Original Study
Intrauterine Contraception in Adolescents and Young Women: A Descriptive Study of Use, Side Effects, and Compliance

This paper was presented at the 23rd Annual Clinical Meeting of the North American Society of Pediatric and Adolescent Gynecology in April 2009 San Antonio TX (first prize poster award), and the 72nd Annual Meeting of the South Atlantic Association of Obstetricians and Gynecologists, January 10-13, 2010, Naples FL.
https://doi.org/10.1016/j.jpag.2010.07.001Get rights and content

Abstract

Objective

Describe characteristics, compliance, efficacy, and side effect profile of adolescents and young women who use intrauterine contraception (IC).

Study Design

Retrospective chart review of adolescent and young women who had IC devices placed over a 3-year period. Comparative statistics between devices and population characteristics were performed using the Fisher exact and the t test.

Results

Eighty-nine patients were included in the study. The mean age at insertion was 19.5 years (range 16-22 years). Copper was used in 13% of patients; levonorgestrel (LNG) was used in 87%. The mean duration of use was 331.3 days (copper vs LNG; P = .2254).

Side effects included infection (9%, but no pelvic inflammatory disease), pain (28%), partner felt strings (9%), and bleeding (32%). Reasons for removal included side effects (25%), desired fertility (5%), expulsion (3%), and pregnancy (2%). There were no pregnancies associated with the LNG IC, and there were fewer removals because of side effects than with the copper IUD (P = .0180).

Conclusion

IC is a reliable method of contraception in teens and young adults. There were fewer removals because of side effects in the LNG group, although overall other variables are similar between methods.

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.

References (15)

There are more references available in the full text version of this article.

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