Continuation Rates of Hormonal Intrauterine Devices in Adolescents and Young Adults when placed for Contraceptive and Non-Contraceptive Indications.

OBJECTIVE: This study aimed to estimate and compare continuation rates of hormonal intrauterine devices (IUDs) when placed for contraceptive or menstrual management indications in adolescents and young adults.

STUDY DESIGN: We conducted a secondary analysis of a prospectively collected database of all hormonal IUD insertions from January 1, 2017 through December 31, 2020, with at least one-year follow-up, across four Adolescent Medicine practices. IUD insertions without known indication were excluded.

RESULTS: A total of 936 IUD insertions were attempted, 45% for contraception only, 18% for menstrual management only, and 37% for both indications. Insertion was successful in 868 (93%) attempts, and success did not differ by indication (p=0.74). The mean age of patients at insertion was 18.9 years (SD=2.4 y), with no difference by indication. Of the completed insertions, 650 (75%) had at least one follow-up during the data analysis period. Excluding those that did not have any follow-up after insertion, the overall continuation rates were 77% at one year, 66% at two years, and 54% at three years. While continuation rates did not differ by indication at one year, at three years, continuation was highest among those who sought the device for menstrual management only (contraception=53%, menstrual=57%, both=53%, p<0.01) Malposition was rare (4.0%), as was device expulsion (2.5%), and these did not differ by indication.

CONCLUSION: IUD continuation rates were high among adolescents and young adults and did not significantly differ when placed for contraceptive or non-contraceptive indication in the first year of use.

IMPLICATIONS STATEMENT: Adolescents and young adults may seek the hormonal IUD for contraception and/or menstrual management. Our study found that IUD continuation rates were high at one year regardless of the indication for utilization.