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  • Title: [Long-term retention of IUD and inflammatory diseases of the internal genitalia].
    Author: Citterbart K, Zavadil M, Zák F, Skrivan J.
    Journal: Cesk Gynekol; 1978 Sep; 43(8):641. PubMed ID: 688455.
    Abstract:
    To determine relationship of long-term IUD retention and inflammatory disease of the internal genitals, 244 women who had an IUD in place for at least 4 years were studied. The IUDs were removed for research purposes an average of 7 days before the onset of menses. The material adhering to them was examined both to determine the stage of the menstrual cycle and to detect the presence of inflammatory infiltration of the endometrium. In 54.8% of the women the endometrium was found to be of the secretory type, in 32.2% of the proliferative type, while 8.1% had stromoglandular dissociation, and debris was found in 4.9% of the samples. In 19 women, inflammatory changes were found. 15 of these women were asymptomatic, but 4 suffered pain, discharge, and menstrual irregularity. In those women with inflammatory changes, 15(78.9%) had endometritis chronica modica, 2 had e. prurulenta, 1 e. subsacuta, and 1 e. acuta. Microscopic analysis of women with e. chronica modica showed presence of lymphocytes, leukocytes, fibroblasts and macrophages, but did not disclose plasmocytes. Endometrial biopsies were performed on 5 women with e. chronica modica in the cycle immediately following the removal of their IUDs. The finding of e. chronica modica did not persist in these women. It therefore seems that some women undergo a pseudoinflammatory process as an immune reaction of the epithelium to the IUD. Elevated leukocyte, lymphocyte, fibroblast and macrophage levels may be correlated with the contraceptive state. A true inflammatory process was seen in only 1.6% of the women studied, and the IUD can't be conclusively implicated as causing this inflammation. If proper precautionary measures are taken it appears safe to leave an IUD in place for at least 4 years.
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