Image: PD. Levonorgestrel molecule.
1. Overall, intrauterine devices had a very low rate of serious complications (<1%) in both teenagers and older women.
2. Levonorgestrel-releasing intra-uterine device (IUD) was associated with fewer complications and less early discontinuation than the copper IUD in all age groups.
Evidence Rating Level: 2 (Good)
Study Rundown: The results of this study found that rates of serious IUD complications, including ectopic pregnancy and pelvic inflammatory disease (PID), were just as low (<1%) in teenagers as they were in older women. These findings suggest that the IUD is an effective, safe and appropriate means of contraception for women of all ages. Assessing outcomes only in insured women limits the generalizability of results. Strengths include a large size to assess rarely-occurring adverse events. Findings from this study support the use of one of the most highly effective forms of birth control available, long-acting reversible contraception via IUD, in our most vulnerable population.
Study author, Dr. Abbey B. Berenson, MD, PhD, talks to 2 Minute Medicine: Department of Obstetrics & Gynecology, University of Texas Medical Branch
“Teenagers are at lower risk of having an unintended pregnancy when they use a long acting reversible method of contraception. This study showed that teenagers did not have more complications with one of the two IUDs currently available than adults and so it is appropriate to offer IUDs to teenagers.”
In Depth [retrospective cohort study]: The study used electronic health insurance claims from a nationwide U.S. private insurance company to evaluate complications in 90,489 women who received IUDs between 2002 and 2009. Outcomes evaluated include contraception failure, IUD removal within 1 year of insertion, and IUD complications such as pain, menstruation disorders, inflammation/infection, and uterine perforation. Multivariate logistic regression models stratified by age group (15-19 vs 20-24 vs 25-44 years) and type of IUD allowed for estimation of the effect of IUD type and age on outcomes.
The rate of serious complications (such as ectopic pregnancy or pelvic inflammatory disease) was <1% in all age groups. Results found that women aged 15-19 years old were more likely than women aged 25-44 to experience minor complications such as dysmenorrhea (odds ratio (OR):1.4, confidence interval (CI):1.1-1.6) and amenorrhea (OR:1.3, CI:1.1-1.5). Rates of early discontinuation were the same in both age groups (13% vs 11%, p>0.5), however a higher proportion of the copper IUD users who discontinued early were teenagers.
By Maren Shapiro and Leah Hawkins
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