title: Adolescent Experiences With Intrauterine Devices: A Qualitative Study.
abstract: OBJECTIVE
  The purpose of this study was to improve understanding of adolescents' reasons for choosing an intrauterine device (IUD) and to explore experiences that led to continuation or discontinuation of the levonorgestrel intrauterine system (LNG-IUS) and the copper IUD (copper IUD).
  
  
  METHODS
  We conducted focus groups (FGs) with adolescents and young women who were current or former IUD users stratified by IUD type and 12-month IUD continuation or discontinuation. All subjects were participants from the Contraceptive CHOICE Project. FG data were supplemented with in-depth interviews (IDIs). Data collection was continued until thematic saturation was reached. Transcripts were independently coded by two researchers, and interrater reliability was calculated using a Kappa coefficient. Analysis followed a standard text-analysis approach.
  
  
  RESULTS
  Thirteen FGs and seven IDIs were conducted with 43 young women. Effectiveness, duration of use, convenience, and potential bleeding changes emerged as themes for both choosing and continuing IUDs. Some women chose the LNG-IUS to achieve amenorrhea, whereas copper IUD users wanted a nonhormonal method and continued menses. Copper IUD users cited expulsion and bleeding irregularities as reasons for discontinuation, whereas LNG-IUS users reported bleeding irregularities and continued pain as reasons for removal. IUD users noted an adjustment period of weeks to months in which side effects were present before lessening.
  
  
  CONCLUSIONS
  Effectiveness, duration of use, convenience, and potential changes in bleeding patterns drove adolescents' choice and continuation of an IUD. Bleeding changes and pain contributed to IUD discontinuation. Discussion of effectiveness, duration and convenience, and anticipatory guidance regarding post-insertion side effects may be important in counseling young women about IUDs.
authors.affiliation: Department of Obstetrics and Gynecology, North Shore-LIJ Hofstra School of Medicine, Manhasset, New York. Electronic address: eschmidt@nshs.edu.
authors.forename: Elizabeth O
authors.initials: EO
authors.lastname: Schmidt
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors.forename: Aimee
authors.initials: A
authors.lastname: James
authors.affiliation: Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors.forename: K Michele
authors.initials: KM
authors.lastname: Curran
authors.affiliation: Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Peipert
authors.affiliation: Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors.forename: Tessa
authors.initials: T
authors.lastname: Madden
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D003268:Contraception Behavior / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D005500:Follow-Up Studies; D006801:Humans; D007435:Intrauterine Devices, Copper / Q000009:adverse effects / Q000706:statistics & numerical data*; D008297:Male; D008598:Menstruation / Q000502:physiology; D036301:Qualitative Research; D014592:Uterine Hemorrhage / Q000209:etiology
keywords: Adolescent; CHOICE; Continuation; Discontinuation; Focus group; In-depth interview; Intrauterine device; Levonorgestrel intrauterine system; Long-acting reversible contraception; Qualitative; Selection; Side effects