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Complications and Continuation of Intrauterine Device Use Among Commercially Insured Teenagers

Berenson, Abbey B. MD, PhD; Tan, Alai MD, PhD; Hirth, Jacqueline M. PhD, MPH; Wilkinson, Gregg S. PhD, MA

doi: 10.1097/AOG.0b013e31828b63a0
Original Research

OBJECTIVE: Many U.S. health care providers remain reluctant to prescribe intrauterine devices (IUDs) to teenagers as a result of concerns about serious complications. This study examined whether 15–19-year-old IUD users were more likely to experience complications, failure, or early discontinuation than adult users aged 20–24 years and 25–44 years and whether there were differences in these outcomes between users of levonorgestrel-releasing intrauterine systems and copper IUDs.

METHODS: A retrospective cohort study was conducted using health insurance claims obtained from a private insurance company of 90,489 women who had an IUD inserted between 2002 and 2009. Logistic regression models were used to estimate the odds of experiencing complications, method failure, or early discontinuation within 12 months of insertion by age group and type of IUD inserted.

RESULTS: Serious complications, including ectopic pregnancy and pelvic inflammatory disease, occurred in less than 1% of patients regardless of age or IUD type. Women aged 15–19 years were more likely than those aged 25–44 years to have a claim for dysmenorrhea (odds ratio [OR] 1.4, confidence interval [CI] 1.1–1.6), amenorrhea (OR 1.3, CI 1.1–1.5), or normal pregnancy (OR 1.4, CI 1.1–1.8). Overall, early discontinuation did not differ between teenagers and women aged 25–44 years (13% compared with 11%, P>.05). However, use of the levonorgestrel-releasing intrauterine system was associated with fewer complications and less early discontinuation than the copper IUD in all age groups.

CONCLUSIONS: The IUD is as appropriate for teenagers to use as it is for older women, with serious complications occurring infrequently in all groups. The levonorgestrel-releasing intrauterine system may be a better choice than the copper IUD as a result of lower odds of complications, discontinuation, and failure.

LEVEL OF EVIDENCE: II

Serious complications are rare among teenagers using intrauterine devices, with users of levonorgestrel-containing devices less likely than copper users to experience complications, discontinuation, and failure.

Department of Obstetrics & Gynecology, Center for Interdisciplinary Research in Women's Health, the Department of Preventive Medicine, Sealy Center on Aging, and the Departments of Obstetrics and Gynecology and Preventive Medicine & Community Health and Family Medicine, University of Texas Medical Branch, Galveston, Texas.

Corresponding author: Abbey B. Berenson, MD, PhD, University of Texas Medical Branch, Department of Obstetrics & Gynecology, 301 University Boulevard, Route 0587, Galveston, TX 77555-0587; e-mail: abberens@utmb.edu.

Funded by the Society of Family Planning (SFP4-1, Abbey B. Berenson, MD, PhD, Principal Investigator). Supported by the Institute for Translational Sciences at the University of Texas Medical Branch, which is partially funded by a Clinical and Translational Science Award (UL1RR029876) from the National Center for Research Resources, National Institutes of Health, and by the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) of the National Institutes of Health (National Institutes of Health/NICHD K24 HD04365, Abbey B. Berenson, MD, PhD, Principal Investigator). Dr. Hirth is currently supported by ORWH (NICHD K12HD052023, Abbey B. Berenson, MD, PhD, Principal Investigator) and was supported at the time of initial submission by the NICHD through an institutional training grant (National Research Service Award T32HD055163, Abbey B. Berenson, MD, PhD, Prinicipal Investigator).

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NICHD, the National Institutes of Health, or the Society of Family Planning.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.