IUDs in Teens: Most Effective but Least Likely to UseRiverside physicians led national IUD Study
Newport News, Va. -- A new study evaluating intrauterine devices (IUDs) was published in the journal Obstetrics & Gynecology by researchers affiliated with Riverside Health System (Newport News, Virginia) and Georgetown University School of Medicine (Washington, DC.) The study looked at women between ages 13 and 35 who used IUDs for contraception.
The authors note that the most frequently chosen methods of birth control by US teens are withdrawal, condoms and oral contraceptive pills. These methods are associated with relatively high failure rates and low rates of continuation, which, in turn, contribute to high rates of unplanned teen pregnancies.
Of all reversible contraceptives, IUDs have been shown to have one of the highest rates of satisfaction and continuation and effectiveness. The safety of IUD use in adolescents and nulliparous women (women who have not borne a child) is supported by recent recommendations from the U.S. Medical Eligibility Criteria for Contraceptive Use.
However, IUDs are currently underused in this patient population: only 4.5% of teens and women under the age of 20 years use long-acting reversible contraception. A lack of knowledge and some misconceptions exist among both patients and healthcare professionals regarding IUD use in adolescents and nulliparous women.
“This information is unique because until this publication, limited data existed on the various outcomes of the currently approved IUDs (Mirena® and Paraguard®) in adolescent patients. Many providers have not been counseling adolescents about the use of an IUD for contraception because of an unwarranted concern of an increased risk of infection in this patient population,” said Dr. Dale W. Stovall, one of the principal investigators in this trial.
Riverside Medical Group was the primary site for this study, and the concept for the study was developed by Dr. Stovall and Dr. Joelle Aoun. It was the lack of information about use of IUDs in adolescents that prompted them to design this study. Healthcare professionals are reluctant to offer this method of contraception to these young women primarily as a result of their concerns about its safety and effectiveness.
Researchers decided to analyze IUD-related outcomes including expulsion, contraceptive failure, and early discontinuation; in addition, they compared these outcomes in regards to age, parity, and type of IUD used. The investigators conducted a multicenter retrospective (backward-looking) chart review of teens and women aged 13–35 years who had an IUD inserted for contraception between June 2008 and June 2011.
They reviewed 2,523 patient charts and patients were followed for an average of 37 ± 11 months. The overall rate of IUD expulsion was 6% and the overall pregnancy rate was 1%. No significant differences were found in regard to age or parity.
After 12 months of follow-up, IUD discontinuation rates were 19%; discontinuation rates were 41% after an average follow-up of 37 months. Despite similar rates of IUD discontinuation between age groups at 12 months of use, teens and young women aged 13–19 years were more likely to request early discontinuation at the end of the total follow-up period. No significant difference was noted in pelvic inflammatory disease (PID) rates (2%) based on age.
After adjusting for age and parity, the researchers found that copper IUD users were more likely to experience expulsion and contraception failure compared with levonorgestrel intrauterine system users (1.62-fold greater risk).
The authors concluded that, similar to adults, IUD use in teens and nulliparous women is effective and associated with low rates of serious complications. They recommended that healthcare professionals should consider IUDs for contraception in all females. They noted that teens and young women are more likely to request premature discontinuation of their IUDs and may benefit from additional counseling on what to expect.
“Now, healthcare providers who counsel adolescents regarding various methods of contraception have data that they can rely upon that demonstrates that IUDs are both a safe and effective contraception option in adolescent patients,” said Stovall.
The findings of this study were presented at the North American Society of Pediatric and Adolescent Gynecology meeting, the American Congress of Obstetricians and Gynecologists Virginia section meeting and was selected by the American Board of Obstetricians and Gynecologists as a required article for board recertification.
Published: August 21, 2014