title: Intrauterine Contraception Continuation in Adolescents and Young Women: A Systematic Review.
abstract: OBJECTIVE
  Adolescents are at high risk for unintended pregnancies. Although intrauterine devices (IUDs), long-acting reversible contraceptives (LARCs), are known to be highly effective in preventing pregnancy, little is known about IUD adherence in adolescents. In this systematic review (SR) we examined IUD continuation rates compared with other forms of contraception in young women aged 25 years and younger. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A systematic search of Ovid Medline, Cochrane Library, and Embase was conducted for the years 1946-2015. Included studies examined IUD use in women 25 years of age and younger, compared IUD use with another form of contraception, and measured continuation rates at 12 months. The quality of each study was appraised using the Downs and Black criteria, and 12-month continuation rates among studies were pooled and analyzed according to contraceptive type.
  
  
  RESULTS
  Of 3597 articles retrieved, 9 studies met criteria for SR. Synthesized across studies, 12-month continuation was significantly higher for IUD users (86.5%, 12,761/14,747) compared with oral contraceptives (39.6%, 1931/4873), Depo-Provera (Pfizer Inc, New York, NY) hormonal injection (39.8%, 510/1282), vaginal ring (48.9%, 196/401), and transdermal patch (39.8%, 37/93; all P values < .001). There was no statistically significant difference in 12-month continuation between the IUD and another LARC method, the subdermal etonogestrel implant (85.3%, 4671/5474).
  
  
  CONCLUSIONS
  Findings of this SR suggest that continuation rates for IUDs are generally higher compared with other contraceptive methods for women aged 25 years and younger. In a population with high rates of unintended pregnancies, generally low adherence, and imperfect use with other non-LARCs, IUD use should be encouraged.
authors.affiliation: Columbia University School of Nursing, New York, New York.
authors.forename: K M
authors.initials: KM
authors.lastname: Usinger
authors.affiliation: Columbia University School of Nursing, New York, New York.
authors.forename: S B
authors.initials: SB
authors.lastname: Gola
authors.affiliation: Columbia University School of Nursing, New York, New York.
authors.forename: M
authors.initials: M
authors.lastname: Weis
authors.affiliation: Columbia University School of Nursing, New York, New York. Electronic address: ams130@cumc.columbia.edu.
authors.forename: A
authors.initials: A
authors.lastname: Smaldone
mesh_terms: D000293:Adolescent; D000328:Adult; D003267:Contraception / Q000379:methods*; D003268:Contraception Behavior; D003271:Contraceptive Agents, Female / Q000627:therapeutic use; D003274:Contraceptive Devices, Female / Q000706:statistics & numerical data; D003276:Contraceptives, Oral / Q000627:therapeutic use; D017135:Desogestrel / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007434:Intrauterine Devices / Q000706:statistics & numerical data*; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D013997:Time Factors; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D003276:Contraceptives, Oral; C044815:etonogestrel; D017135:Desogestrel; D017258:Medroxyprogesterone Acetate
keywords: Adolescent; Compliance; Continuation; Contraception; IUD; Young women