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New study clarifies benefits of IUD use

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A new study evaluated intrauterine devices (IUDs) based on age, parity (number of deliveries) and type of IUD. The study should be help patients and their healthcare providers determine which type of birth control is the best choice. The findings were published in the March edition of the journal Obstetrics & Gynecology by researchers affiliated with Riverside Health System (Newport News, Virginia) and Georgetown University School of Medicine (Washington, DC).

The authors note that the most frequently chosen methods of birth control by US teens are withdrawal, condoms, and oral contraceptive pills. These methods are associated with relatively high failure rates and low rates of continuation, which, in turn, contribute to high rates of unplanned teen pregnancies. It is known that 82% of the approximately 750,000 teen pregnancies that occur every year in the US. Of all reversible contraceptives, IUDs have been shown to have one of the highest rates of satisfaction and continuation and an effectiveness that is comparable to sterilization. The safety of IUD use in adolescents and nulliparous women (women who have not borne a child) is supported by recent recommendations from the US Medical Eligibility Criteria for Contraceptive Use.; however, IUDs are currently underused in this patient population: only 4.5% of teens and women under the age of 20 years use long-acting reversible contraception. A lack of knowledge and some misconceptions exist among both patients and healthcare professionals regarding IUD use in adolescents and nulliparous women. Due to the limited amount of information regarding the use of IUDs in adolescents, healthcare professionals are reluctant to offer this method of contraception to these young women primarily as a result of their concerns about its safety and effectiveness. Therefore, the researchers conducted a study to analyze IUD-related outcomes including expulsion, contraceptive failure, and early discontinuation; in addition, the compared these outcomes in regard to age, parity, and type of IUD used.

The investigators conducted a multicenter retrospective (backward-looking) chart review of teens and women aged 13–35 years who had an IUD inserted for contraception between June 2008 and June 2011. They reviewed 2,523 patient charts. Among them, 2,138 women were included in the analysis. The patients were followed for an average of 37 ± 11 months. The overall rates of IUD expulsion was 6% and the overall pregnancy rate was 1%. No significant differences were found in regard to age or parity. After 12 months of follow-up, IUD discontinuation rates were 19%; discontinuation rates were 41% after an average follow-up of 37 months. Despite similar rates of IUD discontinuation between age groups at 12 months of use, teens and young women aged 13–19 years were more likely to request early discontinuation at the end of the total follow-up period. No significant difference was noted in pelvic inflammatory disease (PID) rates (2%) based on age. After adjusting for age and parity, the researchers found that copper IUD users were more likely to experience expulsion and contraception failure compared with levonorgestrel intrauterine system users (1.62-fold greater risk).

The authors concluded that, similar to adults, IUD use in teens and nulliparous women is effective and associated with low rates of serious complications. They recommended that healthcare professionals should consider IUDs for contraception in all females. They noted that teens and young women are more likely to request premature discontinuation of their IUDs and may benefit from additional counseling.

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