Oral contraceptive pill use and pelvic inflammatory disease.

The relationship between the oral contraceptive pill (OCP) and pelvic inflammatory disease (PID) is a particularly complex and confusing one. Here we attempt to summarise the often quite conflicting current data on this issue. In this paper the term pelvic inflammatory disease will encompass one or more of the following: endometritis salpingitis tubo-ovarian abscess or pelvic colitis. Numerous studies appear to substantiate the claim that the OCP does indeed confer protection against PID; for example the Womens Health Study which is probably one of the most detailed analyses of the association between oral contraceptives and PID reports a 50% reduction in the incidence of PID in women using an OCP for at least 1 year compared with women who did not. Senanayake and Kramer and Wolner-Hanssen et al. also showed that patients hospitalised for PID had a lower than expected usage of OCPs. Even more convincing are studies which indicate that OCPs also appear to attenuate the frequency and severity of PID in women with laparoscopically or histologically proven disease. Women who were on OCPs had less tubal inflammation less perihepatitis perisplenitis and pericolitis . Even when it came to chlamydial PID Spinillo et al. showed that amongst women with chlamydial PID the OCP usage rate was lower than in women with PID of different aetiology; furthermore women on OCPs had a decreased risk of symptomatic chlamydial PID. The issue of whether OCPs protect against or predispose to PID acquisition is an important one given the large numbers of women on the Pill the prevalence of asymptomatic chlamydial endocervicitis of 4% and the well-known adverse reproductive sequelae of PID such as infertility and ectopic pregnancies. Aral et al. found that 44% of women who were treated for PID had fertility problems compared with 21% of women who had fertility problems but who had no previous treatment for PID. The above establishes PID as an entity with a significant health impact and sets the scene for discussing the putative protective effect or otherwise of oral contraceptives against PID. (authors)