To the Editor.—
Wølner-Hanssen et al1 report a decreased risk of symptomatic chlamydial pelvic inflammatory disease associated with oral contraceptive use. Pelvic inflammatory disease is the principal cause of ectopic pregnancy (EP), yet our recent findings do not indicate a decreased risk of EP with use of oral contraceptives.
We conducted a case-control study between January 1988 and March 1989 in seven departments of obstetrics and gynecology in the Paris area. A group of 279 patients with EP, confirmed by laparoscopy or laparotomy, were individually matched with two control women: the first woman admitted to give birth and the first woman admitted with a miscarriage to the same department. The case women and control women were interviewed with respect to prior gynecologic disease and surgical procedures, pregnancy history, contraceptive use at the time of the current conception, sexual activity, smoking habits, and constitutional and socioeconomic factors. The