IUDs Appear as Safe for Teenagers as for Adults

Larry Hand

April 08, 2013

Intrauterine devices (IUDs), once considered by many as risky for teenage girls, are as safe to prescribe to teenagers as they are for older women, according to an article published online April 5 in Obstetrics & Gynecology.

Abbey B. Berenson, MD, PhD, director of the Center for Interdisciplinary Research in Women's Health at the University of Texas Medical Branch in Galveston, and colleagues analyzed health insurance claims of more than 90,000 commercially insured women between 2002 and 2009.

The rate of IUD insertion among insured women rose from 2 per 1000 in 2002 to 8 per 1000 in 2007, the researchers write. They examined whether 15- to 19-year-old IUD users were more likely than 20-to 24- and 25- to 44-year-olds to experience complications or discontinue use of IUDs during the 12 months after insertion.

The researchers found that serious complications, such as ectopic pregnancy and pelvic inflammatory disease, occurred in less than 1% of all the women, regardless of age, although teenagers were more susceptible to other complications.

For instance, the researchers found that teenagers were more likely than 25- to 44-year-olds to have claims for dysmenorrhea (odds ratio [OR], 1.35; 95% confidence interval [CI], 1.12 - 1.62), absence of menstruation (OR, 1.32; 95% CI, 1.12 - 1.54), or normal pregnancy (OR, 1.42; 95% CI, 1.13 - 1.78). The pregnancy difference may be a result of differences in fertility between age groups, the researchers write, and they do not regard the other complications as serious.

The researchers used logistic regression models, controlling for age, IUD type, provider specialty, region, and year of insertion, to calculate ORs.

When they compared complications by type of IUD, the authors found that use of the levonorgestrel-releasing intrauterine system (LNG-IUS) was associated with fewer complications and fewer early discontinuations than use of the intrauterine copper contraceptive (CuT380A).

Overall, although women of all ages who used the LNG-IUS were less likely to discontinue use within 12 months compared with those who received the CuT380A, the proportion of those who used the CuT380A and discontinued within a year was much higher among teenagers (discontinued percentage: 20% for ages 15 to 19 years, 15% for ages 20 to 24 years, and about 12% for ages 25 to 44 years). In addition, "the CuT380A device was more likely to be removed within 30 days of a complication or failure than the LNG-IUS (OR: 1.34; 95% CI: 1.21-1.48)," the researchers write, although they could not determine from the source data set whether an IUD was removed because of a complication.

The study demonstrates growth in prescription of IUDs for teenagers, the researchers write, but because many teenagers in this study received theirs after an infant delivery, the practice may not be as widespread among teenagers who have not delivered. In addition, the de-identified dataset did not contain socioeconomic or race/ethnicity factors.

The researchers conclude, "Overall, these data indicate that the IUD is an appropriate contraceptive for younger women, and is not likely to cause serious side effects among teenagers.... Thus, physicians should include information about the highly effective method when they counsel young patients on their contraceptive options to help reduce the unintended pregnancy rate among teenagers in the United States."

Funding for this study was provided by the Society of Family Planning. Additional support was provided by the Eunice Kennedy Shriver National Institute of Child Health & Human Development and the National Center for Research Resources (through the University of Texas Medical Branch. The authors have disclosed no relevant financial relationships.

Obstet Gynecol. Published online April 5, 2013. Abstract