Original StudyIntrauterine Contraception in Adolescents and Young Women: A Descriptive Study of Use, Side Effects, and Compliance
Introduction
Sexual activity and inconsistent contraceptive use contribute to the high rate of adolescent pregnancy in the United States, which exceeds that of other industrialized countries.1, 2, 3 The rates of compliance with diverse methods of contraception in this age group are low; most reports of adolescent contraceptive use show a 50%-60% continuation of use over 1 year.4 The most prevalent reasons adolescents do not continue to use their current contraceptive method are lack of compliance, perception of decreased risk of pregnancy, as well as the necessary steps to achieve proper contraception with some of the methods (ie, injectable every 3 months, taking a pill every day, monthly ring insertion). Adolescents are a population that is known for noncompliance, not only for medications, but also for office visits. Studies in adult women have shown that when patients request an intrauterine device (IUD) during postpartum hospitalization, only 60% will eventually receive one5; this number is likely to be lower in adolescents.
Intrauterine devices are used by fewer than 3% women of reproductive age in the United States.6, 7 Concerns about pelvic inflammatory disease (PID), sexually transmitted infections (STI), infertility, and difficult insertion have limited the use of the IUD and intrauterine systems (IUS) in adolescents. On the other hand, the World Health Organization (WHO) supports the use of intrauterine contraception in women from menarche to age 20 years, stating that the benefits of intrauterine contraception generally outweigh the risks.8
The American College of Obstetricians and Gynecologists (ACOG) recently released a committee opinion regarding the use of IUS in the adolescent population.6 The policy reiterates the benefits of using IUDs and IUSs in this population, based on compliance, prevention of unintended pregnancy, and ease of use. There are few studies in women under the age of 22 that examine how well IUDs work.9, 10 The literature, however, on use in adult women is extensive.11, 12, 13
The unfortunate consequences associated with a teen pregnancy for the mother and her family increase the benefits of the use of IC; teens may have higher failure rates with other methods or not use any at all. A recent Cochrane review by Grimes et al concluded that further research in the area of IUD use and adolescents is necessary, but current safety data appear reassuring.14
Section snippets
Method
The gynecology clinic at Carilion Clinic is an urban residency program OB/GYN clinic caring mostly for uninsured and underinsured patients. This clinic has been inserting levonorgestrel IUSs in adolescents and young women; numbers have increased over the past 2 years as a result of patient request and ease of use. Many societies define adolescents as patients under the age of 21 (ACOG) and up to age 22 (American Academy of Pediatrics).
After IRB approval and with the use of ICD 9 codes 58300
Results
Eighty-nine patients met criteria for inclusion. Patient characteristics are described in Table 1. There was no difference in demographic characteristics by IC type. Mean age at insertion was 19.5 years (range 16-22 years); mean duration of use was 331.3 days (range 8-1430 days), with a median of 253 days. Three percent of patients were nulliparous. Thirteen percent of patients used a copper device, whereas 87% used levonorgestrel (LNG) devices (median duration of use 344 vs 228 days; P =
Discussion
This study illustrates the characteristics of adolescents and young patients choosing IC as their method to prevent pregnancy. As stated in the introduction and methods sections, the purpose of this study was to describe the characteristics of patients who historically use IC, thereby assisting the practitioner in selecting the appropriate population that will benefit from and maximize the use of these devices. The results that used comparative statistics are not meant to describe associations,
Acknowledgments
We would like to thank Robert “Bob” Herbertson from the Statistics Department at Carilion Clinic for his assistance in the data analysis.
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Cited by (33)
Incidence of Discontinuation of Long-Acting Reversible Contraception among Adolescent and Young Adult Women Served by an Urban Primary Care Clinic
2017, Journal of Pediatric and Adolescent GynecologySaignements utérins anormaux chez les femmes préménopausées
2016, Journal of Obstetrics and Gynaecology CanadaCitation Excerpt :Les attitudes et les lignes directrices ont évolué vers la prise en considération de l’utilisation d’un SIU à libération d’un progestatif à titre d’option de première intention en ce qui concerne cette jeune population27–29. De multiples études en ont démontré l’innocuité et l’efficacité; toutefois, leur utilisation chez des adolescentes de moins de 16 ans a été limitée30,31. Le SIU à libération d’un progestatif a également été utilisé chez des adolescentes atteintes de troubles hémostatiques, ce qui a mené à des améliorations spectaculaires des scores PBAC et de qualité de vie32.
Challenges of diagnosing and managing the adolescent with heavy menstrual bleeding
2016, Thrombosis ResearchA comparison of male partners' reactions to different intrauterine device strings
2015, International Journal of Gynecology and ObstetricsAssociation of short-term bleeding and cramping patterns with long-acting reversible contraceptive method satisfaction
2015, American Journal of Obstetrics and GynecologyCitation Excerpt :The bleeding and cramping patterns reported by CHOICE participants were similar to those reported by IUD users in studies conducted primarily outside the United States. Increased volume of menstrual bleeding after insertion of a copper IUD has been shown in several prior studies.7,14,15 However, few studies have established patterns of changes in bleeding frequency associated with copper IUD use.
Metals
2014, Side Effects of Drugs AnnualCitation Excerpt :However, there was a mild inflammatory reaction in the surrounding tissues [45E]. In a retrospective chart review of adolescent and young women who had intrauterine contraceptive devices (copper in 13% of patients and levonorgestrel in 87%) inserted over a 3-year period, no pregnancies were associated with levonorgestrel and there were more removals because of adverse effects from the copper device [46c]. Skin Airborne allergic contact dermatitis caused by gold is rare and is usually due to sensitization because of occupational exposure to gold dust and gold leaf.