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This case-control study found that women with intrauterine adhesions (IUA) were significantly more likely to have previously used progestin-releasing intrauterine devices compared to women with polyps or infertility. The association strengthened with duration of use, with use exceeding five years showing a seven-fold increased odds of IUA overall, and a twelve-fold increase among nulliparous women who had no prior uterine surgery. The study also observed that progestin-IUD use was less common among women with endometrial polyps, suggesting a potential protective effect against polyp formation.
Why it matters
These findings raise important questions about the long-term uterine effects of progestin-releasing IUDs, particularly for women using them beyond five years who have never been pregnant. If confirmed by prospective studies, this could influence contraceptive counseling and monitoring practices for women concerned about future fertility.
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⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
Progestin-IUD use was more frequent among IUA cases (29.9%) than polyp (3.4%) or infertile (11.1%) comparison groups. Compared to infertile comparators, any prior progestin-IUD use was independently associated with IUA (aOR 3.12; 95% CI 2.01, 4.85). There was a duration-response pattern: use of 5 years or less was modestly associated with IUA case status (aOR 1.99; 1.09, 3.64), whereas use >5 years conferred more than a seven-fold increase (aOR 7.26; 3.27, 16.11). The association persisted among surgically naive women (aOR 3.98; 2.44, 6.48) and was concentrated in those who were nulliparous, where use beyond five years conferred an approximately twelve-fold increase in odds (aOR 12.74; 5.25, 30.92). Progestin-IUD use was less frequent in polyp controls relative to IUA and infertile comparators, suggesting a possible role for progestin exposure in preventing endometrial polyp formation. The case control design does not allow for estimation of absolute risk for an individual and cannot inform causation. Further prospective studies are needed to better assess the relationship between progestin-IUD’s, particularly when used beyond five years, and adverse fertility outcomes.
Source: Intrauterine adhesions and prior use of a progestin-releasing intrauterine device