres adultas jóvenes. Estudio prospectivo y transversal de 35 mujeres no embarazadas, entre 18 y 35 años de edad, durante el período comprendido entre el 01 de enero al 01 de julio de 2004; que ingirieron o no anticonceptivos orales y a quienes se les estudiaron las citologías de los epitelios vaginal, faríngeo y nasal, según el porcentaje de índice de maduración de células exfoliadas y la cuantificación sérica de estrógeno y progesterona. En el Departamento de Obstetricia y Ginecología Hospital Chiquinquirá de Maracaibo, Estado Zulia. Se determinó que no existe diferencia significativa entre la celularidad de los epitelios estudiados. Se estableció que existe buena correlación entre las células superficiales e intermedias de los frotis de vagina, faringe y nariz durante las fases del ciclo menstrual, en todas las mujeres, aun en las que recibieron píldoras anticonceptivas. Los niveles de estrógenos y progesterona tuvieron concordancia con las fases del ciclo, con el porcentaje y tipo de células exfoliadas. Los resultados obtenidos demuestran que los epitelios nasales y faríngeos responden al influjo de hormonas ováricas similarmente como ocurre en la vagina y que estos métodos pueden ser aplicados en condiciones de difícil acceso a laboratorios hormonales o en pacientes vírgenes o con atresia/agenesia vaginal y niñas

To determine and compare the cytological characteristics of nasal, pharyngeal and vaginal epitheliums in young adult women. A prospective and transversal study of 35 non pregnant women of 18 to 35 years old during the period January 1, 2004 - November 2004; some on contraceptives pills, were studied by analysis of smear of nasal, pharyngeal and vaginal trough maturation index of exfoliated cells and serum level of estrogen and progesterone. Department of Obstetrics and Gynecology, Hospital Chiquinquira, Maracaibo, Estado Zulia. Venezuela. It was established that exists a good correlation between the superficial and intermediate cells in the different phases of the menstrual cycle and those who received oral contraceptives and the group that did not. Is established that there are correlation between the cells when compared vaginal-pharynx and vaginal-nose, in both groups. The serum levels of estrogen and progesterone were accorded to the cycle phases and with the percentage of cells in both, medicated and non medicated patients. Ours results demonstrate that the nasal and pharyngeal epitheliums respond to ovarian hormones, similar to what occurs in the vagina. It is recommended to use this method in those patients where it is need to investigate the endocrine status and where it is difficult to reach the vagina: nubile girls, vaginal agenesis, imperforate hymen; or where there is not a endocrine laboratory near

Guía de prevención del embarazo en la adolescencia en Guatemala / Guide to teenage pregnancy prevention in Guatemala

Guía de trabajo para contribuir a la prevención de embarazo en la adolescencia en donde se definen temas básicos que deben ser abordados desde los diferentes ámbitos de interrelación, tomando en cuenta la participación de los adolescentes, padres, líderes, educadores, comunidad así como los diferentes sectores, a través de acciones preventivas y educación para la salud. Entre las temáticas esenciales en el abordaje de los adolescentes se tienen: crecimiento y desarrollo, sexo, sexualidad, género, autoestima, violencia, ITS VHI/sida, paternidad y maternidad responsable, anticoncepción, aborto, creciendo con características especiales (discapacidad), proyecto de vida, entre otros.

Contraceptive discontinuation and non-use in Santarém, Brazilian Amazon / Interrupção do uso e não-uso de métodos contraceptivos em Santarém, Amazônia brasileira

In this paper we discuss the causes of non-adherence to reversible contraceptives, especially hormonal methods, among women in rural Santarém in the Brazilian Amazon. The analysis is based on questionnaires with 398 women and visits to health centers. We consider the motives reported by women who: never used contraception; used some method in the past; and who at the time of the survey were using a different method from the ones they used in the past. The results indicate a rejection of hormonal contraception and a preference for female sterilization, an option possibly influenced by the characteristics of health services in the region. The side effects of hormonal contraceptive use reported by part of the interviewees contribute to a generalized fear of the side effects even among women who have never used such methods. To improve women's health services in the Amazon, we recommend further studies of the relationship between reported side effects and available services and prescriptions, as well as an analysis of women's discourse and perceptions.

Discutimos sobre as causas da não-adesão aos contraceptivos reversíveis, especialmente os métodos hormonais, entre moradoras rurais de Santarém, na Amazônia brasileira. A análise baseia-se em questionários aplicados a 398 mulheres e em visitas a centros de saúde. Consideramos os motivos relatados por mulheres que: nunca usaram contraceptivos; que usaram métodos no passado; que, no momento do levantamento, usavam método diferente dos utilizados no passado. Os resultados indicam rejeição aos contraceptivos hormonais e preferência pela esterilização feminina, opção possivelmente influenciada pelas características dos serviços de saúde na região. Efeitos colaterais do uso de contraceptivos hormonais relatados por parte das entrevistadas contribuem para o medo generalizado de efeitos colaterais, mesmo entre mulheres que nunca usaram métodos hormonais. Para aprimorar o serviço de saúde da mulher na Amazônia, recomendamos futuros estudos sobre o relacionamento entre os efeitos colaterais relatados, os serviços e medicamentos disponíveis, assim como uma análise dos discursos e das percepções das mulheres.

Los regímenes extendidos, una opción válida para conocer y promover / Extended regimes, a valid option for know and to promote

La prescripción del uso continuo de los anticonceptivos orales combinados activos (regímenes extendidos), ha tenido una gran difusión y aceptación en años recientes, esto ha sido particularmente significativo en las naciones más desarrolladas. Inicialmente su uso estuvo limitado a indicaciones médicas específicas, como son el tratamiento de la Endometriosis, anemia asociada a disfunciones menstruales, dismenorrea y otras entidades, a los que se han ido agregando recientemente nuevas indicaciones, ocupando un lugar protagónico aquellas motivadas por la decisión o deseo personal. En la actualidad este método goza de una creciente popularidad entre las mujeres con un impacto importante en la calidad de vida. Hasta la fecha no se han reportado efectos adversos asociados a este patrón de uso de los anticonceptivos, en tanto múltiples son las ventajas asociadas a su uso, lo cual incluye incluso una reducción en los costos de la anticoncepción a largo plazo. Es por ello que consideramos oportuno realizar la presente revisión sobre el tema, con el objetivo de brindar a los profesionales de la salud que trabajan en la esfera de la Planificación Familiar y Salud Reproductiva, las herramientas necesarias que le permitan conocer el método e introducirlo paulatinamente en la práctica diaria, lo que consideramos sería un positivo aporte para el mejoramiento de la calidad de vida de la mujer cubana. Conocer los Nuevos Regímenes y sus potencialidades constituye un reto y una necesidad imperiosa para los médicos de hoy, es su responsabilidad ineludible el mantener un alto nivel de actualidad e información en todos los temas referentes a la anticoncepción.

Prescription of continuous use of active combined oral contraceptives (open regimes) has had a great diffusion and acceptation in recent years; it has been particularly significant in more developed countries. Initially, its use was limited to specific medical indications, such as, endometriosis, menstrual dysfunction-associated anemia, dysmenorrhea, and other entities, occupying a key place those related to a decision or a personal desire. At present times, this method is very popular among women with a marked impact on quality of life. So far, there were no side effects with use pattern of contraceptives, since there are multiple advantages associated with its use, including a reduction in anticonceptional long-term costs. That is why we consider very appropriate to carry out present review on this topic, to offer health professional working in Family Plan and Reproductive Health sphere, the tools needed allowing them to know method and its introduction in daily practice, considering that it will be a positive contribution for improvement of quality of life of Cuban woman. To know the new regimes and their potentials is a challenge and an urgent need for present physicians, being an unavoidable responsibility to maintain a updating high level and information on all topics referring anticonceptional practice.

Muchas mujeres podrían preferir un régimen extendido de anticonceptivos orales / Premenstrual symptomatology and oral contraceptives

Los síntomas relacionados con la menstruación son frecuentes en mujeres en edad fértil, incluso en aquellas que están tomando anticonceptivos orales. A pesar de que el diagnóstico de síndrome premenstrual se basa en mujeres que tienen síntomas durante la ovulación, estos síntomas, que incluyen los emocionales, han sido descritos en mujeres que toman anticonceptivos por vía oral en un régimen 21/7. En una investigación en mujeres que utilizan un régimen extendido de anticonceptivos orales (que omite los siete días de intervalo libre de hormonas) y contiene drosperinona y etinilestradiol se halló una mejoría en los síntomas relacionados con la menstruación, incluidos los afectivos. El mayor inconveniente de los regímenes extendidos es el molesto inconveniente del sangrado intermenstrual. Se ha demostrado que el intervalo de tres días libre de hormonas, en los casos de problemas de sangrado prolongado, resuelve más a menudo los casos de pérdidas que la toma continua de comprimidos activos. Un régimen extendido es un plan terapéutico aceptable para muchas mujeres porque es una modificación o una reanudación de un tratamiento previamente utilizado en oposición al agregado de medicación psicotrópica.

Associação de alterações cromáticas e uso de anticoncepcionais orais / Association of color vision alterations and the use of oral contraceptives

OBJETIVOS: Avaliar, em mulheres em idade fértil, a associação entre o uso de anticoncepcionais (ACO) orais de baixa dosagem e alterações na visão de cores. MÉTODOS: Foram incluídas no estudo 30 mulheres, 16 usuárias de ACO oral há menos de cinco anos (Grupo I) e 14 usuárias de anticoncepcionais orais há mais de cinco anos (Grupo II). Foram utilizados os testes de Ishihara, City University Color Vision Test e D 15 dessaturado. RESULTADOS: Não foram observados padrões característicos de distúrbio da visão cromática em nenhum teste dos dois grupos. CONCLUSÃO: Na amostra estudada, o uso de ACO oral de baixa dosagem não influenciou a visão de cores, independente do tempo de uso.

PURPOSE: To evaluate the association between oral low-dose contraceptives and color vision alterations. METHODS: Were included in the study 30 women, sixteen used oral contraceptive for less than five years (Group I) and 14 used it for more than five years (Group II). The Ishihara, City University Color Vision Test, and the D 15 desaturated tests were used. RESULTS: No characteristic alterations in the chromatic perception were found in any of the groups. CONCLUSION: In the studied sample, low-dose oral contraceptive has not influenced color vision, independent of the time of use.

Serum HDL-cholesterol in women using low dose oral contraceptives.

This study was done to appraise the effects of low-dose oral contraceptives (OCs) containing 30microgm ethinyl estradiol and 150microgm levonorgestrel on lipid metabolism by a lipid variable-serum HDL-cholesterol (HDL-C). HDL-C has been identified as a lipoprotein that protects against atherosclerosis and its levels are inversely proportional to the risk for developing ischemic coronary disease and venous thromboembolic disorders. Ninety young women within reproductive age group were picked for this study. Sixty women using low-dose oral contraceptives served as experimental group and thirty age matched hormonal contraceptive non users were selected for control group. Experimental group was again subdivided into OCs users for last one-year group, three-year group and five-year group. The result showed that there was no significant difference on serum HDL-cholesterol levels between users & non-users women. It is concluded that low-dose oral contraceptives regimens did not significantly affect the lipid metabolism. It can be safely used as contraceptive & non-contraceptive purposes. The value of studied parameter for serial longer duration of OCs uses needs to be assessed.

Lifestyle factors and breast cancer: a case-control study in Kuala Lumpur, Malaysia.

Breast cancer is the most common female cancer and the commonest cause of death due to cancer for women in Malaysia. This study was performed to identify the relationship with lifestyle factors. A case-control study was conducted among females with breast cancer who came for treatment to the Breast Clinic Hospital Kuala Lumpur in July until September 2004. A total of 203 female patients were recruited as cases along with 203 patients who attended the Outpatient Clinic, Hospital Kuala Lumpur during the study period as the controls. The study showed women who did not exercise regularly to have four times higher risk (adjusted odds ratio is 3.49, 95% CI is 1.84 to 6.62) compared to those who exercised regularly. Women with a high fat diet were also at elevated risk (adjusted odds ratio 3.84, 95% CI is 1.20 to 12.34) compared to those consuming a low fat diet. Women without breast cancer generally had a longer duration of lifetime lactation with a median of thirty-three months compared to women with breast cancer (twenty months, p<0.05). Women who did not take oral contraceptive pills but had breast-fed their child have a 56.0% lower risk (crude odds ratio 0.44, CI is 0.22 to 0.87) compared to women who did not take oral contraceptive pill and also did not breast-feed their child. If they had breast fed for thirteen months and above, they faced a 61.0% lower risk (crude odds ratio 0.39, 95% CI is 0.17 to 0.87). There was a significant inverse trend for lifetime lactation and breast cancer risk. In conclusion certain life styles of women are associated with a higher risk of breast cancer development. Therefore, the promotion of a healthy life style should be emphasized.

A randomized trial on the impact of starting day on ovarian follicular activity in very low dose oral contraceptive pills users.

In a randomized trial, the impact of starting day (the first and the seventh day of the period) on ovarian follicular activity was assessed during administration of a very low dose of oral contraceptive pills (20 microgram (mcg) ethinyl estradiol (EE) and 75 mcg gestodene (GS) [Meliane, Schering, Germany]). One hundred and sixty healthy women aged: 23-44 years, who had a regular cycle, and who were not using any type of oral contraceptive (OCs) steroid were studied at the Family Planning Clinic of King Chulalongkorn Memorial Hospital, Bangkok, Thailand. In the trial, each subject received a package of Meliane. They were blockwise randomized, 1:1 ratio; in the first group, subjects began their pills on the first day of their period (n = 80) and the other group, the seventh day of their period (n = 80). During the treatment cycle, ovarian activity was evaluated by transvaginal sonography (TVS) to determine the follicular-like structure (FLS). Ovulation was defined as the dominant FLS detected by TVS and followed-up every other day until its collapse. It occurred in 0 of 77 cases who started on the first day of their period and occurred in 8 of 78 cases of the group which started on the seventh day of their period. The difference was of statistical significance (p = 0.006). The result of this clinical trial is beneficial information for users of OCs containing 20 mcg EE who delay start of the OCs package.

Eficacia y aceptabilidad en mujeres venezolanas de un anticonceptivo oral monofásico que contiene 20 microgramos de etinilestradiol y 150 microgramos de desogestrel / Efficacy and acceptability in Venezuelan females of a oral monophasic contraceptive containing ethynilestradiol 20 micrograms and desogestrel 150 micrograms

Evaluar la eficacia anticonceptiva, control de ciclo, aceptabilidad por parte de la usuaria, cambios en el peso corporal y tensión arterial con el uso de un anticonceptivo oral monofásico que contiene 20 microgramos de etilestradiol y 150 microgramos de desogestrel. Estudio abierto no comparativo multicéntrico donde participaron 122 mujeres proporcionando datos relativos a 600 ciclos. Ocho centros privados localizados en Caracas, Barquisimeto y Mérida. De las 122 mujeres evaluadas durante 600 ciclos, no se presentó embarazo, el control del ciclo tuvo una duración en todos los casos entre 3 a 5 y no huvo cambios estadísticamente significativos con respecto al peso corporal y tensión arterial. Los resultados derivados de este estudio sugieren que la reducción en la dósis de etinilestradiol a 20 microgramos permite todavía una máxima eficacia, buena aceptabilidad y un adecuado control de ciclo

¿Son los dispositivos intrauterinos y el inicio de las relaciones sexuales factores de riesgo y los anticonceptivos orales factor protector para la enfermedad inflamatoria pélvica?: (estudio de casos y controles) / Are the intrauterine devices and the begin of the sexuals relations risk factors and the contraceptives orals protecting factor to the inflamatory pelvic disease?: (study of case and controls)

Evaluar la asociación entre uso de DIU, ACO e incio de las relaciones sexuales con EIP. Estudio de casos y controles de historias de pacientes hospitalizadas en (Ginecología, Hospital Universitario de Caracas (1987-1993). Fueron estudiadas 184 mujeres (15-45 años), activas sexualmente; 92 casos y 92 controles. Se estimó el riesgo relativo, intervalos de confianza al 95 por ciento y la prueba estadística X². Comparando usaurias DIU con no usuarias se encontró un riesgo estimado de 4,5, estadísticamente significante (X² 13,13;IC 95 por ciento) 2,01-10,00). Los ACO tuvieron riesgo estimado de 0,8 (X² 0,55;IC 95 por ciento 0,36-1,74), estadísticamente no significante. Se encontró asociación causal entre la actividad sexual y EIP, con riesgo estimado de 1,7(X² 2;6;IC 95 por ciento 0,84 3,71) estadísticamente no significante. El DIU es el único factor de riesgo significantemente comprobado este estudio