Levonorgestrel Intrauterine System Continuation in Adolescents and Adult Women [14N]

    loading  Checking for direct PDF access through Ovid

Abstract

INTRODUCTION:

Up to 60% of women elect to remove the levonorgestrel intrauterine system (LNG-IUS) prematurely for side effects (SEs). Removal rates may differ between adolescents and adult women. We investigated the effect of age on removal patterns in first time LNG-IUS users.

METHODS:

We retrospectively reviewed women ages 15–44 undergoing LNG-IUS placement for contraception at an academic tertiary care center from 2006–2009. Women with previous LNG-IUS were excluded. Continuation rates without removal for SEs were estimated using the Kaplan-Meier method. Associations with time to removal were evaluated using Cox models.

RESULTS:

Of 1,062 eligible women, 79% had follow-up. Of these, 24.7% requested removal for SEs, most commonly bleeding. At 1, 3, and 5 years post-insertion, continuation rates without removal for SEs were 87%, 76%, and 71%, respectively. Each 1-year increase in age was associated with a 3% decrease in removal risk for SEs (HR 0.97, P=.004). Adolescents ages 15–21 (n=60) were compared to adult women ages 22–44 (n=778). Thirty five percent of adolescents and 23.9% of adult women requested removal for SEs. Continuation rates without removal for SEs at t 1, 3, and 5 years were 82%, 66%, and 49%, respectively, for adolescents and 88%, 76%, and 72%, respectively, for adults. Adolescents were 69% more likely to request removal for SEs (HR 1.69; P=.02) and chose less reliable alternative contraception (P=.001).

CONCLUSION:

Adolescents request LNG-IUS removal for SEs more frequently than adult women, though the method is overall well accepted across all age groups. Understanding removal patterns and patient expectations helps guide contraceptive counseling.

Related Topics

    loading  Loading Related Articles