Abstract

PIP: A detailed study of the Lippes loop over 10 years and 27,954 woman-months showed that the pregnancy rate was highest during the 1st 2 years, after which it fell to an annual average of 0.5. The rate of removals for bleeding and pain was also highest during the 1st 2 years, after which it fell more slowly. All expulsions occurred during the 1st 3 years. Women using IUDs are more likely to develop pelvic inflammatory disease than other women. Infection is most common during the 1st year after fitting but may occur at any time. All devices tend to accumulate small deposits of calcium, and this may be associated with some corrosion of the underlying plastic. There is debate as to how long an IUD should remain in the uterus. Clearly it should be removed if it is causing symptoms. The woman who has been wearing her device symptom-free for many years and shows nothing abnormal on pelvic and cytological examination should be allowed to continue as she is, provided that she agrees to return for routine medical examination. This should include a cervical smear at yearly intervals, and immediate reporting if she develops any gynecological symptoms. The IUD should eventually be removed 1-2 years after the menopause; in most cases this will be accomplished without difficulty.