Young Age, Nulliparity, and Continuation of Long-Acting Reversible Contraceptive Methods.
OBJECTIVE
To assess the relationship among young age, nulliparity, and continuation of long-acting reversible contraceptive (LARC) methods.


METHODS
We performed a secondary analysis of the Contraceptive CHOICE Project database, an observational cohort study of 9,256 sexually active reproductive-aged females. This analysis focused on continuation of the intrauterine device and implant in nulliparous adolescent participants compared with parous, older women. We analyzed our data by age-parity groups and individual characteristics and used multivariable analysis to assess the association of age and parity on continuation.


RESULTS
There were 6,106 participants in our analytic set, including 863 aged 14-19 years. Long-acting reversible contraceptive continuation rates at 12 months were high and similar between all age-parity groups ranging from 82-86%. In the Cox proportional hazards model, nulliparous participants using the copper intrauterine device and implant were more likely to discontinue their LARC method (copper intrauterine device: adjusted hazard ratio [HR] 1.76, 95% CI 1.13-2.73, implant: adjusted HR 1.89, 95% CI 1.35-2.64) than parous participants. This effect was not observed among levonorgestrel intrauterine system users (adjusted HR 1.16, 95% CI 0.92-1.46). Age younger than 20 years was not associated with discontinuation at 12 months (adjusted HR 0.95, 95% CI 0.74-1.22).


CONCLUSIONS
We found that LARC continuation rates were high and similar across age and parity. Clinicians should not hesitate to recommend LARC methods to young nulliparous females owing to fear of early discontinuation.


METHODS
II.
Department of Obstetrics and Gynecology and Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Margaret
M
Abraham
Qiuhong
Q
Zhao
Jeffrey F
JF
Peipert
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D003267:Contraception / Q000706:statistics & numerical data*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007435:Intrauterine Devices, Copper / Q000706:statistics & numerical data*; D016912:Levonorgestrel / Q000008:administration & dosage*; D010298:Parity; D010349:Patient Compliance / Q000706:statistics & numerical data*; D055815:Young Adult
D003271:Contraceptive Agents, Female; D016912:Levonorgestrel