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
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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.