Background: Pelvic inflammatory disease is a community-acquired infection accounting for approximately 1.2 million hospital visits and $1.88 billion in cost annually in the United States. Few interventions are available for the prevention of pelvic inflammatory disease. Intrauterine devices are a well established method of contraception, in addition, levonorgestrel-releasing intrauterine devices may provide a protective advantage against pelvic inflammatory disease. This review aims to evaluate the available evidence to determine if levonorgestrel intrauterine devices, in addition to contraception, provide a protective benefit against pelvic inflammatory disease when compared to other intrauterine devices.
Method: An extensive literature search was performed using the databases MEDLINE , Web of Science, and CINAHL. Duplicate results and non-English articles were excluded. Articles meeting inclusion criteria were analyzed using the GRADE system.
Results: The literature search identified three articles that met inclusion criteria. All studies were randomized comparison trials involving a levonorgestrel intrauterine device compared to one or more forms of copper intrauterine device. Studies showed conflicting evidence supporting the benefit of levonorgestrel intrauterine devices for the prevention of pelvic inflammatory disease. All studies were of very low quality.
Conclusion: Limited very low quality evidence is available to support the potential benefit of levonorgestrel intrauterine devices for the prevention of pelvic inflammatory disease. Research results are conflicting and there is a small amount of very low quality evidence to support this theory. Based on the current research levonorgestrel intrauterine devices for the prevention of pelvic inflammatory disease are not recommended. Further well designed prognostic studies are needed to determine the protective potential of levonorgestrel intrauterine devices.
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