Intrauterine devices at six months: does patient age matter? Results from an urban family medicine federally qualified health center (FQHC) network.
BACKGROUND
Federally qualified health centers (FQHCs) can address high rates of unintended pregnancy among adolescents in the United States by increasing access to intrauterine devices (IUDs) in underserved settings. Despite national guidelines endorsing adolescent use of IUDs, some physicians remain concerned about IUD tolerance and safety in adolescents. Therefore we compared adolescents and adults in a family physician staffed FQHC network with regard to (1) IUD postinsertion experience, (2) device discontinuation, and (3) sexually transmitted infection (STI) rates.


METHODS
We conducted a retrospective cohort study among women <36 years old who had an IUD inserted in 2011 at a New York City FQHC staffed by family physicians.


RESULTS
We included 684 women (27% adolescents, 73% adults). During the 6-month postinsertion period, 59% of adolescents and 43% of adults initiated IUD-related clinical contact after insertion, most commonly for bleeding changes and pelvic or abdominal pain. There were no significant differences between groups in IUD expulsion or removal or STI rates.


CONCLUSIONS
Urban FQHC providers may anticipate that, compared with their adult IUD users, adolescents will initiate more clinical follow-up visits after insertion. Both groups will, however, have similar clinical concerns about, reasons for, and rate of device discontinuation and low STI rates.
From the Beth Israel Residency in Urban Family Practice, New York, NY (AR); the Institute for Family Health, New York, NY (LP, NM); Department of Sociology, State University of New York, New Paltz (EW); and the Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY (SER). anita.ravi@aya.yale.edu.
Anita
A
Ravi
From the Beth Israel Residency in Urban Family Practice, New York, NY (AR); the Institute for Family Health, New York, NY (LP, NM); Department of Sociology, State University of New York, New Paltz (EW); and the Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY (SER).
Linda
L
Prine
From the Beth Israel Residency in Urban Family Practice, New York, NY (AR); the Institute for Family Health, New York, NY (LP, NM); Department of Sociology, State University of New York, New Paltz (EW); and the Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY (SER).
Eve
E
Waltermaurer
From the Beth Israel Residency in Urban Family Practice, New York, NY (AR); the Institute for Family Health, New York, NY (LP, NM); Department of Sociology, State University of New York, New Paltz (EW); and the Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY (SER).
Natasha
N
Miller
From the Beth Israel Residency in Urban Family Practice, New York, NY (AR); the Institute for Family Health, New York, NY (LP, NM); Department of Sociology, State University of New York, New Paltz (EW); and the Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY (SER).
Susan E
SE
Rubin
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003151:Community Health Centers / Q000706:statistics & numerical data; D020878:Device Removal / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007433:Intrauterine Device Expulsion; D007434:Intrauterine Devices / Q000009:adverse effects*; D009519:New York City / Q000453:epidemiology; D012189:Retrospective Studies; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
Adolescents; Contraception; Intrauterine Devices