Intrauterine Devices at Six Months: Does Patient Age Matter? Results from an Urban Family Medicine Federally Qualified Health Center (FQHC) Network

Abstract

Background Federally Qualified Health Centers (FQHCs) can address high unintended adolescent pregnancy rates in the United States by increasing access to intrauterine devices (IUDs) in underserved settings. Despite national guidelines endorsing IUDs in adolescents, some physicians remain concerned about IUD tolerance and safety in adolescents. Thus, we compared adolescents and adults in a family physician staffed FQHC network with regard to: (1) IUD post-insertion experience, (2) device discontinuation and (3) sexually transmitted infection (STI) rates. Methods We conducted a retrospective cohort study among women less than 36 years of age who had a 2011 IUD insertion at a New York City family physician staffed FQHC network. Results 684 women (27 % adolescents, 73% adults) were included. During the six month post-insertion period, 59% of adolescent and 43% of adults initiated IUD related post-insertion clinical contact, most commonly for bleeding changes and pelvic or abdominal pain. There were no significant differences between groups in IUD expulsion, removal or STI rates. Conclusions Urban FQHC providers may anticipate that, as compared to their adult IUD utilizers, adolescents will initiate more clinical follow-up visits post-insertion. However both groups will have similar clinical concerns, reasons for and rate of device discontinuation and low STI rates.

The safety of intrauterine devices among young women: a systematic review

“…Of seven retrospective cohort studies, one examined the LNG-IUD, and four examined a mix of Cu-IUD and LNG-IUD users and reported no significant differences in expulsion between younger women and older women [11–13,21,24]; one study of the Cu-IUD (II-2, poor) reported decreasing rates of expulsion with increasing age, but no significance testing was performed [10]; one study reported higher crude rates of expulsion for younger women compared with older women using two different Cu-IUDs, but no significance testing was performed [22].…”

“…This study showed a significant difference in crude rates of either LNG- or Cu-IUD expulsions by age group that ranged from 5.1% to 8.0% (p=.03); however, in adjusted models, there was no significant difference among women aged 13–19 years compared with 20–24 years (aHR 0.79, 95% CI 0.47–1.35, p=.39) or compared with women aged 25–35 years (aHR 0.68, 95% CI 0.40–1.13, p=.14) after adjusting for race and IUD type [12]. Two retrospective cohort studies (Level II-2, fair to poor) reported crude rates of expulsion for younger women compared with older women (aged <21 years versus 21–35 years and aged 13–17 years versus 18–24 years) for Cu- and LNG-IUD users and found no significant differences between age groups with rates ranging from 2.7% to 8.8% over 1 and 6 years of follow-up [21,24]. A retrospective cohort study (Level II-2, poor) that combined 938 NovaT and 717 Multiload 250 users reported cumulative 6-year rates of loss of IUD for those aged less than 20, 20–24, 25–29, 30–35 and 35+ years; loss of IUD was not further described.…”

“…Nine studies, reported in 11 articles, reported on pregnancy as an outcome. These included one RCT, one prospective cohort study and seven retrospective cohort studies [11–18,21–23]. Only two studies provided direct evidence by evaluating pregnancy rates among young IUD users compared with young women using other contraceptive methods.…”

“…When compared with women aged 25–44 years, there were no significant differences in odds of ectopic pregnancy or abnormal pregnancy or odds of spontaneous abortion among women aged 15–19 years; however, there were slightly elevated odds of normal pregnancy among the younger age group (aOR 1.42, 95% CI 1.13–1.78). Finally, a retrospective cohort study (Level II-2, poor) reviewed charts up to 6 months after Cu-IUD or LNG-IUD insertion for 684 women and reported 1 pregnancy among 502 women (0.2%) aged 21–35 years compared with no pregnancy among women aged less than 21 years; no significance testing was reported [21].…”

Practice-based Research Networks at the Crossroads of Research Translation

“…However, whether tailoring patient treatment would result in improved long-term outcomes is not yet known. Ravi et al 18 looked at outcomes of intrauterine device use during a 6-month follow-up period among adolescents and adults in a retrospective cohort study of federally qualified health centers in New York City. Outcomes included postinsertion experience, device discontinuation, and sexually transmitted infections.…”