ABSTRACT
PIP: Analysis was performed of data relative to 10,001 IUD insertions (mostly Lippes Loop D and C) in 8091 women in Slovenia between 1965 and 1972. Data were gathered on sociodemographic characteristics of the users; cumulative life-table rates per 100 women for removals due to pregnancy, expulsion, bleeding/pain, other medical reasons, and personal reasons as well as continuation rates and the rate of follow-up; and the proportion of women with bleeding, spotting, vaginitis, and pelvic inflammatory disease (PID) at 1-, 5-, and 10-year follow-up. The most frequent reason for removal was bleeding. Increased duration of IUD use was associated with a smaller number of women with bleeding and PID episodes. Of those with first insertions, 608 were hospitalized for IUD-related complications (49% for bleeding requiring curettage and 20% with PID). IUD use for more than five years carried a relative risk of 3.9 for a severe episode when PID developed. Of the women who terminated use of their first IUD because of expulsions, pregnancy, or bleeding, 28% asked for reinsertion. Over the 15 years of IUD use, 853 pregnancies occurred with an IUD in situ. If the IUD was removed after conception, the pregnancy outcome did not differ from women without IUDs. If the IUD was not removed, there was an increased risk of spontaneous abortion, preterm labor, and intrauterine fetal infection. While the IUD users experienced the same risk of ectopic pregnancy as noncontraceptors, if the IUD user did become pregnant, their risk of ectopic pregnancy was twice as high as that faced by those who did not use IUDs. Duration of IUD use and type of IUD had no effect on time from removal to desired conception. This duration was increased, however, in women with a history of PID and in older women. Women over 40 tolerated the IUD better than younger women but as women approached 50, removals for bleeding became more frequent. In conclusion, the IUD is a very safe contraceptive agent and is well tolerated if users are selected carefully, are motivated, and receive help with side effects.^ieng
