Intrauterine devices for adolescents: a systematic review.
BACKGROUND
The appropriateness of IUDs for adolescents remains unsettled, as does the definition of the term adolescent. Unplanned pregnancy among teenagers remains epidemic, and long-acting methods, such as IUDs, offer the promise of top-tier effectiveness.


METHODS
We conducted a systematic review of the literature concerning IUD use in adolescents using MEDLINE, Popline, EMBASE and CINAHL databases.


RESULTS
Six cohort studies and seven case-series reports met our inclusion criteria; none included IUDs in current use in the United States. Overall, continuation rates were high and cumulative pregnancy rates low, ranging from 2% at 6 months to 11% at 48 months. Compared with combined oral contraceptives, IUDs had similar or better continuation rates; pregnancy rates were similar at 2 years. IUD expulsion rates may be inversely related to age.


CONCLUSIONS
The literature on IUD use among adolescents is scanty and obsolete. Nevertheless, published reports were generally reassuring. Randomized controlled trials and cohort studies comparing contemporary IUDs with other methods are urgently needed.
Deans
Elizabeth I
EI
Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7570, USA.
Grimes
David A
DA
D000293:Adolescent; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007434:Intrauterine Devices; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control*; D012725:Sexual Behavior / Q000502:physiology