To assess attendance of an initial follow-up visit after long-acting reversible contraception (LARC) insertion and whether follow-up was associated with a higher likelihood of method continuation in adolescents and young adults (AYAs).
Retrospective chart review including patients receiving LARC (etonogestrel 68 mg implant, levonorgestrel 52 mg intrauterine device, or copper intrauterine device) between January 1, 2014, and August 1, 2017.
An urban adolescent center providing primary care and reproductive health services. Participants: A total of 331 patients 13-28 years of age.
Attendance of a follow-up visit 4-8 weeks after LARC insertion.
Main Outcome Measures
Follow-up was defined as visits addressing LARC method or routine physical examinations in the adolescent center or affiliated school-based health clinics. Continuation and discontinuation were defined as documented presence or removal, respectively, of device at various time points. Descriptive analyses, χ2 test, Fisher exact test, t test, and survival analysis were used.
Approximately one-third (29.3%) of the patients attended a follow-up visit. Follow-up was associated with a higher likelihood of LARC removal in the first year (hazard ratio [HR] = 2.10, 95% confidence interval [CI] 1.33-3.32). At 500 days post-insertion and beyond, there was no difference in LARC continuation between AYAs who followed-up and those who did not (HR = 1.07, 95% CI 0.67-1.71).
Few AYAs attended an initial follow-up visit after LARC placement. These visits were associated with an increased likelihood of LARC removal in the first year; however, this association was not observed long term. More information is needed to determine how to approach follow-up this population.
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- The safety of intrauterine devices among young women: a systematic review.Contraception. 2017; 95: 17
- Sexual and reproductive health care: A position paper of the society for adolescent health and medicine references.J Adolesc Health. 2014; 54: 491
- ACOG Committee opinion no. 735: adolescents and long-acting reversible contraception: implants and intrauterine devices.Obstet Gynecol. 2018; 131: 130
- Contraception for adolescents.Pediatrics. 2014; 134: e1257
- Trends in long-acting reversible contraception use among U.S. women aged 15-44. NCHS data brief, no 188.National Center for Health Statistics, Hyattsville, MD2015
- Current contraceptive status among women aged 15-49: United States, 2015-2017. NCHS data brief, no 327.National Center for Health Statistics, Hyattsville, MD2018
- Continuation of reversible contraception in teenagers and young women.Obstet Gynecol. 2012; 120: 1298
- Three-year continuation of reversible contraception.Am J Obstet Gynecol. 2015; 213: 662
- Young age, nulliparity, and continuation of long-acting reversible contraceptive methods.Obstet Gynecol. 2015; 126: 823
- Twenty-four-month continuation of reversible contraception.Obstet Gynecol. 2013; 122: 1083
- Realizing reproductive health equity needs more than long-acting reversible contraception (LARC).Am J Public Health. 2016; 106: 18
- Strategies to improve adherence and acceptability of hormonal methods of contraception.Cochrane Database Syst Rev. 2013; 10: CD004317
- The effect of follow-up visits or contacts after contraceptive initiation on method continuation and correct use.Contraception. 2013; 87: 625
- A randomized clinical trial of the effect of intensive versus non-intensive counselling on discontinuation rates due to bleeding disturbances of three long-acting reversible contraceptives.Hum Reprod. 2014; 29: 1393
- Comparing effectiveness of active and passive client follow-up approaches in sustaining the continued use of long acting reversible contraceptives (LARC) in rural Punjab: a multicentre, non-inferiority trial.PLoS One. 2016; 11: 1
- Frequency of 6-week follow-up appointment scheduling after intrauterine device insertion.BMJ Sex Reprod Health. 2018; 44: 33
- 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
- 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
- Follow-up care and 6-month continuation rates for long-acting reversible contraceptives in adolescents and young adults: a retrospective chart review.J Pediatr Adolesc Gynecol. 2020; 33: 39
- U.S. selected practice recommendations for contraceptive use, 2016.MMWR Recomm Reports. 2016; 65: 1
- Sexual activity, contraceptive use, and childbearing of teenagers aged 15-19 in the United States. NCHS data brief, no 209.National Center for Health Statistic, Hyatsville, MD2015
- Continuation of long-acting reversible contraceptives among Medicaid patients.Contraception. 2018; 98: 125
- An analysis of the personal reasons for discontinuing IUD use.Contraception. 1994; 50: 339
- Analysis of client characteristics that may affect early discontinuation of the TCu-380A IUD.Contraception. 1999; 60: 155
Published online: January 21, 2021
The authors declare that they have no conflicts of interest.
Results of this work were selected for poster presentation at the 2020 annual meeting of the Society for Adolescent Health and Medicine scheduled for March 11, 2020. Due to the COVID-19 pandemic, the meeting was cancelled, and the poster was made available via an online platform.
© 2021 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.