Abstract
Objective
The objective was to determine the association between use of intrauterine devices
(IUDs) by young women and risk of adverse outcomes.
Methods
We searched Pubmed, CINAHL, Embase, Popline and the Cochrane Library for articles
from inception of database through December 2015. For outcomes specific to IUD use
(IUD expulsion and perforation), we examined effect measures for IUD users generally
aged 25 years or younger compared with older IUD users. For outcomes of pregnancy,
infection, pelvic inflammatory disease (PID), and heavy bleeding or anemia, we examined
young IUD users compared with young users of other contraceptive methods or no method.
Results
We identified 3169 articles of which 16 articles from 14 studies met our inclusion
criteria. Six studies (Level II-2, good to poor) reported increased risk of expulsion
among younger age groups compared with older age groups using copper-bearing (Cu-)
IUDs. Two studies (Level II-2, fair) examined risks of expulsion among younger compared
with older women using levonorgestrel-releasing (LNG-) IUDs; one reported no difference
in expulsion, while the other reported increased odds for younger women. Four studies
(Level II-2, good to poor) examined risk of expulsion among Cu- and LNG-IUD users
combined and reported no significant differences between younger and older women.
For perforation, four studies (Level II-2, fair to poor) found very low perforation
rates (range, 0%-0.1%), with no significant differences between younger and older
women. Pregnancies were generally rare among young IUD users in nine studies (Level
I to II-2, fair to poor), and no differences were reported for young IUD users compared
with young combined oral contraceptive (COC) or etonogestrel (ENG) implant users.
PID was rare among young IUD users; one study reported no cases among COC or IUD users,
and one reported no difference in PID among LNG-IUD users compared with ENG implant
users from nationwide insurance claims data (Level I to II-2, fair). One study reported
decreased odds of bleeding with LNG-IUD compared with COC use among young women, while
one study of young women reported decreased odds of removal for bleeding with LNG-IUD
compared with ENG implant (Level I to II-2, fair).
Conclusion
Overall evidence suggests that the risk of adverse outcomes related to pregnancy,
perforation, infection, heavy bleeding or removals for bleeding among young IUD users
is low and may not be clinically meaningful. However, the risk of expulsion, especially
for Cu-IUDs, is higher for younger women compared with older women. If IUD expulsion
occurs, a young woman is exposed to an increased risk of unintended pregnancy if replacement
contraception is not initiated. IUDs are safe for young women and provide highly effective
reversible contraception.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ContraceptionAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Long-acting reversible contraception for adolescents and young adults: patient and provider perspectives.J Pediatr Adolesc Gynecol. 2013; 26: 86-95
- Sexually transmitted diseases treatment guidelines, 2015.MMWR Recomm Rep. 2015; 64: 1-137
- Does insertion and use of an intrauterine device increase the risk of pelvic inflammatory disease among women with sexually transmitted infection? A systematic review.Contraception. 2006; 73: 145-153
- Intrauterine device and upper-genital-tract infection.Lancet. 2000; 356: 1013-1019
- Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women.N Engl J Med. 2001; 345: 561-567
- Contraceptive technology.20 ed. Ardent Media, Inc., Atlanta, GA2011
- Medical eligibility criteria for contraceptive use.5th ed. 2015 ([Geneva])
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.Ann Intern Med. 2009; 151: 264-269
- Current methods of the US Preventive Services Task Force: a review of the process.Am J Prev Med. 2001; 20: 21-35
- Analysis of minor complications in copper IUD wearers.Clin Invest Ginecol Obstet. 1983; 10: 16-22
- Retrospective review of intrauterine device in adolescent and young women.J Pediatr Adolesc Gynecol. 2012; 25: 195-200
- Effects of age, parity, and device type on complications and discontinuation of intrauterine devices.Obstet Gynecol. 2014; 123: 585-592
- Duration of use of a levonorgestrel IUS amongst nulliparous and adolescent women.Contraception. 2011; 84: e5-e10
- Complications and continuation of intrauterine device use among commercially insured teenagers.Obstet Gynecol. 2013; 121: 951-958
- Complications and continuation rates associated with 2 types of long-acting contraception.Am J Obstet Gynecol. 2015; 212: 761.e1-761.e8
- Five years' experience of intrauterine contraception with the Nova-T and the Copper-T-200.Am J Obstet Gynecol. 1983; 147: 885-892
- Factors affecting the clinical performance of Nova T and Copper T 200.Obstet Gynecol. 1984; 64: 524-529
- Intrauterine contraception with Nova-T and Copper-T-200 during three years.Contraception. 1981; 24: 529-542
- Association of age and parity with intrauterine device expulsion.Obstet Gynecol. 2014; 124: 718-726
- Complications among adolescents using copper intrauterine contraceptive devices.Int J Gynaecol Obstet. 2011; 115: 269-272
- Intrauterine devices at six months: does patient age matter? Results from an urban family medicine federally qualified health center (FQHC) network.J Am Board Fam Med. 2014; 27: 822-830
- Complications caused by intrauterine contraceptive devices.Ugeskr Laeger. 1990; 152: 3002-3006
- Clinical performance of a levonorgestrel-releasing intrauterine system and oral contraceptives in young nulliparous women: a comparative study.Contraception. 2004; 69: 407-412
- Insertion characteristics of intrauterine devices in adolescents and young women: success, ancillary measures, and complications.Am J Obstet Gynecol. 2015; : 515.e1-515.e5
- Risk factors for copper T IUD expulsion: an epidemiologic analysis.Contraception. 1992; 46: 427-433
- Nulliparous women, IUD and pelvic infection.Ann Clin Res. 1979; 11: 121-124
- Two-year rates for Nova T and Copper T in a comparative study.Contraception. 1980; 21: 321-334
- Contraceptive failure in the United States.Contraception. 2011; 83: 397-404
Article info
Publication history
Published online: October 19, 2016
Accepted:
October 13,
2016
Received in revised form:
October 13,
2016
Received:
June 8,
2016
Footnotes
☆The authors have no financial disclosures or conflicts of interest to disclose.
☆☆Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Identification
Copyright
Published by Elsevier Inc.
