IUDs Safe and Effective in Adolescent Girls With Disabilities

By Megan Brooks

July 24, 2020

NEW YORK (Reuters Health) - Intrauterine devices (IUDs) are safe and highly effective for menstrual management and contraception in adolescents with physical, intellectual and developmental disabilities, according to a retrospective study.

Writing in Pediatrics, the authors note that the American College of Obstetricians and Gynecologists (ACOG) lists off-label use of the 52-mg levonorgestrel IUD as an option for menstrual management in adolescents with disabilities, but data are lacking on their use in this population.

"We conducted this study because there are many reasons why young women with disabilities and their families may request menstrual management and yet there is minimal published information about different treatments," first author Dr. Beth Schwartz, from Thomas Jefferson University in Philadelphia, told Reuters Health by email.

"Hormonal IUDs are a great option for women with disabilities, but patients, families, and providers rarely consider them due to misconceptions about whether they are appropriate for use in this population. We hope that this study raises awareness of the viability and safety of this option for both contraception and menstrual management in young women with disabilities," Dr. Schwartz said.

The researchers reviewed the charts of 159 girls and young women with physical, intellectual, and developmental disabilities who received a levonorgestrel IUD. Only seven patients (4%) had ever been sexually active.

The average age at IUD insertion was 16.3 years (range, 9 to 22 years); 96% of IUDs were inserted in the operating room.

The amenorrhea rate was roughly 60% throughout the duration of IUD use among those with available follow-up data.

Ninety-five percent of patients were still using the IUD at one year and 73% at five years. Twenty-six patients used their IUDs for beyond the five-year approved duration. Discontinuations before five years were due to bleeding issues (seven patients), systemic hormonal side effects (three patients), and concern for vaginal or uterine infection (two).

"Complications were rare. Device malposition and expulsion were the most common, with a combined rate of 5%. There were no cases of pelvic inflammatory disease, uterine perforation, or pregnancy," Dr. Schwartz and colleagues report in their article.

"This is by far the largest study on levonorgestrel IUD use in adolescents and young adults with disabilities. With it, we provide much needed data on the therapeutic benefit and safety of this option for menstrual management and contraception in this population, for which data are lacking despite recommendations for use," they add.

In a linked editorial, Dr. Cynthia Robbins and Dr. Mary Ott from Indiana University in Indianapolis say this study confirms that IUDs are safe and acceptable in adolescents with special needs.

The article also raises "three important issues in IUD use and contraceptive decisions among adolescents with disabilities: recognition of the adolescent's sexuality and rights to sexual and reproductive health; the need to incorporate quality of life into risk/benefit decisions; and the use of shared and supported decision-making approaches to maximize autonomy and dignity," Dr. Robbins and Dr. Ott note.

"Adolescents with disabilities are often left out of reproductive decisions, with these decisions falling to their parents or guardians and providers," they point out. "In a shared decision-making approach, providers, adolescents, and, when the adolescent chooses, parents share the best available data on contraceptive options, and the adolescent is supported by the provider to express their preferences."

"As clinicians, it is up to us to highlight these adolescents' abilities to exercise their rights to sexual and reproductive health," the editorial writers conclude.

Dr. Schwartz and colleagues have declared no relevant financial conflicts of interest. The study was supported by a Bayer Healthcare Investigator-Initiated Research grant for women's health. There was no sponsor involvement in the conduct of the study; collection, analysis, or interpretation of the data; preparation, review, or approval of the article; or decision to submit for publication.

SOURCE: https://bit.ly/39lAZsx and https://bit.ly/2OR9spf Pediatrics, online July 23, 2020.