(546) The Grave Sequalae of the Prolong IUD Use

Abstract Introduction Intrauterine devices (IUDs) are widely used for contraception, but their prolonged use beyond the expiration date, the utilization of banned devices, or the domestic manufacture of IUDs pose significant, underreported risks. Reported side effects include pelvic pain and pelvic inflammatory disease (PID); however, there are only few cases detailing the severe sequelae associated with these practices. Objective To call attention to the highly frequent findings in a specific socio-geographical area of the serious consequences in women who have had an IUD over the time of expiration (ranging from 5 to 52 years). We present an increasingly observed clinical entity (the "IUD Syndrome") characterized by the prolonged use of an IUD and the development of severe medical consequences, including endometritis, pyometra, tubo-ovarian abscesses (TOA), peritonitis, sepsis, and permanent infertility. Methods We conducted a retrospective study of 119 patients (aged 26 to 75 years; 112 of Cuban origin) admitted to the emergency department between 2005 and 2025. Patients presented with chronic pelvic pain or severe acute abdominal pain (98%), with common diagnoses including TOA (78%) and PID. Elevated white blood count was found in 78% and fever in 13%. Diagnosis was confirmed by ultrasound and/or open uterus examination (after surgery). Results Of the 119 patients, 21 had no major medical consequences and underwent IUD removal via hysteroscopy (IUD use 8-25 years). The majority (98 patients) required aggressive treatment: 51 underwent exploratory laparotomy, 26 interventional radiology, and 21 received medical treatment with IV antibiotics and IUD removal (with 5 eventually requiring surgery). Sequelae included TOA (92 patients, 34 requiring ICU), endometritis (96), salpingitis (90), peritonitis (6, with 2 sepsis cases in the ICU), PID (98), and one case of large pyometra with sepsis requiring ICU admission. Conclusions The lack of continuous medical care, the increased IUD placement in patients with low medical literacy, the global phenomenon of continuous immigrant movement, the lack of emphasis on IUD removal at expiration, and the use of locally produced IUDs (e.g., fishing line) have significantly increased the number of women with severe consequences from prolonged IUD use. These sociopolitical and clinical gaps must be addressed to mitigate this rising health crisis. Disclosure No