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Intrauterine Contraception Continuation in Adolescents and Young Women: A Systematic Review.
J Pediatr Adolesc Gynecol 2016; 29(6):659-667JP

Abstract

STUDY OBJECTIVE

Adolescents are at high risk for unintended pregnancies. Although intrauterine devices (IUDs), long-acting reversible contraceptives (LARCs), are known to be highly effective in preventing pregnancy, little is known about IUD adherence in adolescents. In this systematic review (SR) we examined IUD continuation rates compared with other forms of contraception in young women aged 25 years and younger. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A systematic search of Ovid Medline, Cochrane Library, and Embase was conducted for the years 1946-2015. Included studies examined IUD use in women 25 years of age and younger, compared IUD use with another form of contraception, and measured continuation rates at 12 months. The quality of each study was appraised using the Downs and Black criteria, and 12-month continuation rates among studies were pooled and analyzed according to contraceptive type.

RESULTS

Of 3597 articles retrieved, 9 studies met criteria for SR. Synthesized across studies, 12-month continuation was significantly higher for IUD users (86.5%, 12,761/14,747) compared with oral contraceptives (39.6%, 1931/4873), Depo-Provera (Pfizer Inc, New York, NY) hormonal injection (39.8%, 510/1282), vaginal ring (48.9%, 196/401), and transdermal patch (39.8%, 37/93; all P values < .001). There was no statistically significant difference in 12-month continuation between the IUD and another LARC method, the subdermal etonogestrel implant (85.3%, 4671/5474).

CONCLUSION

Findings of this SR suggest that continuation rates for IUDs are generally higher compared with other contraceptive methods for women aged 25 years and younger. In a population with high rates of unintended pregnancies, generally low adherence, and imperfect use with other non-LARCs, IUD use should be encouraged.

Authors+Show Affiliations

Columbia University School of Nursing, New York, New York.Columbia University School of Nursing, New York, New York.Columbia University School of Nursing, New York, New York.Columbia University School of Nursing, New York, New York. Electronic address: ams130@cumc.columbia.edu.

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

27386754

Citation

Usinger, K M., et al. "Intrauterine Contraception Continuation in Adolescents and Young Women: a Systematic Review." Journal of Pediatric and Adolescent Gynecology, vol. 29, no. 6, 2016, pp. 659-667.
Usinger KM, Gola SB, Weis M, et al. Intrauterine Contraception Continuation in Adolescents and Young Women: A Systematic Review. J Pediatr Adolesc Gynecol. 2016;29(6):659-667.
Usinger, K. M., Gola, S. B., Weis, M., & Smaldone, A. (2016). Intrauterine Contraception Continuation in Adolescents and Young Women: A Systematic Review. Journal of Pediatric and Adolescent Gynecology, 29(6), pp. 659-667. doi:10.1016/j.jpag.2016.06.007.
Usinger KM, et al. Intrauterine Contraception Continuation in Adolescents and Young Women: a Systematic Review. J Pediatr Adolesc Gynecol. 2016;29(6):659-667. PubMed PMID: 27386754.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intrauterine Contraception Continuation in Adolescents and Young Women: A Systematic Review. AU - Usinger,K M, AU - Gola,S B, AU - Weis,M, AU - Smaldone,A, Y1 - 2016/07/04/ PY - 2016/01/20/received PY - 2016/04/07/revised PY - 2016/06/21/accepted PY - 2016/7/9/pubmed PY - 2017/3/11/medline PY - 2016/7/9/entrez KW - Adolescent KW - Compliance KW - Continuation KW - Contraception KW - IUD KW - Young women SP - 659 EP - 667 JF - Journal of pediatric and adolescent gynecology JO - J Pediatr Adolesc Gynecol VL - 29 IS - 6 N2 - STUDY OBJECTIVE: Adolescents are at high risk for unintended pregnancies. Although intrauterine devices (IUDs), long-acting reversible contraceptives (LARCs), are known to be highly effective in preventing pregnancy, little is known about IUD adherence in adolescents. In this systematic review (SR) we examined IUD continuation rates compared with other forms of contraception in young women aged 25 years and younger. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A systematic search of Ovid Medline, Cochrane Library, and Embase was conducted for the years 1946-2015. Included studies examined IUD use in women 25 years of age and younger, compared IUD use with another form of contraception, and measured continuation rates at 12 months. The quality of each study was appraised using the Downs and Black criteria, and 12-month continuation rates among studies were pooled and analyzed according to contraceptive type. RESULTS: Of 3597 articles retrieved, 9 studies met criteria for SR. Synthesized across studies, 12-month continuation was significantly higher for IUD users (86.5%, 12,761/14,747) compared with oral contraceptives (39.6%, 1931/4873), Depo-Provera (Pfizer Inc, New York, NY) hormonal injection (39.8%, 510/1282), vaginal ring (48.9%, 196/401), and transdermal patch (39.8%, 37/93; all P values < .001). There was no statistically significant difference in 12-month continuation between the IUD and another LARC method, the subdermal etonogestrel implant (85.3%, 4671/5474). CONCLUSION: Findings of this SR suggest that continuation rates for IUDs are generally higher compared with other contraceptive methods for women aged 25 years and younger. In a population with high rates of unintended pregnancies, generally low adherence, and imperfect use with other non-LARCs, IUD use should be encouraged. SN - 1873-4332 UR - https://www.unboundmedicine.com/medline/citation/27386754/Intrauterine_Contraception_Continuation_in_Adolescents_and_Young_Women:_A_Systematic_Review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-3188(16)30088-2 DB - PRIME DP - Unbound Medicine ER -