Decreased risk of PID with use of OCP?!?

[AbuJadenDO]

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So in my board prep a few books mentioned a reduced risk of PID with use of OCP's...I asked my FP attending to explain and he was clueless...any thoughts???

I looked this up online and all I found were JAMA and Journal of OBGYN entries that state this association but none of them say how/why.

thanks!

UPDATE FROM UPTODATE: Oral contraceptives — Oral contraceptives (OCs) have a complex interaction with PID. Several studies have shown that OC use nearly doubles the prevalence of both chlamydial and gonococcal infection of the cervix [47]. However, OC use has traditionally been associated with a 50 percent reduction in PID risk [48].

Resolution of this apparent quandary is emerging. Among OC users with cervical infection, asymptomatic endometritis is fourfold more common than among their counterparts not using OCs [49], although gross salpingitis is reduced fivefold [50]. Thus, women using OCs appear to develop PID in response to cervical initiating agents about as frequently as other women, but the severity of the infection — with respect to both symptoms and tissue damage — is substantially diminished.

 

[ozzidoc]

Progesterone-only pills form a thick mucous plug, which is thought to reduce the chances of microbial migration into the uterus etc.

 

[primadonna22274]

Estrogens increase cervical mucus which does make it a little harder for infectious agents to ascend into the uterus. Not impossible, seen plenty of PID in women on OCs, Depo, etc.