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Editorial SEPTEMBER 2007
Use of Contraceptive Intrauterine Devices
in Adolescents
Julie Strickland, MD, MPH
The intrauterine device (IUD)—particularly the levonorgestrel-releasing
intrauterine system—offers many advantages for adolescents
and should
be considered as a contraceptive option for sexually
active teenaged girls. Despite a decline in sexual activity
among adolescents in the last decade, 47% of female adolescents
engage in sexual intercourse prior to age 19.1 The
quest continues for a reliable, safe, and readily reversible
contraceptive method that is tailored to adolescent needs.
Contraceptive knowledge and the overall use of contraception
are growing among adolescent girls.2 However,
the low compliance and inconsistent use of specific methods
among
teenagers puts them at high risk for failure and unintended
pregnancy. Long-acting, non-user-dependent,
and cost-effective methods with a low incidence of side
effects are especially appealing for adolescents. The
noncontraceptive benefits of decreased menstrual bleeding
and reduced dysmenorrhea in the levonorgesterel system
also address problems that are common among girls just
after menarche.
Young women aged 15 to 19 years have the highest
incidence of sexually transmitted infections (STIs)
of any female population group.3 Thus,
one concern regarding IUD use in this group is the
potentially
increased risk of pelvic inflammatory disease (PID)
among users. However, after the first month of use
IUD risk remains at a low level—ie, 1.4 per
1,000.4 That
initial risk may be due to concomitant infection
at insertion. A review of the reports of upper genital
tract infections related to IUD use indicated that
these concerns may be exaggerated due to methodologic
errors.5 Because
of the high incidence of asymptomatic STIs in this
population, preinsertion STI screening
is indicated in all teenagers considering IUD use.
Concerns have also been expressed regarding the
ability to successfully place the device in the office
setting. There is little evidence to suggest that
insertion would be more difficult in postpubertal,
sexually active girls than in motivated, nulliparous
adult patients. Expulsion and infection rates and
length of use in nulligravid women appear to be similar
to those observed in parous women.6
In conclusion, the benefits of reliable, long-term,
cost-effective, compliance-guaranteed contraception
and dysmenorrhea/menorrhagia relief make the IUD a
viable contraceptive alternative for teenaged girls.
Age alone should not be a factor excluding adolescents
from consideration with regard to this option.
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Julie Strickland, MD, MPH, Editorial
Advisory,
Board Member
References
- Grunbaum JA, Kann L, Kinchen S, et al. Youth risk behavior sur-veillance—United States, 2003.
MMWR Surveill Summ. 2004; 53(2):1-96.
- Abma JC, Martinez GM, Mosher WD, Dawson BS. Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2002. Vital
Health Stat 23. 2004;(24):1-48.
- Centers for Disease Control and Prevention. Sexually
Transmitted Disease Surveillance. 2004. Atlanta, GA: US Department of Health and Human Services; 2005.
- Farley TM, Rosenberg MJ, Rowe PJ, Chen JH, Meirik O. Intrau-
terine devices and pelvic inflammatory disease: an international perspective. Lancet. 1992;339(8796):
785-788.
- Grimes DA. Intrauterine device and upper-genital-tract infec-tion. Lancet. 2000;356(9234): 1013-1019.
- uenas JL, Albert A, Carrasco F. Intrauterine contraception in nulligravida vs. parous women. Contraception. 1996;53(1):23-24.
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