title: Adolescent experience with intrauterine device insertion and use: a retrospective cohort study.
abstract: BACKGROUND
  Adolescents contribute disproportionately to the epidemic level of unintended pregnancy in the USA. Intrauterine devices (IUDs) are highly effective but underutilized in this age group.
  
  
  METHODS
  We searched our electronic clinic database to identify females ≤ 19 years old who underwent attempted IUD insertion between January 2007 and June 2009. This retrospective cohort study primarily compared the insertion and postinsertion experiences between nulliparous and parous teens.
  
  
  RESULTS
  Of the 307 charts reviewed, the majority of subjects were white (73.4%) and nulliparous (77.5%), with a median age of 18 years (range 15-19). The vast majority (96.4%, 296/307) had a successful IUD insertion upon first attempt; all of the 11 unsuccessful IUD insertion attempts were among nulliparous teens. Follow-up was available for 56% (172/307). During the first 12 months of use, there were 2.9% (5/172) IUD expulsions and 24.4% (42/172) removals, with no differences between nulliparous and parous teens. IUD continuation at 6 months was 83.3%. Pelvic inflammatory disease was diagnosed in 4.6% (8/172) of post-IUD insertions. There were no pregnancies reported in those teens with IUD continuation, while six were reported in subjects who underwent IUD removal. Independent predictors of IUD discontinuation were a history of chronic pelvic pain or dysmenorrhea, and bleeding and/or pain complaints at any post-IUD visit.
  
  
  CONCLUSIONS
  Overall, adolescents experience minimal complications with IUD use, with similar rates of successful insertion as adults. IUD discontinuation rates were not significantly different between nulliparous and parous teens. While discontinuation was higher than reported in adults, it was lower than reported among teens using other forms of contraception.
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR 97239, USA. bayerl@ohsu.edu
authors.forename: Lisa L
authors.initials: LL
authors.lastname: Bayer
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Jensen
authors.forename: Hong
authors.initials: H
authors.lastname: Li
authors.forename: Mark D
authors.initials: MD
authors.lastname: Nichols
authors.forename: Paula H
authors.initials: PH
authors.lastname: Bednarek
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology; D007433:Intrauterine Device Expulsion; D007434:Intrauterine Devices / Q000009:adverse effects; D010146:Pain; D010298:Parity; D000292:Pelvic Inflammatory Disease / Q000209:etiology; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control*; D012189:Retrospective Studies; D014592:Uterine Hemorrhage; D055815:Young Adult