Advertisement

Intrauterine Contraception Continuation in Adolescents and Young Women: A Systematic Review

      Abstract

      Study Objective

      Adolescents are at high risk for unintended pregnancies. Although intrauterine devices (IUDs), long-acting reversible contraceptives (LARCs), are known to be highly effective in preventing pregnancy, little is known about IUD adherence in adolescents. In this systematic review (SR) we examined IUD continuation rates compared with other forms of contraception in young women aged 25 years and younger.

      Design, Setting, Participants, Interventions, and Main Outcome Measures

      A systematic search of Ovid Medline, Cochrane Library, and Embase was conducted for the years 1946-2015. Included studies examined IUD use in women 25 years of age and younger, compared IUD use with another form of contraception, and measured continuation rates at 12 months. The quality of each study was appraised using the Downs and Black criteria, and 12-month continuation rates among studies were pooled and analyzed according to contraceptive type.

      Results

      Of 3597 articles retrieved, 9 studies met criteria for SR. Synthesized across studies, 12-month continuation was significantly higher for IUD users (86.5%, 12,761/14,747) compared with oral contraceptives (39.6%, 1931/4873), Depo-Provera (Pfizer Inc, New York, NY) hormonal injection (39.8%, 510/1282), vaginal ring (48.9%, 196/401), and transdermal patch (39.8%, 37/93; all P values < .001). There was no statistically significant difference in 12-month continuation between the IUD and another LARC method, the subdermal etonogestrel implant (85.3%, 4671/5474).

      Conclusion

      Findings of this SR suggest that continuation rates for IUDs are generally higher compared with other contraceptive methods for women aged 25 years and younger. In a population with high rates of unintended pregnancies, generally low adherence, and imperfect use with other non-LARCs, IUD use should be encouraged.

      Key Words

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ott M.A.
        • Sucato G.S.
        Committee on Adolescence. Contraception for adolescents.
        Pediatrics. 2014; 134: e1257
        • Oringanje C.
        • Meremikwu M.M.
        • Eko H.
        • et al.
        Interventions for preventing unintended pregnancies among adolescents.
        Cochrane Database Syst Rev. 2009; 4: CD005215
        • Mosher W.D.
        • Jones J.
        • Abma J.C.
        Intended and unintended births in the United States: 1982-2010.
        Natl Health Stat Report. 2012; 55: 1
        • Finer L.B.
        • Henshaw S.K.
        Disparities in rates of unintended pregnancy in the United States, 1994 and 2001.
        Perspect Sex Reprod Health. 2006; 38: 90
        • Santelli J.S.
        • Lindberg L.D.
        • Finer L.B.
        • et al.
        Explaining recent declines in adolescent pregnancy in the United States: the contribution of abstinence and improved contraceptive use.
        Am J Public Health. 2007; 97: 150
        • Blanc A.K.
        • Tsui A.O.
        • Croft T.N.
        • et al.
        Patterns and trends in adolescents’ contraceptive use and discontinuation in developing countries and comparisons with adult women.
        Int Perspect Sex Reprod Health. 2009; 35: 63
        • Trussell J.
        Contraceptive failure in the United States.
        Contraception. 2011; 83: 397
        • American College of Obstetricians and Gynecologists
        ACOG Committee Opinion No. 392, December 2007. Intrauterine device and adolescents.
        Obstet Gynecol. 2007; 110: 1493
        • Committee on Adolescence
        Contraception for adolescents.
        Pediatrics. 2014; 134: e1244
        • Madden T.
        • Allsworth J.E.
        • Hladky K.J.
        • et al.
        Intrauterine contraception in Saint Louis: a survey of obstetrician and gynecologists’ knowledge and attitudes.
        Contraception. 2010; 81: 112
        • Finer L.B.
        • Jerman J.
        • Kavanaugh M.L.
        Changes in use of long-acting contraceptive methods in the United States, 2007-2009.
        Fertil Steril. 2012; 98: 893
        • Harper C.C.
        • Blum M.
        • de Bocanegra H.T.
        • et al.
        Challenges in translating evidence to practice: the provision of intrauterine contraception.
        Obstet Gynecol. 2008; 111: 1359
        • Luchowski A.T.
        • Anderson B.L.
        • Power M.L.
        • et al.
        Obstetrician-gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations.
        Contraception. 2014; 89: 572
        • Teal S.B.
        • Romer S.E.
        Awareness of long-acting reversible contraception among teens and young adults.
        J Adolesc Health. 2013; 52: S35
        • Hathaway M.
        • Torres L.
        • Vollett-Krech J.
        • et al.
        Increasing LARC utilization: any woman, any place, any time.
        Clin Obstet Gynecol. 2014; 57: 718
        • Rubin S.E.
        • Davis K.
        • McKee M.D.
        New York City physicians' views of providing long-acting reversible contraception to adolescents.
        Ann Fam Med. 2013; 11: 130
        • Middleton A.J.
        • Naish J.
        • Singer N.
        General practitioners’ views on the use of the levonorgestrel-releasing intrauterine system in young, nulligravid women, in London, UK.
        Eur J Contracept Reprod Health Care. 2011; 16: 311
        • Hubacher D.
        • Lara-Ricalde R.
        • Taylor D.J.
        • et al.
        Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women.
        N Engl J Med. 2001; 345: 561
        • Mohllajee A.P.
        • Curtis K.M.
        • Peterson H.B.
        Does insertion and use of an intrauterine device increase the risk of pelvic inflammatory disease among women with sexually transmitted infection? A systematic review.
        Contraception. 2006; 73: 145
        • Farley T.M.
        • Rosenberg M.J.
        • Rowe P.J.
        • et al.
        Intrauterine devices and pelvic inflammatory disease: an international perspective.
        Lancet. 1992; 339: 785
        • Hubacher D.
        Copper intrauterine device use by nulliparous women: review of side effects.
        Contraception. 2007; 75: S8
        • Brockmeyer A.
        • Kishen M.
        • Webb A.
        Experience of IUD/IUS insertions and clinical performance in nulliparous women–a pilot study.
        Eur J Contracept Reprod Health Care. 2008; 13: 248
        • Thonneau P.
        • Almont T.
        • de La Rochebrochard E.
        • et al.
        Risk factors for IUD failure: results of a large multicentre case-control study.
        Hum Reprod. 2006; 21: 2612
        • Tang J.H.
        • Lopez L.M.
        • Mody S.
        • et al.
        Hormonal and intrauterine methods for contraception for women aged 25 years and younger.
        Cochrane Database Syst Rev. 2012; 11: CD009805
        • Krashin J.
        • Tang J.H.
        • Mody S.
        • et al.
        Hormonal and intrauterine methods for contraception for women aged 25 years and younger.
        Cochrane Database Syst Rev. 2015; 8: CD009805
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • et al.
        Preferred Reporting Items for Systematic Reviews and Meta-analyses: the PRISMA statement.
        PLoS Med. 2009; 6: e1000097
        • Downs S.H.
        • Black N.
        The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions.
        J Epidemiol Community Health. 1998; 52: 377
        • Rosenstock J.R.
        • Peipert J.F.
        • Madden T.
        • et al.
        Continuation of reversible contraception in teenagers and young women.
        Obstet Gynecol. 2012; 120: 1298
        • Bergqvist A.
        • Rybo G.
        IUD compared with oral contraception in nulliparae.
        Contraception. 1979; 20: 407
        • Goldman J.A.
        • Reichman J.
        Contraception in the teenager. A comparison of four methods of contraception in adolescent girls.
        Isr J Med Sci. 1980; 16: 510
        • Graves W.L.
        • Bradshaw B.R.
        Early reconception and contraceptive use among black teenage girls after an illegitimate birth.
        Am J Public Health. 1975; 65: 738
        • Howard D.L.
        • Wayman R.
        • Strickland J.L.
        Satisfaction with and intention to continue Depo-Provera versus the Mirena IUD among post-partum adolescents through 12 months of follow-up.
        J Pediatr Adolesc Gynecol. 2013; 26: 358
        • Suhonen S.
        • Haukkamaa M.
        • Jakobsson T.
        • et al.
        Clinical performance of a levonorgestrel-releasing intrauterine system and oral contraceptives in young nulliparous women: a comparative study.
        Contraception. 2004; 69: 407
        • Townsend P.K.
        Contraceptive continuation rates in Papua New Guinea.
        P N G Med J. 1983; 26: 114
        • Berenson A.B.
        • Tan A.
        • Hirth J.M.
        Complications and continuation rates associated with 2 types of long-acting contraception.
        Am J Obstet Gynecol. 2015; 212: 761.e1
        • Cohen R.
        • Sheeder J.
        • Arango N.
        • et al.
        Twelve-month contraceptive continuation and repeat pregnancy among young mothers choosing postdelivery contraceptive implants or postplacental intrauterine devices.
        Contraception. 2016; 93: 178
        • Abraham M.
        • Zhao Q.
        • Peipert J.F.
        Young age, nulliparity, and continuation of long-acting reversible contraceptive methods.
        Obstet Gynecol. 2015; 126: 823
        • Hall A.M.
        • Kutler B.A.
        Intrauterine contraception in nulliparous women: a prospective survey.
        J Fam Plann Reprod Health Care. 2016; 42: 36
        • Raine T.R.
        • Foster-Rosales A.
        • Upadhyay U.D.
        • et al.
        One-year contraceptive continuation and pregnancy in adolescent girls and women initiating hormonal contraceptives.
        Obstet Gynecol. 2011; 117: 363
        • Hubacher D.
        • Goco N.
        • Gonzalez B.
        • et al.
        Factors affecting continuation rates of DMPA.
        Contraception. 1999; 60: 345
        • Chen X.K.
        • Wen S.W.
        • Fleming N.
        • et al.
        Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study.
        Int J Epidemiol. 2007; 36: 368
        • Jatlaoui T.C.
        • Marcus M.
        • Jamieson D.J.
        • et al.
        Postplacental intrauterine device insertion at a teaching hospital.
        Contraception. 2014; 89: 528
        • Hubacher D.
        Intrauterine devices & infection: review of the literature.
        Indian J Med Res. 2014; 140: S53
        • Duenas J.L.
        • Albert A.
        • Carrasco F.
        Intrauterine contraception in nulligravid vs parous women.
        Contraception. 1996; 53: 23
        • Veldhuis H.M.
        • Vos A.G.
        • Lagro-Janssen A.L.
        Complications of the intrauterine device in nulliparous and parous women.
        Eur J Gen Pract. 2004; 10: 82
        • Potter J.
        • Koyama A.
        • Coles M.S.
        Addressing the challenges of clinician training for long-acting reversible contraception.
        JAMA Pediatr. 2015; 169: 103
        • Ricketts S.
        • Klingler G.
        • Schwalberg R.
        Game change in Colorado: widespread use of long-acting reversible contraceptives and rapid decline in births among young, low-income women.
        Perspect Sex Reprod Health. 2014; 46: 125
        • Sonfield A.
        Implementing the Federal Contraceptive Coverage Guarantee: progess and prospects.
        Guttmacher Policy Review. 2013; 16: 8