An analysis on the complication rates associated with IUD placement aimed to determine whether the contraceptive method is appropriate for teenagers.
Frank J. Domino, MD
Berenson AB, et al. Complications and continuation of intrauterine device use among commercially insured teenagers. Obstet Gynecol. 2013;121(5):951—8. http://journals.lww.com/greenjournal/pages/articleviewer.aspx?year=2013&issue=05000&article=00008&type=abstract.
To determine the use and complication rates associated with intrauterine device (IUD) placement in women, this retrospective cohort study obtained US health insurance claims data of 90,489 privately-insured women who had an intrauterine device inserted between 2002 and 2009. The study particularly set out to determine the risks associated with IUD use in teenage females between the ages of 15 and 19 years old.
Patient data was obtained from electronic health insurance claims, and the geographic and gender information was considered similar in distribution to the US population. However, it was estimated that more whites, youth, and middle-aged adults were included in the data set than the overall US population.
Intervention and Control
Health insurance claims obtained from a private insurance company were reviewed to identify patients who had an IUD inserted between 2002 and 2009, determine the age of the patient when the IUD was inserted, find out whether the IUD was levonorgestrel-releasing or copper, and detect any serious complications.
Results and Outcomes
The study's primary outcomes included complications such as ectopic pregnancy, pelvic inflammatory disease, dysmenorrhea, amenorrhea, or normal pregnancy, which were all discovered in medical billings. The risk of early discontinuation and the difference rates of adverse outcomes between the levonorgestrel-releasing IUD and the copper IUD were also examined during the study.
Serious complications — including ectopic pregnancy and pelvic inflammatory disease — occurred in less than 1% of patients regardless of age or IUD type. However, levonorgestrel-releasing IUD use was associated with fewer complications and less early discontinuation than the copper IUD throughout all age groups. Women between the ages of 15 and 19 years old were more likely than those between 25 and 44 years old 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). Nevertheless, early discontinuation did not differ overall between teenagers and middle-aged women (13% versus 11%, P> 0.05).
An IUD is appropriate for teenagers to use, as serious complications occur infrequently among all age groups. However, the levonorgestrel-releasing intrauterine system may be a better option than the copper IUD, since it's associated with lower odds of complications, early discontinuation, and failure.
IUDs have been used as contraceptive methods for more than 35 years with good reason, as they have numerous advantages, such as causing few side effects while being cost-effective, safe, and highly efficacious in protecting against pregnancy. In addition, copper IUDs offer emergency contraception for up to 5 days after unprotected intercourse.This study shows that the lingering worry from the 1970s regarding an increased risk of pelvic inflammatory disease is unlikely to be a reality. It also adds to our clinical knowledge about the efficacy and safety of an IUD in the high-risk teenage population. Family physicians who are still fearful toward the use of IUDs should reconsider their position, and with clear, informed consent from the teen, they should advise patients of all reproductive ages about the advantages of the device.
About the Author
Frank J. Domino, MD, is Professor and Pre-Doctoral Education Director for the Department of Family Medicine and Community Health at the University of Massachusetts Medical School in Worcester, MA. Domino is Editor-in-Chief of the 5-Minute Clinical Consult series (Lippincott Williams & Wilkins). Additionally, he is Co-Author and Editor of the Epocrates LAB database, and author and editor to the MedPearls smartphone app. He presents nationally for the American Academy of Family Medicine and serves as the Family Physician Representative to the Harvard Medical School’s Continuing Education Committee.