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Practical Tips for Intrauterine Device Counseling, Insertion, and Pain Relief in Adolescents: An Update

  • Paula J. Adams Hillard
    Correspondence
    Address correspondence to: Paula J. Adams Hillard, MD, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305-5317
    Affiliations
    Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
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Published:February 22, 2019DOI:https://doi.org/10.1016/j.jpag.2019.02.121

      Abstract

      The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists have endorsed intrauterine devices as first-line contraceptive choices for nulliparous and parous adolescents. Practical concerns about intrauterine devices might be barriers to use for teens and clinicians; this review is devoted to “practical tips” for clinicians, on the basis of an update of the available literature as well as the author's clinical experience. Counseling about contraceptive choices, preventive guidance about possible side effects, informed consent, and pain management are addressed to promote successful use of this long-acting reversible contraption option.

      Key Words

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      References

        • American College of Obstetricians and Gynecologists
        ACOG committee opinion no. 392, December 2007. Intrauterine devices and adolescents.
        Obstet Gynecol. 2007; 110: 1493
      1. Committee on Adolescence: Contraception for adolescents.
        Pediatrics. 2014; 134: e1244
        • Jaccard J.
        • Levitz N.
        Counseling adolescents about contraception: towards the development of an evidence-based protocol for contraceptive counselors.
        J Adolesc Health. 2013; 52: S6
      2. ACOG committee opinion no. 735: adolescents and long-acting reversible contraception: implants and intrauterine devices.
        Obstet Gynecol. 2018; 131: e130
        • Moskowitz E.
        • Jennings B.
        Directive counseling on long-acting contraception.
        Am J Public Health. 1996; 86: 787
        • Jaccard J.
        Unlocking the contraceptive conundrum: reducing unintended pregnancies in emergent adulthood.
        (Available:)
        • Winner B.
        • Peipert J.F.
        • Zhao Q.
        • et al.
        Effectiveness of long-acting reversible contraception.
        N Engl J Med. 2012; 366: 1998
        • Wong R.C.
        • Bell R.J.
        • Thunuguntla K.
        • et al.
        Implanon users are less likely to be satisfied with their contraception after 6 months than IUD users.
        Contraception. 2009; 80: 452
        • Secura G.M.
        • Allsworth J.E.
        • Madden T.
        • et al.
        The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception.
        Am J Obstet Gynecol. 2010; 203: 115.e1-115.e7
        • Mestad R.
        • Secura G.
        • Allsworth J.E.
        • Madden T.
        • Zhao Q.
        • Peipert J.F.
        Acceptance of long-acting reversible contraceptive methods by adolescent participants in the Contraceptive CHOICE Project.
        Contraception. 2011; 84: 493
        • Hatcher R.A.
        • Guest F.
        • Stewart F.
        • et al.
        Contraceptive Technology: 1990-91.
        Irvington Publishers, New York1990
        • Barnett B.
        Clients prefer method choices.
        Network. 1998; 19: 14
        • Hatcher R.A.
        • Nelson A.L.
        • Trussell J.
        • et al.
        Contraceptive Technology.
        21st ed. Managing Contraception LLC. Ardent Media Inc, New York, NY2018
        • 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
        • Peipert J.F.
        • Zhao Q.
        • Allsworth J.E.
        • et al.
        Continuation and satisfaction of reversible contraception.
        Obstet Gynecol. 2011; 117: 1105
        • Mishell Jr., D.
        • Sulak P.J.
        The IUD: dispelling the myths and assessing the potential.
        Dialogues Contracept. 1997; 5: 1
        • Trussell J.
        Update on and correction to the cost-effectiveness of contraceptives in the United States.
        Contraception. 2012; 85: 611
        • Bednarek P.H.
        • Jensen J.T.
        Safety, efficacy and patient acceptability of the contraceptive and non-contraceptive uses of the LNG-IUS.
        Int J Womens Health. 2010; 1: 45
        • Sergison J.E.
        • Maldonado L.Y.
        • Gao X.
        • et al.
        Levonorgestrel intrauterine system associated amenorrhea: a systematic review and meta-analysis.
        Am J Obstet Gynecol. 2019; 220: 440
        • Baldaszti E.
        • Wimmer-Puchinger B.
        • Loschke K.
        Acceptability of the long-term contraceptive levonorgestrel-releasing intrauterine system (Mirena): a 3-year follow-up study.
        Contraception. 2003; 67: 87
        • Foran T.
        • Butcher B.E.
        • Kovacs G.
        • et al.
        Safety of insertion of the copper IUD and LNG-IUS in nulliparous women: a systematic review.
        Eur J Contracept Reprod Health Care. 2018; 23: 379
        • Hubacher D.
        Copper intrauterine device use by nulliparous women: review of side effects.
        Contraception. 2007; 75: S8
        • Teal S.B.
        • Romer S.E.
        • Goldthwaite L.M.
        • et al.
        Insertion characteristics of intrauterine devices in adolescents and young women: success, ancillary measures, and complications.
        Am J Obstet Gynecol. 2015; 213: 515.e1
        • Farley T.M.
        • Rosenberg M.J.
        • Rowe P.J.
        • et al.
        Intrauterine devices and pelvic inflammatory disease: an international perspective.
        Lancet. 1992; 339: 785
      3. Planned Parenthood.
        2014
        • Bayer Pharmaceuticals
        What to expect after placement of Mirena.
        (Available:)
        https://www.mirena-us.com/after-placement/
        Date accessed: January 4, 2019
        • Brahmi D.
        • Steenland M.W.
        • Renner R.M.
        • et al.
        Pregnancy outcomes with an IUD in situ: a systematic review.
        Contraception. 2012; 85: 131
        • Foster D.G.
        • Karasek D.
        • Grossman D.
        • et al.
        Interest in using intrauterine contraception when the option of self-removal is provided.
        Contraception. 2012; 85: 257
        • Yen S.
        • Saah T.
        • Hillard P.J.
        IUDs and adolescents--an under-utilized opportunity for pregnancy prevention.
        J Pediatr Adolesc Gynecol. 2010; 23: 123
        • Bahamondes L.
        • Fernandes A.
        • Bahamondes M.V.
        • et al.
        Pregnancy outcomes associated with extended use of the 52-mg 20 μg/day levonorgestrel-releasing intrauterine system beyond 60 months: a chart review of 776 women in Brazil.
        Contraception. 2018; 97: 205
        • Wu J.P.
        • Pickle S.
        Extended use of the intrauterine device: a literature review and recommendations for clinical practice.
        Contraception. 2014; 89: 495
        • Ortiz M.E.
        • Croxatto H.B.
        Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action.
        Contraception. 2007; 75: S16
        • FHI360
        Mechanisms of the Contraceptive action of Hormonal Methods and Intrauterine Devices (IUDs).
        FHI 360, Durham, NC2012
        • Curtis K.M.
        • Jatlaoui T.C.
        • Tepper N.K.
        • et al.
        U.S. selected practice recommendations for contraceptive use, 2016.
        MMWR Recomm Rep. 2016; 65: 1
        • World Health Organization
        Selected Practice Recommendations for Contraceptive Use, 2008 Update.
        World Health Organization, Geneva, Switzerland2008
        • Hillard P.J.
        Practical tips for intrauterine devices use in adolescents.
        J Adolesc Health. 2013; 52: S40
        • Elkind D.
        Egocentrism in adolescence.
        Child Dev. 1967; 38: 1025
        • Schwartz P.D.
        • Maynard A.M.
        • Uzelac S.M.
        Adolescent egocentrism: a contemporary view.
        Adolescence. 2008; 43: 441
        • Jensen J.T.
        Contraceptive and therapeutic effects of the levonorgestrel intrauterine system: an overview.
        Obstet Gynecol Surv. 2005; 60: 604
      4. Mirena (levonorgestrel-releasing intrauterine system) [prescribing information]. Bayer HealthCare Pharmaceuticals Inc, Whippany, NJ2017
        • Hidalgo M.
        • Bahamondes L.
        • Perrotti M.
        • et al.
        Bleeding patterns and clinical performance of the levonorgestrel-releasing intrauterine system (Mirena) up to two years.
        Contraception. 2002; 65: 129
        • Adeyemi-Fowode O.A.
        • Santos X.M.
        • Dietrich J.E.
        • et al.
        Levonorgestrel-releasing intrauterine device use in female adolescents with heavy menstrual bleeding and bleeding disorders: single institution review.
        J Pediatr Adolesc Gynecol. 2017; 30: 479
        • Zetina-Lozano G.
        Menstrual bleeding expectations and short-term contraception discontinuation in Mexico.
        Stud Fam Plann. 1983; 14: 127
        • Emans S.J.
        • Grace E.
        • Woods E.R.
        • et al.
        Adolescents’ compliance with the use of oral contraceptives.
        JAMA. 1987; 257: 3377
        • Gallo M.F.
        • Lopez L.M.
        • Grimes D.A.
        • et al.
        Combination contraceptives: effects on weight.
        Cochrane Database Syst Rev. 2014; 1: CD003987
        • O’Flynn O’Brien K.L.
        • Akers A.Y.
        • Perriera L.K.
        • et al.
        Intrauterine device insertion procedure duration in adolescent and young adult women.
        J Pediatr Adolesc Gynecol. 2019; 32: 312
        • Braverman P.K.
        • Breech L.
        • Committee on Adolescence
        American Academy of Pediatrics. Clinical report—gynecologic examination for adolescents in the pediatric office setting.
        Pediatrics. 2010; 126: 583-590
        • Kebodeaux C.A.
        • Schwartz B.I.
        Experience with intrauterine device insertion in never sexually active adolescents: a retrospective cohort study.
        Am J Obstet Gynecol. 2018; 219: 600.e1
        • Abou-Setta A.M.
        • Houston B.
        • Al-Inany H.G.
        • et al.
        Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery.
        Cochrane Database Syst Rev. 2013; 1: CD005072
        • Imai A.
        • Matsunami K.
        • Takagi H.
        • et al.
        Levonorgestrel-releasing intrauterine device used for dysmenorrhea: five-year literature review.
        Clin Exp Obstet Gynecol. 2014; 41: 495
        • Harper C.C.
        • Speidel J.J.
        • Drey E.A.
        • et al.
        Copper intrauterine device for emergency contraception: clinical practice among contraceptive providers.
        Obstet Gynecol. 2012; 119: 220
        • Brown M.
        • Dehlendorf C.
        • Auerswald C.
        Use of intrauterine contraception among nulliparous adolescents: a qualitative approach to exploring counseling experiences and preferences.
        Contraception. 2012; 85: 319
        • Hein K.
        The first pelvic examination and common gynecological problems in adolescent girls.
        Women Health. 1984; 9: 47
        • Arvidson C.R.
        The adolescent gynecologic exam.
        Pediatr Nurs. 1999; 25: 71
        • Wijma B.
        • Siwe K.
        Examiner’s unique possibilities to catalyze women’s empowerment during a pelvic examination.
        Acta Obstet Gynecol Scand. 2004; 83: 1102
        • Berek J.S.
        • Hillard P.A.
        Initial assessment and communication.
        in: Berek J.S. Adashi E.Y. Hillard P.A. Novak’s Gynecology. 12th ed. Williams & Wilkins, Baltimore, MD1996: 3-20
        • Akers A.Y.
        • Harding J.
        • Perriera L.K.
        • et al.
        Satisfaction with the intrauterine device insertion procedure among adolescent and young adult women.
        Obstet Gynecol. 2018; 131: 1130
        • Caddy S.
        • Yudin M.H.
        • Hakim J.
        • et al.
        Best practices to minimize risk of infection with intrauterine device insertion.
        J Obstet Gynaecol Can. 2014; 36: 266
        • Zbella E.A.
        • Vermesh M.
        • Gleicher N.
        Contraceptive practices of female physicians.
        Contraception. 1986; 33: 423
        • The Gallup Organization
        A Survey of Female Ob-Gyns on Health Issues and Concerns.
        American College of Obstetricians and Gynecologists, Princeton, NJ2004
        • Evans M.L.
        • Espey E.
        • Ogburn T.
        • et al.
        Use of long-acting reversible contraception by obstetrics and gynecology residents: an examination of access for all women.
        Obstet Gynecol. 2018; 131: 538
        • 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
        • Maguire K.
        • Morrell K.
        • Westhoff C.
        • Davis A.
        Accuracy of providers’ assessment of pain during intrauterine device insertion.
        Contraception. 2014; 89: 22-24
        • Narayan A.
        • Sheeder J.
        • Guiahi M.
        Association of anticipated insertional pain with intrauterine device initiation.
        J Adolesc Health. 2018; 63: 37
        • Tolcher R.
        Intrauterine techniques: contentious or consensus opinion?.
        J Fam Plann Reprod Health Care. 2003; 29: 21
        • Maguire K.
        • Davis A.
        • Rosario Tejeda L.
        • et al.
        Intracervical lidocaine gel for intrauterine device insertion: a randomized controlled trial.
        Contraception. 2012; 86: 214
        • Goldstuck N.D.
        • Matthews M.L.
        A comparison of the actual and expected pain response following insertion of an intrauterine contraceptive device.
        Clin Reprod Fertil. 1985; 3: 65
        • Murty J.
        Use and effectiveness of oral analgesia when fitting an intrauterine device.
        J Fam Plann Reprod Health Care. 2003; 29: 150
        • Lopez L.M.
        • Bernholc A.
        • Zeng Y.
        • et al.
        Interventions for pain with intrauterine device insertion.
        Cochrane Database Syst Rev. 2015; 7: CD007373
        • Massey S.E.
        • Varady J.C.
        • Henzl M.R.
        Pain relief with naproxen following insertion of an intrauterine device.
        J Reprod Med. 1974; 13: 226
        • Matthews L.R.
        • O’Dwyer L.
        • O’Neill E.
        Intrauterine device insertion failure after misoprostol administration: a systematic review.
        Obstet Gynecol. 2016; 128: 1084
        • Li Y.T.
        • Kuo T.C.
        • Kuan L.C.
        • et al.
        Cervical softening with vaginal misoprostol before intrauterine device insertion.
        Int J Gynaecol Obstet. 2005; 89: 67
        • Samy A.
        • Abbas A.M.
        • Mahmoud M.
        • et al.
        Evaluating different pain lowering medications during intrauterine device insertion: a systematic review and network meta-analysis.
        Fertil Steril. 2019; 111: 553
        • Abd Ellah N.H.
        • Abouelmagd S.A.
        • Abbas A.M.
        • et al.
        Dual-responsive lidocaine in situ gel reduces pain of intrauterine device insertion.
        Int J Pharm. 2018; 538: 279
        • Rapkin R.B.
        • Achilles S.L.
        • Schwarz E.B.
        • et al.
        Self-administered lidocaine gel for intrauterine device insertion in nulliparous women: a randomized controlled trial.
        Obstet Gynecol. 2016; 128: 621
        • Zapata L.B.
        • Jatlaoui T.C.
        • Marchbanks P.A.
        • et al.
        Medications to ease intrauterine device insertion: a systematic review.
        Contraception. 2016; 94: 739
        • Fouda U.M.
        • Salah Eldin N.M.
        • Elsetohy K.A.
        • et al.
        Diclofenac plus lidocaine gel for pain relief during intrauterine device insertion. A randomized, double-blinded, placebo-controlled study.
        Contraception. 2016; 93: 513
        • Allen R.H.
        • Bartz D.
        • Grimes D.A.
        • et al.
        Interventions for pain with intrauterine device insertion.
        Cochrane Database Syst Rev. 2009; 3: CD007373
        • McNicholas C.P.
        • Madden T.
        • Zhao Q.
        • et al.
        Cervical lidocaine for IUD insertional pain: a randomized controlled trial.
        Am J Obstet Gynecol. 2012; 207: 384.e1-384.e6
        • Mody S.K.
        • Farala J.P.
        • Jimenez B.
        • et al.
        Paracervical block for intrauterine device placement among nulliparous women: a randomized controlled trial.
        Obstet Gynecol. 2018; 132: 575
        • Perez-Lopez F.R.
        • Martinez-Dominguez S.J.
        • Perez-Roncero G.R.
        • et al.
        Uterine or paracervical lidocaine application for pain control during intrauterine contraceptive device insertion: a meta-analysis of randomised controlled trials.
        Eur J Contracept Reprod Health Care. 2018; 23: 207
        • Thiery M.
        Pain relief at insertion and removal of an IUD: a simplified technique for paracervical block.
        Adv Contracept. 1985; 1: 167
        • Akers A.Y.
        • Steinway C.
        • Sonalkar S.
        • et al.
        Reducing pain during intrauterine device insertion: a randomized controlled trial in adolescents and young women.
        Obstet Gynecol. 2017; 130: 795
        • Mody S.K.
        • Kiley J.
        • Rademaker A.
        • et al.
        Pain control for intrauterine device insertion: a randomized trial of 1% lidocaine paracervical block.
        Contraception. 2012; 86: 704
        • Hubacher D.
        • Reyes V.
        • Lillo S.
        • et al.
        Pain from copper intrauterine device insertion: randomized trial of prophylactic ibuprofen.
        Am J Obstet Gynecol. 2006; 195: 1272
        • Ngo L.L.
        • Braaten K.P.
        • Eichen E.
        • et al.
        Naproxen sodium for pain control with intrauterine device insertion: a randomized controlled trial.
        Obstet Gynecol. 2016; 128: 1306
        • Stubblefield P.G.
        Control of pain for women undergoing abortion.
        Suppl Int J Gynecol Obstet. 1989; 3: 131
        • Davis J.E.
        Paracervical block in obstetrics and gynecology.
        Calif Med. 1966; 105: 421
        • Chi I.C.
        • Wilkens L.R.
        • Siemens A.J.
        • et al.
        Syncope and other vasovagal reactions at interval insertion of Lippes Loop D--who is most vulnerable?.
        Contraception. 1986; 33: 179
        • Trobough G.E.
        Pelvic pain and the IUD.
        J Reprod Med. 1978; 20: 167
        • Aydin M.A.
        • Salukhe T.V.
        • Wilke I.
        • et al.
        Management and therapy of vasovagal syncope: a review.
        World J Cardiol. 2010; 2: 308
        • Moglia M.L.
        • Nguyen H.V.
        • Chyjek K.
        • et al.
        Evaluation of smartphone menstrual cycle tracking applications using an adapted APPLICATIONS scoring System.
        Obstet Gynecol. 2016; 127: 1153
        • Sinning K.M.
        • Jude D.C.
        • Yoost J.L.
        Postinsertional pain after intrauterine device placement among nulliparous adolescents.
        J Pediatr Adolesc Gynecol. 2018; 31: 400
        • Neuteboom K.
        • de Kroon C.D.
        • Dersjant-Roorda M.
        • et al.
        Follow-up visits after IUD-insertion: sense or nonsense? A technology assessment study to analyze the effectiveness of follow-up visits after IUD insertion.
        Contraception. 2003; 68: 101
        • Behringer T.
        • Reeves M.F.
        • Rossiter B.
        • et al.
        Duration of use of a levonorgestrel IUS amongst nulliparous and adolescent women.
        Contraception. 2011; 84: e5
        • Rasheed S.M.
        • Abdelmonem A.M.
        Complications among adolescents using copper intrauterine contraceptive devices.
        Int J Gynaecol Obstet. 2011; 115: 269
        • Grimes D.A.
        Intrauterine device and upper-genital-tract infection.
        Lancet. 2000; 356: 1013
        • Steenland M.W.
        • Zapata L.B.
        • Brahmi D.
        • et al.
        The effect of follow-up visits or contacts after contraceptive initiation on method continuation and correct use.
        Contraception. 2013; 87: 625
        • Ravi A.
        • Prine L.
        • Waltermaurer E.
        • et al.
        Intrauterine devices at six months: does patient age matter? Results from an urban family medicine federally qualified health center (FQHC) network.
        J Am Board Fam Med. 2014; 27: 822
        • Schmidt E.
        • James A.
        • Curran K.
        • et al.
        Adolescent experiences with IUDs: a qualitative study.
        J Adolesc Health. 2015; 57: 381
        • Grimes D.A.
        • Hubacher D.
        • Lopez L.M.
        • et al.
        Non-steroidal anti-inflammatory drugs for heavy bleeding or pain associated with intrauterine-device use.
        Cochrane Database Syst Rev. 2011; 4: CD006034
        • Alanwar A.
        • Abbas A.M.
        • Hussain S.H.
        • et al.
        Oral micronised flavonoids versus tranexamic acid for treatment of heavy menstrual bleeding secondary to copper IUD use: a randomised double-blind clinical trial.
        Eur J Contracept Reprod Health Care. 2018; 23: 365
        • Grunloh D.S.
        • Casner T.
        • Secura G.M.
        • et al.
        Characteristics associated with discontinuation of long-acting reversible contraception within the first 6 months of use.
        Obstet Gynecol. 2013; 122: 1214
        • Workowski K.A.
        • Berman S.
        Sexually transmitted diseases treatment guidelines, 2010.
        MMWR Recomm Rep. 2010; 59: 1
        • American College of Obstetricians and Gynecologists Committee on Gynecologic Practice
        Long-Acting Reversible Contraception Working Group: ACOG committee opinion no. 450: increasing use of contraceptive implants and intrauterine devices to reduce unintended pregnancy.
        Obstet Gynecol. 2009; 114: 1434