Complications and continuation of intrauterine device use among commercially insured teenagers

Abstract

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.

Figure 1

Ratio of levonorgestrel-releasing intrauterine system compared with copper intrauterine device (IUD) insertion by age and year of insertion (2002–2009).

Figure 2

Intrauterine device (IUD) discontinuation within 1 year, by age (2002–2009). Copper IUD users in the 15–19 age group were more likely to discontinue early compared with levonorgestrel-releasing intrauterine system users in all age groups and compared with users of the copper IUD aged 20–24 years and 25–44 years (interaction of type of IUD and age group: P=.01). Odds ratios (95% confidence intervals [CI]) of levonorgestrel-releasing intrauterine system users compared with copper IUD discontinuation within 1 year: Age 15–19 years, 0.77 (0.65–0.91); age 20–24 years, 0.86 (0.80–0.93); age 25–44 years, 0.90 (0.88–0.93).