Intrauterine devices and pelvic inflammatory disease: Meta-analyses of published studies, 1974-1990

We conducted a meta analysis of 36 papers published between 1974 and 1990 to estimate the effects of intrauterine device (IUD) use and Dalkon Shield use, in particular; on pelvic inflammatory disease (PID). The number of women studied in each report ranged from SD to 26,507. For general IUD use, analyses were separated by type of PID (symptomatic or asymptomatic) because of extreme rate-ratio heterogeneity across studies. Dalkon Shield rate ratios were more homogeneous and were considered in a single mete-regression. were was substantial heterogeneity, however, in all three mete-regressions; the rate-ratio estimates ranged from 0.51 to 12 for IUD use and symptomatic PID, from 1.0 to 132 for IUD use and asymptomatic PID, and from 0.32 to 28 for Dalkon-Shield use and FID. This heterogeneity appeared to be due to differences in reference groups, study populations, and characteristics of study design. We observed consistent, positive associations of IUD use with both symptomatic and asymptomatic PID. These associations were largest for the Dalkon Shield.