title: Incidence of Discontinuation of Long-Acting Reversible Contraception among Adolescent and Young Adult Women Served by an Urban Primary Care Clinic.
abstract: OBJECTIVE
  To estimate long-acting reversible contraception (LARC) discontinuation rates. Secondary aims were to determine risk factors for discontinuation, describe reasons for discontinuation, evaluate complications related to placement, and estimate pregnancy rates after discontinuation.
  
  
  METHODS
  We conducted a retrospective cohort study of LARC method use through review of electronic medical record data.
  
  
  METHODS
  Our program is housed in an academic primary care pediatric and adolescent clinic in Baltimore, Maryland.
  
  
  METHODS
  One hundred sixty women ages 12-24 years who received an intrauterine device or subdermal implant through our program between December 10, 2012 and December 10, 2015.
  
  
  METHODS
  None.
  
  
  METHODS
  Complications from LARC insertion, device discontinuation, reason(s) for discontinuation, pregnancies resulting from device failure, and occurrence of pregnancy within 1 year of discontinuation.
  
  
  RESULTS
  Thirty-five women discontinued their LARC method. The 6-month discontinuation rate was 11.3% and the 12-month rate was 21.9%. Discontinuation was associated with history of sexually transmitted infection (adjusted hazard ratio, 3.21; 95% confidence interval, 1.49-6.90). The most common reason for discontinuation was bleeding for the implant and expulsion for the intrauterine device.
  
  
  CONCLUSIONS
  Our results support the safety and low discontinuation rates of LARC provision to adolescents and young adult women in a primary care setting. Discontinuation rates and reasons are consistent with those described in other studies.
authors.affiliation: Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: kraisle1@jhmi.edu.
authors.forename: Katharine K
authors.initials: KK
authors.lastname: Sznajder
authors.affiliation: Section on Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Kathy S
authors.initials: KS
authors.lastname: Tomaszewski
authors.affiliation: Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Population, Family, and Reproductive Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Burke
authors.affiliation: Section on Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Population, Family, and Reproductive Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Maria
authors.initials: M
authors.lastname: Trent
mesh_terms: D000293:Adolescent; D015142:Baltimore; D002648:Child; D003267:Contraception / Q000379:methods / Q000706:statistics & numerical data*; D003271:Contraceptive Agents, Female; D004343:Drug Implants; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011247:Pregnancy; D018873:Pregnancy Rate; D049168:Pregnancy, Unplanned; D011320:Primary Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D019037:Urban Health Services / Q000706:statistics & numerical data; D014592:Uterine Hemorrhage / Q000209:etiology; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants
keywords: Adolescent; Contraception; LARC; Long-acting reversible contraception