Teens More Likely to Discontinue IUD Use, Despite Good Outcomes

By Anne Harding

February 17, 2014

NEW YORK (Reuters Health) - Intrauterine devices (IUDs) are as effective for adolescents as they are for women in their 20s and early 30s, and complication rates are similarly low, new findings show

However, adolescents are more likely than older women to request early discontinuation due to pain and bleeding, Dr. Joelle Aoun of Riverside Health System in Newport News, Virginia, and her colleagues found.

"Data from our study showed that, similar to adults, IUD use in adolescents and nulliparous women is highly effective and associated with low rates of serious complications such as expulsion, perforation, ectopic pregnancy and pelvic inflammatory disease; which is in contrast to the misconceptions among many women and health care practitioners," Dr. Aoun told Reuters Health via E-mail.

Withdrawal, condoms and oral contraceptives are the most frequently used birth control methods among US adolescents, Dr. Aoun and her team write in Obstetrics & Gynecology. Just 4.5% of adolescents use long-acting reversible contraception (LARC), they add.

"Because of the paucity of information regarding the use of IUDs in teenagers, health care practitioners remain hesitant to offer this method of contraception to this population primarily as a result of their concerns about its safety and efficacy," the researchers continue.

To investigate the influence of age on IUD-related outcomes, Dr. Aoun and her team performed a multicenter retrospective chart review on 2,138 adolescents and women ages 13 to 35 who had IUDs inserted between 2008 and 2011.

During follow-up, which lasted a mean of 37 months, 6% of women expelled the IUD, and 1% got pregnant. These rates were similar regardless of age and parity.

Overall, 19% of women had discontinued IUD use at 12 months and 41% had discontinued use by the end of follow-up. While 12-month discontinuation rates were similar for women of all ages, 49% of adolescents discontinued the IUD by the end of follow-up, vs 45% of women 20 to 24 years old and 37% of women aged 25 to 35. Thirty-eight percent of adolescents reported pain with the IUD, versus 32% of 20- to 24-year-olds and 25% of women 25 to 35.

Rates of pelvic inflammatory disease were similar across all age groups, at 2%. However, women using copper IUDS were nearly twice as likely to expel the devices compared to levonorgestrel IUD users, and their risk of pregnancy was increased nearly five-fold.

The failure rate of both IUD types was still below that of oral contraceptives, patches, ring condoms and injectable methods, Dr. Aoun noted in an interview. "The copper IUD thus still remains a good and effective option for both adults and adolescents; it is in addition cheaper than the levonorgestrel IUD, which is very helpful in cases where the budget is an issue."

She added: "Although adolescents did not experience more abnormal bleeding with IUD use, they were more likely to give up on their IUD and elect removal when they experienced this side effect as compared to adults. Our data also showed that women who had their IUD inserted and were counseled by OBGYN providers were less likely to elect removal of their IUD as compared to those who were counseled by family physicians or nurse practitioners. Maybe this has to do with differences in the counseling provided by the different providers."

"The biggest new information here is that there's at least in this study no increased risk for expulsion among adolescents," Dr. Paula Hillard, a professor in the department of obstetrics and gynecology at Stanford University School of Medicine, said in an interview. Dr. Hillard, who studies LARC in adolescents, reviewed the study for Reuters Health.

Dr. Jeffrey Peipert, Robert J. Terry professor of obstetrics and gynecology and vice chair of clinical research at Washington University School of Medicine in St. Louis, also reviewed the study for Reuters Health. "Providers/clinicians should consider IUDs as a first-line contraceptive method for young women, including women who have not had children (nulliparous women). It may not be right for ALL women, but all women should be given this option for contraception," he told Reuters Health via email.

The differences seen in the study between copper and levonorgestrel IUDs don't show that one type is better than other overall, he added. "If a young woman, or a woman of any age, wants to avoid a hormonal method, the copper IUD is a better choice. The levonorgestrel IUD may be a better choice for women who bleed heavily or have painful periods."

SOURCE: https://bit.ly/1eX0Y9U

Obstet Gynecol 2014.


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