Postinsertional Pain after Intrauterine Device Placement among Nulliparous Adolescents

Abstract

Study objective: To quantify the "normal" adolescent experience after intrauterine device insertion, to provide appropriate counseling for future adolescents.

Design: Prospective cohort study.

Setting: Marshall University Department of Obstetrics and Gynecology generalist and adolescent gynecology clinics.

Participants: Nulliparous adolescents age 13-18 years and parous adults 18 years of age or older who received a levonorgestrel intrauterine system (LNG-IUS).

Interventions: Visual analogue scale (VAS) pain score and medication log was used for data collection for 2 weeks after LNG-IUS insertion. A separate chart review was completed for demographic factors and indications for procedure.

Main outcome measures: VAS pain scores and medication use was compared between groups.

Results: Ninety-three subjects returned the VAS record and medication log (46 adolescents and 47 adults). There was no difference in the incidence of endometriosis or dysmenorrhea, but there was a higher prevalence of menorrhagia among adolescents (30/46, 65.2% vs 10/47, 21.3%; P < .001). Forty-five of forty-seven (95.7%) adults vs 25/46 (54.3%) adolescents had contraception as an indication for intrauterine device use (P < .001). Pain scores were statistically higher among the adolescent group each day (P < .05) in the 2-week study period. The greatest mean differences occurred in the first 4 days. More adolescents (15/46, 32.6%) than adults (6/47, 12.8%) had a pain score greater than 5 during the first 3 days (P = .022). A statistical difference in amount of ibuprofen recorded was only noted on day 1 (P = .023) and day 4 (P = .046).

Conclusion: Nulliparous adolescents who undergo LNG-IUS placement experience more postinsertional discomfort compared with parous adults; however, this method should still be considered first-line treatment in this age group.

Keywords: Adolescent contraception; Dysmenorrhea; Intrauterine device; Levonorgestrel intrauterine system.