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Pelvic inflammatory disease - Management
What contraceptive advice should I give?

  • Women who have a history of, or currently have, pelvic inflammatory disease (PID) may use the following contraceptive methods (UK Medical Eligibility Criteria [UKMEC] category 1, that is, a condition for which there is no restriction for the use of the contraceptive method):
    • Combined oral contraceptive (COC) pill.
    • Progestogen-only pill.
    • Depot progestogen injection.
    • Progesterone-only contraceptive implant.
  • For women with a history of PID who wish to have an intrauterine device (IUD) fitted:
    • Explain that the relative risk of PID is increased six-fold in the 20 days following insertion, but that the absolute risk remains low (approximately 1%). After this time, the risk is the same as the population without an IUD and remains low unless there is exposure to sexually transmitted infection (STI).
    • If the woman has had a subsequent pregnancy, there are no restrictions on the use of both the copper IUD and the levonorgestrel intrauterine system (LNG-IUS) (UKMEC category 1).
    • If the woman has not had a subsequent pregnancy, the benefit of using either the copper IUD or the LNG-IUS generally outweighs the theoretical or proven risks (UKMEC category 2, that is, a condition where the advantages of using the method generally outweigh the theoretical or proven risks).
    • Test for the following infections a few days before IUD insertion to allow infection to be treated before or at the time of insertion:
      • Chlamydia trachomatis in women at risk of STIs.
      • Neisseria gonorrhoeae in women at risk or STIs from areas where gonorrhoea is prevalent.
      • All STIs, if this is requested by the woman.
      • Consider taking a high vaginal swab to test for other vaginal infections.
    • Give prophylactic antibiotics before IUD insertion if testing for STIs is not possible or has not been completed.
      • There is no consensus about which antibiotic regimen to use. Choose a regimen (seeking specialist advice where appropriate) that will treat chlamydia infection and that will also treat gonorrhoea if local prevalence is high.
  • If the woman currently has PID, an IUD should not be inserted as there is an unacceptable health risk (UKMEC category 4, that is, a condition which represents an unacceptable health risk if the contraceptive method is used).
  • If the woman requires sterilization:
    • A pelvic examination should be done to rule out recurrent or persistent PID and to determine the mobility of the uterus.
    • Provided there is no current PID, and if the woman has had a subsequent pregnancy, there are no medical reasons to deny sterilization.
    • If the woman has not had a subsequent pregnancy or has current PID, provide an alternative form of contraception until she can be fully assessed. At operation, it may be difficult to localize the tubes due to pelvic adhesions.
  • Women should be advised to use a barrier method of contraception to protect against STIs.

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