Impact of intrauterine devices on microbiota in women: Identification of bacterial colonization

Aim: The intrauterine device (IUD) is the second most widely used contraceptive method globally due to its effectiveness, affordability, and reliability. There are two primary types: copper and hormonal. However, IUDs are associated with potential complications, including ectopic pregnancy, uterine perforation, and pelvic inflammatory disease. This study aims to assess and compare the safety and complication rates of copper and hormonal IUDs, with a focus on their impact on vaginal microbiota. Material and Methods: The study included 233 women who had their IUDs removed at our clinic. The IUDs were analyzed using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) to identify the microbiota present on the devices. Results: Participants' ages ranged from 20 to 70 years, with a mean age of 39.64 +/- 8.37. The majority (84.4%) used copper IUDs, while 15.6% used levonorgestrel-releasing IUDs. Among the patients, 41.2% reported vaginal discharge, 39.5% experienced dyspareunia, and 18.5% had a history of pelvic inflammatory disease or tubo-ovarian abscess. Discussion: IUD use significantly impacts vaginal microbiota, with Escherichia coli being a common pathogen in both copper and hormonal IUD users. Regular gynecological check-ups, sterile insertion practices, and patient education on infection symptoms are crucial for mitigating risks. Probiotics may help maintain microbiota balance during IUD use. Future studies should investigate long-term microbiota changes, compare different IUD types, and explore infection prevention strategies. This research is a vital contribution to understanding the effects of IUDs on vaginal microbiota.