IUD use in adolescent mothers: retention, failure and reasons for discontinuation

Background: Many professional organizations recommend intrauterine device (IUD) use in adolescents, but data on performance of currently available devices in US teens are scant. We describe IUD continuation, side effect and pregnancy rates in parous adolescents.

Study design: Between 2002 and 2008, a cohort of 136 young mothers from an adolescent pregnancy/postpartum program received either a CuT380A or LNG-IUS for contraception. A minimum of 2 years postplacement, IUD status was ascertained by records review and phone interviews. Discontinuation, side effect and pregnancy rates by IUD type were calculated and compared.

Results: Mean and median survival times were 25.1 and 14.1 months, respectively, and did not differ by IUD type. Twelve-month continuation was 55%. Of the 87 removals, the most common reasons were expulsion (14.2%), pain (12.2%), bleeding (7.4%), pregnancy desire (6.8%) and pregnancy (4.7%), and rates did not differ significantly by IUD type. First-year pregnancy rates with IUD in situ was 6.2% for the CuT380A and 3.7% for the LNG-IUS (p=.5). Rates of removal for bleeding and pain were similar for both devices.

Conclusion: Over half of parous adolescents who choose IUDs keep them for at least 1 year. Expulsion rates and pregnancy rates are higher than reported in the general population.