Elsevier

Contraception

Volume 86, Issue 5, November 2012, Pages 443-451
Contraception

Original research article
Adolescent experience with intrauterine device insertion and use: a retrospective cohort study

https://doi.org/10.1016/j.contraception.2012.03.014Get rights and content

Abstract

Background

Adolescents contribute disproportionately to the epidemic level of unintended pregnancy in the USA. Intrauterine devices (IUDs) are highly effective but underutilized in this age group.

Study Design

We searched our electronic clinic database to identify females ≤ 19 years old who underwent attempted IUD insertion between January 2007 and June 2009. This retrospective cohort study primarily compared the insertion and postinsertion experiences between nulliparous and parous teens.

Results

Of the 307 charts reviewed, the majority of subjects were white (73.4%) and nulliparous (77.5%), with a median age of 18 years (range 15–19). The vast majority (96.4%, 296/307) had a successful IUD insertion upon first attempt; all of the 11 unsuccessful IUD insertion attempts were among nulliparous teens.

Follow-up was available for 56% (172/307). During the first 12 months of use, there were 2.9% (5/172) IUD expulsions and 24.4% (42/172) removals, with no differences between nulliparous and parous teens. IUD continuation at 6 months was 83.3%. Pelvic inflammatory disease was diagnosed in 4.6% (8/172) of post-IUD insertions. There were no pregnancies reported in those teens with IUD continuation, while six were reported in subjects who underwent IUD removal. Independent predictors of IUD discontinuation were a history of chronic pelvic pain or dysmenorrhea, and bleeding and/or pain complaints at any post-IUD visit.

Conclusions

Overall, adolescents experience minimal complications with IUD use, with similar rates of successful insertion as adults. IUD discontinuation rates were not significantly different between nulliparous and parous teens. While discontinuation was higher than reported in adults, it was lower than reported among teens using other forms of contraception.

Introduction

Nearly half (42%) of all US females aged 15 to 19 years have had vaginal intercourse at least once [1]. In the 2008 National Survey of Family Growth (NSFG), 79% of adolescents aged 15 to 19 years reported contraceptive use at first sex, and 84% reported current contraceptive use with most recent sex [1]. Despite these findings, the USA has one of the highest teen pregnancy rates of any western industrialized nation [1], [2]. Approximately 750,000 American women younger than 20 years old become pregnant each year, with over 80% of these pregnancies unintended [3], [4].

Contraceptive choices and continuation patterns among adolescents contribute to the high teen pregnancy rate. Among those adolescents using contraception, 54.1% used oral contraceptives (OC), 22.8% the condom, 9.4% the injectable, 3.6% the intrauterine device (IUD) and 10.1% other methods [5]. Success with the most popular contraceptive methods for teens, OC and condom, requires active participation by the user, and these methods have high typical-use failure rates [6], [7]. Moreover, adolescents have particularly high reported discontinuation rates with OC, up to 45% at 3 months and 88% at 1 year [8], [9].

Data have shown that teens have higher contraceptive continuation rates and lower unintended pregnancy rates when they use a method that does not require frequent compliance compared to a method requiring frequent compliance [8], [10], [11]. IUDs provide safe, highly effective, reversible, long-term contraception and are among the most effective reversible options [12]. In 2007, the American Congress of Obstetricians and Gynecologists issued a Committee Opinion that recommended that IUDs be used as first-line contraceptive choices for both nulliparous and parous adolescents [13]. However, IUDs continue to be underutilized among adolescents. Providers often do not recommend IUDs to adolescents due to concerns and misconceptions about infection, infertility and difficulty with insertion [13], [14], [15]. In addition, many adolescents have limited knowledge of IUDs [16], [17].

Since most contraceptive studies exclude adolescents, there are limited data about the risks and benefits of IUD insertion and utilization among adolescents. The purpose of this study is to examine the experience of nulliparous and parous adolescents with IUD insertion and utilization at our institution.

Section snippets

Subject identification and data abstraction

We conducted a retrospective cohort study at the Oregon Health and Science University (OHSU) and Planned Parenthood of Columbia/Willamette (PPCW). Using Current Procedural Terminology codes, the electronic database at each site was used to identify adolescent females (≤ 19 years) who had an IUD insertion or attempted IUD insertion between January 1, 2007, and June 30, 2009. The Institutional Review Board at OHSU approved the study.

Available charts were reviewed to collect sociodemographic

Results

A total of 410 charts were identified as having an IUD insertion attempt during the study period. Of these, 30 did not meet the inclusion criteria (age > 19 years, no attempted IUD insertion or charts contained insufficient data to include in our analyses), and 73 charts could not be obtained for review (charts at remote location, paper charts were not on-site or could not be located). A total of 307 charts were reviewed, and 56% (172/307) of subjects had at least one post-IUD insertion

Discussion

In this study, adolescents experienced minimal complications with IUD insertion. While there were more insertion difficulties reported in nulliparous compared to parous teens, both rates were low. The difficulties reported were minor, and there were no reported uterine perforations. Moreover, there was a high rate of successful IUD insertion even among nulliparous teens without routine need for cervical dilation, use of misoprostol or referral to a faculty physician. Notably, most of the study

Acknowledgments

Special thanks to the OHSU Women's Health Research Unit, and the managers and support staff at Planned Parenthood Columbia/Willamette.

No funding was provided for this study.

References (25)

Cited by (0)

View full text