Home/Pelvic Inflammatory Disease (PID)
Condition Deep-Dive

Pelvic Inflammatory Disease

An infection of the upper female reproductive tract (the uterus, fallopian tubes and ovaries) that 4.4% of sexually experienced US women aged 18 to 44 report having had8. Time-sensitive: prompt antibiotics are what protect fertility, and recovery support comes after them, not instead of them.5

Hormonal & Women's Health Evidence-Based

Last updated:

Definition

What Is PID?

Pelvic inflammatory disease (PID) is the clinical syndrome that results when bacteria ascend from the vagina and cervix into the upper reproductive tract, infecting and inflaming the endometrium, fallopian tubes, ovaries and surrounding peritoneum.

Chlamydia trachomatis and Neisseria gonorrhoeae are the organisms most often identified, though PID is frequently polymicrobial1. Chlamydia is attributable in about a fifth of cases overall, and about a third in women under 25, so most episodes are not explained by chlamydia alone. Other contributors include anaerobic bacteria from bacterial vaginosis and Mycoplasma genitalium; infection can also follow IUD insertion, endometrial biopsy or pregnancy termination. PID is a leading preventable cause of female infertility and tubal-factor ectopic pregnancy.

PID is described by its clinical course:

The uterus, fallopian tubes and ovaries, with arrows showing infection rising from the cervix through the uterus into the inflamed fallopian tubes

Acute PID (active inflammation, < 30 days)

The classic presentation: lower abdominal pain, abnormal discharge, fever, dyspareunia and tenderness on bimanual exam. Antibiotics should start as soon as PID is suspected, because preventing long-term damage depends on early treatment9.

  • โ†’Hallmarks: Bilateral pelvic pain, fever > 101ยฐF (38.3ยฐC), cervical motion tenderness, purulent discharge
  • โ†’Primary lever: Empirical antibiotic combination (ceftriaxone + doxycycline + metronidazole2) within hours of diagnosis

Subclinical (Silent) PID

Many cases cause mild or no symptoms9. Women only discover the damage years later during fertility evaluation.

  • โ†’Hallmarks: No fever, vague pelvic ache, intermittent spotting, mild dyspareunia, fatigue
  • โ†’Watch-out: Often diagnosed retrospectively after infertility workup reveals tubal damage
  • โ†’Key supports: Regular STI screening, prompt treatment of any positive result and treatment of partners

Chronic PID & Pelvic Adhesions

Long-term sequelae of one or more prior episodes. Active infection has cleared but inflammation has matured into scar tissue, adhesions and chronic pelvic pain.

  • โ†’Hallmarks: Chronic pelvic pain > 6 months, deep dyspareunia, dysmenorrhea, bowel/​bladder pain
  • โ†’Primary lever: Specialist assessment of the pain and a pain management plan
  • โ†’Key supports: Pelvic floor physical therapy, with support for sleep and mood

Tubo-Ovarian Abscess (TOA, severe)

A walled-off collection of pus involving the fallopian tube and ovary. Surgical or interventional drainage may be needed in addition to IV antibiotics.

  • โ†’Hallmarks: Severe unilateral pain, palpable mass, high fever, sometimes signs of sepsis
  • โ†’Primary lever: Hospital admission, IV broad-spectrum antibiotics, percutaneous or surgical drainage
  • โ†’Key supports: Completing the full antibiotic course, follow-up review and ordinary recovery nutrition after discharge
By the Numbers

PID by the Numbers

4.4%
of sexually experienced US women aged 18 to 44 report ever having been diagnosed with PID, more among those with a previous STI8
20%
of PID cases in UK women aged 16 to 44 were caused by chlamydia, rising to 35% at ages 16 to 24, in an evidence synthesis14
8%
infertility after one episode of PID, in a Swedish cohort of 1,309 women with PID confirmed at laparoscopy who tried to conceive15
40%
infertility after three or more episodes, and 19.5% after two, in the same cohort15
6.5ร—
the ectopic pregnancy rate in the first pregnancy after PID, 9.1% against 1.4% in women without PID, in the same cohort15
1 in 8
women with a history of PID have difficulty getting pregnant, which is why early treatment matters12
Signs & Symptoms

Symptoms of PID

PID often causes mild or no symptoms, and even mild PID can harm fertility9. Any combination of new pelvic discomfort plus discharge changes plus a recent unprotected encounter is enough to warrant testing.

SymptomWhat happens
Reproductive & Pelvic Symptoms
Lower Abdominal & Pelvic PainBilateral aching, cramping or stabbing pain in the lower abdomen, classically below the umbilicus and worse with movement or intercourse. Onset can follow a recent procedure, or come weeks to months after an infection was acquired.
Abnormal Vaginal DischargeIncreased volume, yellow-green color, foul or fishy odor, or pus-like consistency.
Deep Dyspareunia (Painful Sex)Sharp, deep pelvic pain triggered by penetration, especially with deep thrusting, that persists for hours after.
Intermenstrual or Postcoital BleedingSpotting between periods or after sex reflects an inflamed, friable cervix and endometrium. Heavier, longer or more painful periods may also appear. Any unscheduled bleeding within 3 months of a possible STI exposure is a red-flag symptom.
Painful or Frequent UrinationBurning with urination, urgency and frequency mimic a UTI but persist with a negative urine culture. Any UTI-like symptoms that do not respond to a first-line antibiotic should prompt STI evaluation.
Systemic, Constitutional & Long-Term Symptoms
Fever, Chills & Night SweatsTemperatures over 101ยฐF (38.3ยฐC), often with chills and rigors, support the diagnosis of acute PID, though many women with PID have no fever. Unexplained fever in a sexually active woman of reproductive age should trigger PID workup.
Nausea, Vomiting & Loss of AppetitePeritoneal inflammation can cause significant GI distress, especially if a tubo-ovarian abscess has formed. Persistent vomiting plus pelvic pain warrants emergency evaluation to rule out abscess rupture or appendicitis.
Tubal Infertility & Ectopic RiskScarring of the fallopian tubes blocks the egg's passage or traps a fertilized embryo. Even a single PID episode raises ectopic pregnancy risk about sixfold and raises the risk of tubal infertility. Risk compounds with each subsequent episode.
Right Upper Quadrant Pain (Fitz-Hugh-Curtis)Infection can spread to the lining of the liver, causing sharp pain under the right ribs that is often mistaken for gallbladder disease5. Pain under the right ribs with right shoulder pain is an emergency sign10.
โš ๏ธ Time-sensitive: Pelvic pain + abnormal discharge + recent unprotected sex (or a new partner) within the last 60 days should be treated as suspected PID until proven otherwise. Get a same-day appointment; the emergency signs are listed under When to Seek Care. Women who delay seeking care are about three times as likely to have infertility or an ectopic pregnancy11. Do not wait to "see if it goes away."
Causes

Causes of PID

PID is an infection, most often from an untreated sexually transmitted infection, and prescribed antibiotics clear it; the causes below are what lets infection reach the uterus and tubes12.

CauseHow It Contributes to PIDWhat Helps
Untreated chlamydia or gonorrheaUntreated STIs can cause PID; about half of women diagnosed with acute PID test positive for gonorrhea or chlamydia129A yearly chlamydia and gonorrhea test if you are sexually active and under 25, and prompt testing after any possible exposure; screening and treatment lower the risk of PID9
Other vaginal bacteria, including those of bacterial vaginosisBacteria that normally live in the vagina can also cause PID, and bacterial vaginosis is often present109The prescribed PID regimen, which also treats bacterial vaginosis; whether treating it separately prevents PID is unclear9
Procedures that open the cervixIUD insertion (hormonal or copper), hysteroscopy, abortion or other procedures through the cervix, and damage from childbirth or miscarriage, make PID more likely; the added risk from an IUD is mostly in the first three weeks1012Prompt assessment of pain, fever or unusual discharge after a procedure; if PID is diagnosed, an IUD does not usually need removing9
Sexual partners and ageMore than one partner, a partner who has other partners, and being sexually active at 25 or younger raise the risk12Latex condoms used correctly every time, or a long-term mutually monogamous relationship with a partner who has tested negative12
PID before, and reinfectionHaving had PID before raises the chance of another episode, and a new STI can bring it back12Testing and treatment for recent partners, no sex until you and your partners have finished treatment, and a repeat test 3 months after chlamydial or gonococcal PID9
DouchingDouching is one of the things that make PID more likely12Not douching
Diagnosis

How PID Is Diagnosed

Diagnosis is primarily clinical, made on bedside criteria, with labs and imaging used to confirm and rule out mimics. CDC criteria allow empirical treatment based on minimum findings to avoid delays that destroy fertility.

TestWhat it shows
At-Home Screening
PID requires in-person evaluation, but these signals indicate that you should not wait for a routine appointment; you should be seen the same day:
At-Home STI TestingMail-in nucleic acid amplification test (NAAT) kits test a vaginal swab or urine for chlamydia, gonorrhea, trichomonas and Mycoplasma. A positive result with pelvic pain or other symptoms needs clinical assessment the same day.
Symptom Diary & Vital Sign TrackingTrack temperature twice daily, pain severity (0 to 10), discharge changes and bleeding pattern. Persistent low-grade fever (99.5 to 100.4ยฐF / 37.5 to 38ยฐC) plus pelvic symptoms warrants a same-day appointment even without classic "high" fever.
Lab & Clinical Tests
Pelvic Bimanual Exam (CDC Minimum Criteria)CDC requires only one of the following in a sexually active young woman with pelvic pain to begin empirical treatment: cervical motion tenderness, uterine tenderness or adnexal tenderness.
NAAT for Chlamydia & GonorrheaVaginal swab or first-catch urine NAAT is the diagnostic gold standard for the most common pathogens. Should also include Mycoplasma genitalium, Trichomonas vaginalis, HIV and syphilis. Partners need to be told and treated to prevent reinfection.3
Inflammation & Infection MarkersCBC with differential (elevated WBC and neutrophils), CRP and ESR (elevated in active PID), procalcitonin if available. Wet mount of vaginal fluid showing white blood cells supports the diagnosis. Normal markers do not rule out subclinical PID.
Transvaginal Ultrasound (TVUS)Looks for thickened fluid-filled tubes (hydrosalpinx or pyosalpinx), tubo-ovarian abscess, free pelvic fluid and ovarian inflammation. A normal ultrasound does not rule out PID.
Pregnancy Test & Rule-OutsUrine or serum beta-hCG is mandatory in every PID workup to rule out ectopic pregnancy, which can present identically. Also rule out appendicitis, ovarian torsion, ruptured ovarian cyst, endometriosis flare and UTI.
Endometrial Biopsy & Laparoscopy (Select Cases)Endometrial biopsy showing plasma cell endometritis confirms PID definitively but is rarely used in primary care. Laparoscopy is the gold standard, allows direct visualization of inflamed tubes and adhesions, but is reserved for cases where diagnosis is unclear, treatment is failing or surgical drainage is needed.
Treatment Comparison

Conventional and Holistic Treatment for PID

Note: PID is treated with antibiotics, and they are essential. The holistic approach uses antibiotics first and adds restoration around them.

๐ŸŒฟ HOLISTIC
๐Ÿ’Š CONVENTIONAL
๐ŸŒฟ

Holistic / Functional Approach

Antibiotics first to clear the infection, then recovery support for general health, reinfection prevention and follow-up testing

Primary Treatment
CDC antibiotic regimen, partner treatment, and supportive nutrition during and after the course
Duration
14-⁠day antibiotic course, then recovery and repeat STI testing at 3 months
Effect on Underlying Disorder
The antibiotics clear the infection; recovery support has no evidence of reducing tubal damage, adhesions or chronic pain
Fertility Outcome
Depends mainly on how early antibiotics start and on avoiding reinfection

Full Holistic Approach Includes

  • Complete CDC antibiotic regimen, no shortcuts; treat partner concurrently to prevent reinfection
  • Saccharomyces boulardii during antibiotics to reduce antibiotic-associated diarrhea6
  • A varied diet emphasizing colorful vegetables, fatty fish and legumes, with less sugar and no alcohol during treatment
  • Vitamin D3 and zinc where intake or blood levels are low; NAC and curcumin are optional and unproven in PID
  • Vaginal probiotic suppositories with Lactobacillus crispatus and rhamnosus to rebuild flora6
  • Castor oil packs over the lower abdomen 4 to 5 nights/week if you find them soothing; there is no evidence they affect healing
  • Pelvic floor physical therapy if pain persists after treatment
  • Pelvic rest from sex during treatment + condom use until follow-up STI clearance documented
  • Stress and sleep optimization, both directly affect immune competence during recovery
โš ๏ธ Side effects: Standard antibiotic side effects (GI upset, transient yeast risk) mitigated by S. boulardii and dietary support; mild transient symptoms in the first week as inflammation resolves; gradual return of energy over 4 to 8 weeks.
Supplement Protocol

Evidence-Based Supplements for PID

Supplements work alongside (never instead of) prescribed antibiotics. Their job is to support the gut and vaginal microbiome after antibiotics and correct any deficiency. None of them has been shown to prevent adhesions or the long-term sequelae of PID.

Supplement What it is for Typical range Timing Notes & cautions
Saccharomyces boulardiiHas randomized trial evidence for reducing antibiotic-associated diarrhea.6250 mg (about 5 billion CFU) to 500 mg (about 10 billion CFU) twice a day2 hours apart from antibiotic dosesYeast, not bacteria, so it is not killed by antibiotics. Continue 2 weeks past the last antibiotic dose. Use caution with immunosuppression or a central line, as yeast bloodstream infections have been reported; discuss with your team.
Vitamin D3 (with K2)Regulates innate immunity and antimicrobial peptide (cathelicidin) production, and dampens excessive inflammation.D3: set the dose with your clinician; most adults need no blood test first; K2 (MK-⁠7): 100 to 200 mcg per dayWith a fat-containing mealSevere deficiency is sometimes corrected with higher short-term doses under supervision. Dosing limits: the adult tolerable upper intake level is 4,000 IU/day. The Endocrine Society's 2024 guideline found no clear evidence for an optimal target level; the National Academies (formerly the Institute of Medicine) set sufficiency at 20 ng/mL (50 nmol/L). Any dose above 4,000 IU/day needs a blood test and a clinician, not a self-directed dose. Vitamin K2 can interact with warfarin and similar blood thinners; do not take it with one unless your clinician agrees.
Zinc PicolinateRequired for neutrophil function, T-cell development, mucosal repair and skin/tissue healing. Acute infection often depletes zinc rapidly.15 to 30 mg per dayWith meals (food prevents nausea)Add 1 to 2 mg copper if using > 8 weeks at higher doses.
Vitamin C (Ascorbic Acid)Supports immune cell function and collagen formation; like every supplement here, not shown to prevent tubal damage.1,000 mg once or twice daily, no more than 2,000 mg/daySplit through the day, with foodLower dose if loose stools develop. Liposomal forms absorb at higher levels. 2,000 mg a day is the adult upper intake level, and the body turns vitamin C into oxalate, so anyone who has had kidney stones should not take high doses16.
Omega-⁠3 EPA/DHASpecialized pro-resolving mediators (resolvins, protectins) help resolve inflammation. There is no evidence that fish oil prevents chronic pelvic pain or adhesions after PID.2 to 3 g combined EPA+DHA per dayWith mealsChoose a third-party-tested product. In heart trials, fish oil supplements raised the risk of atrial fibrillation, an irregular heartbeat, more so above 1 g a day17, so check this dose with your clinician first.
Curcumin (Turmeric Extract)Anti-inflammatory in laboratory studies; not shown to prevent scar tissue or adhesions in people.500 to 1,000 mg curcumin per dayWith a fat-containing mealFormulations made to absorb better have been linked to liver damage, and turmeric supplements may be unsafe in pregnancy13. Hold during heavy menstrual flow.
BromelainPineapple-derived enzyme with anti-inflammatory effects in some studies. Not shown to affect adhesions.500 to 1,000 mg, 2,000+ GDU per gram, twice dailyEmpty stomach, between mealsIf used, limit it to 6 months and stop before any surgery. Little is known about its safety in pregnancy or breastfeeding; check with your doctor first, especially if you take other medicines13.
Lactobacillus crispatus + rhamnosus (Vaginal)Aims to restore protective vaginal Lactobacilli after antibiotics; there is some evidence against bacterial vaginosis returning6, but it has not been shown to prevent PID coming back.Vaginal suppository nightly ร— 14 days, then 2x/weekAt bedtime, post-antibiotic phaseLook for L. crispatus CTV-⁠05 or rhamnosus GR-⁠1 strains tested in randomized trials.
Magnesium GlycinateSupports nervous system recovery, sleep quality and smooth muscle relaxation, which is critical for pelvic floor recovery and pain modulation.300 to 400 mg elemental per dayEvening, 30 to 60 min before bedIn pregnancy, check the dose with your midwife or doctor. The top of this range is above the 350 mg/day upper intake level for supplemental magnesium; above that, diarrhea is common. With kidney disease, take it only on your clinician's advice.
Probiotic (Multi-Strain Gut)Gut microbiome recovery after the antibiotic course.25 to 50 billion CFU, multi-strainEmpty stomach or with light mealStart 2 days after antibiotics complete.
Vitamin A (Retinol)Essential for mucosal immunity and epithelial repair throughout the reproductive tract.Preformed retinol up to 5,000 IU/day short-term, and only if pregnancy is excludedWith a fat-containing mealDo not take preformed retinol if pregnant or trying to conceive; beta-carotene from food is the safe alternative. Cod liver oil is a concentrated source of preformed retinol.
B-ComplexSupports methylation, neurotransmitter balance and energy recovery; depleted by both infection and antibiotics.1 capsule per day per product labelMorning with foodFolic acid or L-methylfolate both work; folic acid is the form proven to prevent neural tube defects if you could become pregnant.
What to Expect

What to Expect Over Time

PID is a curable infection treated with prescribed antibiotics; food and supplements support general health around them and do not treat the infection124.

Treatment and supportive care, together
First Weeks

Antibiotics start as soon as PID is suspected, usually an injection plus tablets for 2 weeks10; finish every dose even when symptoms settle12. You should improve within 3 days; if not, you need reassessment and possibly hospital treatment9. Partners from the last 60 days need testing and treatment, and no sex until everyone has finished9.

Months 1 to 3

Have a repeat test 3 months after chlamydial or gonococcal PID9.

Months 3 to 12

Treatment cannot undo damage already done, and a new STI can bring PID back12.

Long Term

Untreated or repeated PID can cause scarring, infertility, ectopic pregnancy and long-term pelvic pain12; delaying care about triples the risk of infertility or ectopic pregnancy11.

When to Seek Care

Call 911 or go to the emergency department for pelvic pain that is severe, worsening or hurts to move, sudden sharp lower belly pain, pelvic pain with heavy bleeding, pain under the right ribs and in the right shoulder, feeling dizzy or faint, a very high temperature or shivering, or vomiting10. Get a same-day appointment for possible PID symptoms, if you are pregnant, or if you are no better after 3 days of antibiotics10.

📬

Get new guides in your inbox. Once a month: new condition guides and research updates, including the trials that did not work. Free, no spam, and you can unsubscribe in one click.

Sign up

Next Steps

Antibiotics First, Recovery Support After

Prompt antibiotics are what protect fertility, and recovery support comes after them, not instead of them. Finish every dose even when symptoms settle, and partners need testing and treatment too. Food supports general health around treatment but does not treat the infection.

Explore Endometriosis โ†’ Explore Ectopic Pregnancy โ†’

References & Evidence Notes

Each numbered entry below is either a source you can follow or a note setting out what the evidence does and does not support. Both are numbered together so the markers in the text line up.

Last reviewed October 20, 2026. Supplement entries are cross-checked against the NIH National Center for Complementary and Integrative Health and the Linus Pauling Institute Micronutrient Information Center.7 The time window is short and the stakes are permanent. Pelvic inflammatory disease is a bacterial infection of the upper genital tract, it is treated with antibiotics, and treating it early is what preserves fertility. Every episode raises the risk of tubal damage, infertility, ectopic pregnancy and chronic pelvic pain. Nothing on this page treats PID. If you have pelvic pain with abnormal discharge, fever, pain during sex or bleeding between periods, particularly after a new partner or unprotected sex, get assessed immediately and start treatment. Three further things: complete the whole antibiotic course even once you feel better, your partner or partners need testing and treatment or you will be reinfected, and severe pain with high fever can mean a tubo-ovarian abscess needing hospital care.

  1. On cause and organisms: PID usually follows ascending infection from the cervix, most commonly Chlamydia trachomatis and Neisseria gonorrhoeae, frequently polymicrobial with anaerobes and organisms associated with bacterial vaginosis, and Mycoplasma genitalium is increasingly recognized. Many episodes are subclinical, which is why tubal damage is sometimes discovered only during infertility investigation. ↩
  2. On treating early and empirically: guidance from the Centers for Disease Control and Prevention recommends a low threshold for empirical treatment in sexually active women with pelvic tenderness and no other explanation, precisely because waiting for confirmation costs tubal function. Regimens combine an injectable cephalosporin with doxycycline and metronidazole. The full course is completed regardless of symptom improvement. ↩
  3. On partners and reinfection: sexual partners from the preceding 60 days require evaluation and treatment, and untreated partners are a leading cause of reinfection, with each further episode compounding tubal damage. Testing for other sexually transmitted infections including HIV and syphilis is standard, and retesting for chlamydia and gonorrhea is recommended around three months later. ↩
  4. On what food can and cannot do: several foods, garlic among them, show antimicrobial activity in laboratory conditions. None of this treats an established pelvic infection. Substituting dietary measures for antibiotics in PID risks permanent tubal damage, and the cost is measured in fertility rather than in symptoms. Nutrition here is for supporting recovery and general health during and after treatment. ↩
  5. On complications: tubo-ovarian abscess presents with severe pain, high fever and a pelvic mass, and requires hospital admission with intravenous antibiotics and sometimes drainage. Fitz-Hugh-Curtis syndrome, perihepatic inflammation, causes right upper quadrant pain and is often mistaken for gallbladder disease. Long-term sequelae include infertility, a markedly raised ectopic pregnancy risk and chronic pelvic pain; all three rise with each episode. ↩
  6. On probiotics after treatment: antibiotic courses disrupt vaginal and gut flora, and there is reasonable evidence for probiotics in reducing antibiotic-associated diarrhea and some evidence in bacterial vaginosis recurrence. S. boulardii is the exception that has been studied alongside antibiotics; other probiotics are aftercare and belong after the course. ↩
  7. National Center for Complementary and Integrative Health (NIH), nccih.nih.gov, and the Linus Pauling Institute Micronutrient Information Center, lpi.oregonstate.edu/mic. ↩
  8. On how common PID is: in US national survey data for 2013 to 2014, 4.4% of sexually experienced women aged 18 to 44 reported ever having been diagnosed with PID, with the highest figures among women who had had a sexually transmitted infection, PubMed 28125569. ↩
  9. On diagnosis and treatment: the CDC's STI treatment guidelines advise a low threshold for diagnosis, note that PID often causes mild or no symptoms yet can still harm fertility, and that about half of women with acute PID test positive for gonorrhea or chlamydia, with vaginal bacteria and bacterial vaginosis often involved. Treatment should start as soon as PID is suspected, because preventing long-term damage depends on early antibiotics, and the usual outpatient regimen is an injected antibiotic plus two oral antibiotics for 14 days, which also treats bacterial vaginosis. Women should improve within 3 days or be reassessed, with hospital care for pregnancy, an abscess, severe illness or vomiting; partners from the 60 days before symptoms should be tested and treated, sex avoided until treatment is complete, and women retested 3 months after chlamydial or gonococcal PID. An IUD does not need to be removed, CDC, STI treatment guidelines, PID. ↩
  10. On when PID is an emergency: NHS guidance advises calling emergency services or going straight to an emergency department for pelvic pain that is severe, getting worse or hurts to move or touch, pelvic pain with heavy vaginal bleeding, sharp, sudden and intense lower belly pain, pain under the right ribs and in the right shoulder, feeling dizzy or faint, a very high temperature or feeling hot, cold or shivery, or nausea or vomiting, and asking for an urgent appointment for possible PID symptoms, in pregnancy, or if there is no improvement after 3 days of antibiotics. It lists common vaginal bacteria, previous birth or miscarriage and procedures that open the cervix among the causes, and abscesses, long-term pelvic pain, fertility problems and ectopic pregnancy among the complications, NHS, pelvic inflammatory disease. ↩
  11. On delay: in a cohort study of women with PID, those who delayed seeking care were three times as likely to have infertility or an ectopic pregnancy as those who sought care promptly; among women with chlamydial PID, 17.8% of those who delayed had impaired fertility against none of those who sought care promptly, PubMed 8498436. ↩
  12. On PID, its risks and its treatment: the US Centers for Disease Control and Prevention states that untreated sexually transmitted infections such as chlamydia and gonorrhea can cause PID, and that infections that are not sexually transmitted can also cause it; that it is more likely with an untreated STI, more than one partner, a partner with other partners, PID before, being sexually active at 25 or younger, douching and, mostly in the first three weeks, a newly placed IUD; that PID diagnosed early can be treated, but treatment will not undo damage already done; that symptoms may go away before the infection is cured, so all the medicine should be finished; that recent partners should be tested and treated, with no sex until both have finished treatment; and that complications include scarring of the fallopian tubes, ectopic pregnancy, infertility and long-term pelvic pain, with 1 in 8 women with a history of PID having difficulty getting pregnant, CDC, about PID. ↩
  13. On turmeric and bromelain: the NIH National Center for Complementary and Integrative Health reports that curcumin formulations made to be better absorbed may harm the liver, with liver damage reported in some people, and that turmeric supplements may be unsafe in pregnancy, NCCIH, turmeric; for bromelain, it notes that little is known about safety in pregnancy or breastfeeding and advises anyone taking medicines to talk to their health care provider first, NCCIH, bromelain. ↩
  14. On chlamydia as a cause: an evidence synthesis using UK data from before national chlamydia screening estimated that chlamydia caused 20% of PID cases in women aged 16 to 44 and 35% in women aged 16 to 24, with wide uncertainty, and that the share falls steeply with age, PubMed 27260786. ↩
  15. On fertility after PID: in a Swedish cohort of women with PID confirmed at laparoscopy, 10.8% of those who tried to conceive had tubal-factor infertility against none of the controls, and the ectopic pregnancy rate in the first pregnancy was 9.1% against 1.4%, PubMed 1411832; a review of the cohort's latest update (1,309 women with PID) gives infertility rates of 8.0%, 19.5% and 40% after one, two, and three or more episodes, PubMed 22228985. ↩
  16. On vitamin C limits: the adult upper limit is 2,000 mg a day from all sources, NIH Office of Dietary Supplements, vitamin C; and the body converts vitamin C to oxalate: in calcium stone formers, 1 g or 2 g a day for 3 days raised urinary oxalate, PubMed 12631089, PubMed 15987848. ↩
  17. Gencer B, Djousse L, Al-Ramady OT, Cook NR, Manson JE, Albert CM. Effect of long-term marine omega-⁠3 fatty acids supplementation on the risk of atrial fibrillation in randomized controlled trials of cardiovascular outcomes: a systematic review and meta-analysis. Circulation. 2021;144(25):1981-⁠1990. PubMed 34612056. Seven trials with 81,210 people followed for about 5 years: omega-⁠3 supplements were linked to a higher risk of atrial fibrillation (hazard ratio 1.25), more so in trials of more than 1 g a day (1.49), and the risk rose with each additional gram. ↩