Dr Savita Brito-Mutunayagam helps dispel the myth that a nulliparous teenager should not have an intrauterine method of contraception

Contraception Mythbusters - The CEU aims to help dispel myths around contraception that may act as a barrier to best practice. This month, the focus is on intrauterine contraception.

MYTH: A nulliparous teenager should not have an intrauterine method of contraception

Evidence
Misconceptions about the risks of intrauterine contraception (IUC) and difficulties with insertion in young and/or nulliparous women are barriers to provision and uptake of this method. Clinicians should discuss all methods of contraception with young women, highlighting the benefits of long-acting reversible contraception including IUC.

The UKMEC suggests the advantages of using IUC in women under the age of 20 years generally outweigh any theoretical or proven risks providing there are no other factors that would affect use (UKMEC 2).1 It further states that nulliparity is condition for which there is no restriction for the use of IUC.1

There is a growing body of evidence in the professional literature that would support IUC use in adolescents. One recent study of 304 adolescents aged 12–18 years requesting the 13.5 mg levonorgestrel intrauterine system (LNG-IUS) reported successful insertion in all but one case. The procedure was well tolerated.2 A 2016 review of eight observational studies and one RCT evaluating continuation rates for IUC in women aged 25 years and younger found that 12-month continuation rates of IUC were significantly higher than continuation rates for non-LARC methods (p=0.001).3 A retrospective case review of emergency copper intrauterine device (Cu-IUD) use in 103 women aged 13–19 years found that the vast majority of insertions were straightforward; 96 insertions were rated as ‘easy’ or ‘average’ and only one insertion failed.4

Furthermore, current evidence suggests that serious complications following insertion of IUC occurred in less than 1% of women regardless of age.5

Young people should be fully counselled on the benefits and risks of the different options and fully informed about the insertion procedure.6

The IUC options available include:

• 52mg LNG-IUS (Mirena®, Levosert®) 
• 13.5mg LNG-IUS (Jaydess®) 
• Cu-IUDs

FACT: There should be no restrictions on provision of any type of IUC based on age or parity alone.

References
1 Faculty of Sexual & Reproductive Healthcare. UK Medical Eligibility Criteria For Contraceptive Use. Clinical Effectiveness Unit. 2016. Available at: https://www.fsrh.org/standards-and-guidance/documents/ukmec-2016/ (Accessed: 14/04/17)
2 Gemzell-Danielsson K, Buhling KJ, Dermout SM, et al. A Phase III, single-arm study of LNG-IUS 8, a low-dose levonorgestrel intrauterine contraceptive system (total content 13.5mg) in postmenarcheal adolescents. Contraception 2016;93:507–512.
3 Usinger KM, Gola SB, Weis M, et al. Intrauterine contraception continuation in adolescents and young women: a systematic review. J Pediatr Adolesc Gynecol 2016;6:659–667.
4 Akintomide H, Vinayagam S, Schünmann C. Emergency intrauterine device insertion in teenagers: an informal retrospective study. J Fam Plann Reprod Health Care 2014;40:196–199.
5 Berenson AB, Tan A, Hirth JM, et al. Complications and continuation of intrauterine device use among commercially insured teenagers. Obstet Gynecol 2013; 121: 951–958
6 Faculty of Sexual & Reproductive Healthcare. Contraceptive Choices for Young People. Clinical Effectiveness Unit. March 2010. Available at: https://www.fsrh.org/standards-and-guidance/documents/cec-ceu-guidance-young-people-mar-2010/ (Accessed: 14/04/17)