December 2013

Beyond offering excellent contraceptive protection and several noncontraceptive benefits. However, many women are unaware that adolescents can safely use IUDs. Although IUD use increased dramatically, by more than tenfold, use remains exceedingly low at only 2.5%.[1]

Recently reporting on the St. Louis CHOICE project, in which women are offered long-acting reversible contraceptives without charge as a first-line option, Jeffrey Peipert, MD, PhD, reported that the birth rate for teens ages 15-19 years enrolled in the study was 6.1 per 1,000, a rate far below the national average of 34.3 per 1,000.[2] The study team found that teens’ rate continuation and reported satisfaction with IUDs did not differ from that of adult users. In fact, more than 80% of adolescents using the LNG-IUS, the copper IUD, and implants continued use for a full year. In contrast the 12-month continuation rate among teens using non-LARC methods was only about 50%. Although the younger teens ages 14-17 years in the project were more likely to select the implant than the IUD as their method, older teens ages 18-20 years were twice as likely to select an IUD over an implant.

A number of studies among adult women have shown that the levonorgestrel intrauterine system (LNg-IUS) can for most users reduce menstrual bleeding, decrease dysmenorrhea, suppress endometriosis, and offer endometrial protection against chronic anovulation.[3] In a recent review, Bayer and Hillard concluded that these same benefits for medical management of menstrual-related problem likely apply to adolescents as well. One of the most common problems in adolescents is heavy menstrual bleeding, which may require a change in tampon or pad every hour or two or may last longer than a week. One study of young women ages 18-25 found that IUD users reported less bleeding than did COC users.[4]

Most adolescents report dysmenorrhea (60-93%). A randomized trial of young women 18-25 years showed that LNG-IUS users had greater alleviation of dysmenorrhea than did pill users. In the rare case of an adolescent who may be at risk of  endometrial hyperplasia, and so may benefit from endometrial protection, may be better managed by LNG-IUS than by pills because she may have risk of deep venous thrombosis or, simply, poor compliance and high discontinuation. The menstrual suppression accompanying LNG-IUS use may be a promising benefit for adolescents with mental retardation and developmental disorders, for whom menstrual cycling represents unique challenges with hygiene and behavioral concerns. However, this particular population may require anesthesia for IUD insertion.