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Contraception for Adolescents: Focusing on Long-Acting Reversible Contraceptives (LARC) to Improve Reproductive Health Outcomes

  • Family Planning (A Burke, Section Editor)
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Abstract

Adolescent pregnancy rates in the USA have reached an all-time low from their peak in the 1980s and 1990s. However, the USA maintains the highest rate of teenage pregnancy among developed nations. Adolescents experience higher typical use failure rates for user-dependent contraceptives compared to their adult counterparts. Long-acting reversible contraception (LARC), intrauterine devices (IUDs), and implants have failure rates that are both very low and independent of user age. In settings where the most effective methods are prioritized and access barriers are removed, the majority of adolescents initiate LARC. Use of LARC by adolescents significantly reduces rates of overall and repeat teen pregnancy. All methods of contraception are safe for use in teens, including IUDs and depot medroxyprogesterone acetate (DMPA). Dual use of LARC and barrier methods to reduce risk of sexually transmitted infection is the optimal contraceptive strategy for most adolescents. Adolescent access to evidence-based and confidential contraceptive services, provided in a manner that respects autonomy, is a vital public health goal.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. O'Neil-Callahan M, Peipert JF, Zhao Q, et al. Twenty-four-month continuation of reversible contraception. Obstet Gynecol. 2013;122:1083–91. This study reports on the 24-month contraceptive continuation rates for women in the Contraceptive CHOICE trial. The authors found that 77% of women who initiated LARC methods were continuing use at 24 months, compared to 41% of users of short-term hormonal methods.

    Article  PubMed  Google Scholar 

  2. Raine TR, Foster-Rosales A, Upadhyay UD, et al. One-year contraceptive continuation and pregnancy in adolescent girls and women initiating hormonal contraceptives. Obstet Gynecol. 2011;117:363–71.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Darney P, Patel A, Rosen K, et al. Safety and efficacy of a single-rod etonogestrel implant (Implanon): results from 11 international clinical trials. Fertil Steril. 2009;91:1646–53.

    Article  PubMed  Google Scholar 

  4. Committee on Adolescent Health Care and the Long-Acting Reversible Contraception Work Group. Committee opinion no. 539: adolescents and long-acting reversible contraception: implants and intrauterine devices. Obstet Gynecol. 2012;120:983–8.

  5. Committee on Adolescence. Contraception for adolescents. Pediatrics. 2014;134:e1244–56.

  6. Kost K, Henshaw S, Carlin L. U.S. Teenage Pregnancies, Births and Abortions: National and State Trends and Trends by Race and Ethnicity. New York: Guttmacher Institute; 2010 [cited 2012 December 25, 2012]. Available from: http://www.guttmacher.org/pubs/USTPtrends.pdf.

  7. Counting It Up: The Public Costs of Teen Childbearing. Washington DC2012 [cited 2014 October 12, 2014]. Available from: http://www.thenationalcampaign.org/costs/default.aspx.

  8. Finer LB, Jerman J, Kavanaugh ML. Changes in use of long-acting contraceptive methods in the United States, 2007-2009. Fertil Steril. 2012;98:893–7. This study used data from the National Survey of Family Growth to evaluate the timing of sexual initiation and contraceptive use among U.S. adolescents. The authors determined that, whereas sexual activity is rare (and often nonconsensual) in early adolescents, the majority of adolescents aged 17-19 are sexually active. While contraceptive uptake among teens 15 and older is similar to that of adult women, females who initiate sexual activity at age 14 or younger are less likely to use a contraceptive method at first sex and take longer to initiate a contraceptive method.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Hatcher R, Trussell J, Nelson A, et al. Contraceptive Techology: Twentieth Revised Edition. New York, NY: Ardent Media; 2011.

  10. Peipert JF, Zhao Q, Allsworth JE, et al. Continuation and satisfaction of reversible contraception. Obstet Gynecol. 2011;117:1105–13.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Darney P, Patel A, Rosen K. Safety and efficacy of a single-rod etonogestrel implant (Implanon): results from 11 international clinical trials. Fertil Steril. 2009;91:1646.

    Article  PubMed  Google Scholar 

  12. Pongsatha S, Ekmahachai M, Suntornlimsiri N, et al. Bone mineral density in women using the subdermal contraceptive implant Implanon for at least 2 years. Int J Gynaecol Obstet: Off Organ Int Fed Gynaecol Obstet. 2010;109:223–5.

    Article  CAS  Google Scholar 

  13. Lopez LM, Grimes DA, Schulz KF, et al. Steroidal contraceptives: effect on bone fractures in women. Cochrane Database Syst Rev. 2014;6:CD006033.

    PubMed  Google Scholar 

  14. Rosenstock JR, Peipert JF, Madden T, et al. Continuation of reversible contraception in teenagers and young women. Obstet Gynecol. 2012;120:1298–305. This study compared contraceptive continuation rates of women in the Contraceptive CHOICE Project based on age. The authors noted that teenagers and adult women had similarly high continuation rates of LARC methods, but that adolescents had lower continuation rates of non-LARC methods than women over age 25.

    PubMed Central  PubMed  Google Scholar 

  15. Hubacher D, Lara-Ricalde R, Taylor DJ, et al. Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women. N Engl J Med. 2001;345:561–7.

    Article  CAS  PubMed  Google Scholar 

  16. Hov GG, Skjeldestad FE, Hilstad T. Use of IUD and subsequent fertility—follow-up after participation in a randomized clinical trial. Contraception. 2007;75:88–92.

    Article  PubMed  Google Scholar 

  17. Farley TM, Rosenberg MJ, Rowe PJ, et al. Intrauterine devices and pelvic inflammatory disease: an international perspective. Lancet. 1992;339:785–8.

    Article  CAS  PubMed  Google Scholar 

  18. Grimes DA. Intrauterine device and upper-genital-tract infection. Lancet. 2000;356:1013–9.

    Article  CAS  PubMed  Google Scholar 

  19. Mohllajee AP, Curtis KM, Peterson HB. Does insertion and use of an intrauterine device increase the risk of pelvic inflammatory disease among women with sexually transmitted infection? A systematic review. Contraception. 2006;73:145–53.

    Article  PubMed  Google Scholar 

  20. US Selected Practice Recommendations for Contraceptive Use, Adapted from the World Health Organization Selected Practice Recommendations for Contraceptive Use, 2nd Edition. Morbidity and Mortality Weekly Report [serial on the Internet]. 2013. Available from: http://www.cdc.gov/mmwr/pdf/rr/rr62e0614.pdf.

  21. Allen RH, Carey MS, Raker C, et al. A prospective cohort study of pain with intrauterine device insertion among women with and without vaginal deliveries. J Obstet Gynaecol : J Inst Obstet Gynaecol. 2014;34:263–7.

    Article  CAS  Google Scholar 

  22. Edelman AB, Schaefer E, Olson A, et al. Effects of prophylactic misoprostol administration prior to intrauterine device insertion in nulliparous women. Contraception. 2011;84:234–9.

    Article  CAS  PubMed  Google Scholar 

  23. Heikinheimo O, Inki P, Kunz M, et al. Double-blind, randomized, placebo-controlled study on the effect of misoprostol on ease of consecutive insertion of the levonorgestrel-releasing intrauterine system. Contraception. 2010;81:481–6.

    Article  CAS  PubMed  Google Scholar 

  24. Swenson C, Turok DK, Ward K, et al. Self-administered misoprostol or placebo before intrauterine device insertion in nulliparous women: a randomized controlled trial. Obstet Gynecol. 2012;120:341–7.

    Article  CAS  PubMed  Google Scholar 

  25. Allen RH, Bartz D, Grimes DA, et al. Interventions for pain with intrauterine device insertion. Cochrane Database Syst Rev. 2009;(3):CD007373. doi:10.1002/14651858.CD007373.pub2.

  26. Pergialiotis V, Vlachos DG, Protopappas A, et al. Analgesic options for placement of an intrauterine contraceptive: a meta-analysis. Eur J Contracept Reprod Health Care : Off J Eur Soc Contracept. 2014;19:149–60.

    Article  CAS  Google Scholar 

  27. Micks EA, Jensen JT, Bednarek PH. The effect of nitroglycerin on the IUD insertion experience in nulliparous women: a pilot study. Contraception. 2014;90:60–5.

    Article  CAS  PubMed  Google Scholar 

  28. Rapkin RB, Achilles SL, Boraas C, et al. Self-administered lidocaine gel for intrauterine device insertion in nulliparous women: a randomized controlled trial. Obstet Gynecol. 2014;123 Suppl 1:110S.

    Article  PubMed  Google Scholar 

  29. Allen RH, Raker C, Goyal V. Higher dose cervical 2% lidocaine gel for IUD insertion: a randomized controlled trial. Contraception. 2013;88:730–6.

    Article  CAS  PubMed  Google Scholar 

  30. Nelson AL, Fong JK. Intrauterine infusion of lidocaine does not reduce pain scores during IUD insertion. Contraception. 2013;88:37–40.

    Article  CAS  PubMed  Google Scholar 

  31. Aoun J, Dines VA, Stovall DW, et al. Effects of age, parity, and device type on complications and discontinuation of intrauterine devices. Obstet Gynecol. 2014;123:585–92. This study describes a retrospective chart review evaluating IUD outcomes in relation to patient age, parity, and IUD type. The authors found no significant relationship between age and rates of expulsion, pregnancy, or pelvic inflammatory disease. Adolescents and young women were more likely to request early IUD discontinuation than their older counterparts. Copper IUD users were more likely to experience expulsion and contraceptive failure than women using levonorgestrel IUDs.

    Article  PubMed  Google Scholar 

  32. Nelson A, Apter D, Hauck B, et al. Two low-dose levonorgestrel intrauterine contraceptive systems: a randomized controlled trial. Obstet Gynecol. 2013;122:1205–13.

    Article  CAS  PubMed  Google Scholar 

  33. Sivin I, el Mahgoub S, McCarthy T, et al. Long-term contraception with the levonorgestrel 20 mcg/day (LNg 20) and the copper T 380Ag intrauterine devices: a five-year randomized study. Contraception. 1990;42:361–78.

    Article  CAS  PubMed  Google Scholar 

  34. Madden T, McNicholas C, Zhao Q, et al. Association of age and parity with intrauterine device expulsion. Obstet Gynecol. 2014;124:718–26. This study describes a planned secondary analysis of Contraceptive CHOICE Project data evaluating the effects of age and parity on IUD expulsion rates. The authors found that the rate of expulsion was lower among nulliparous women than parous women, but slightly higher among women aged 14-19 than among older women.

    Article  PubMed  Google Scholar 

  35. Gemzell-Danielsson K, Schellschmidt I, Apter D. A randomized, phase II study describing the efficacy, bleeding profile, and safety of two low-dose levonorgestrel-releasing intrauterine contraceptive systems and Mirena. Fertil Steril. 2012;97(3):616–22.e1–3.

  36. Gemzell-Danielsson K, Buhling K, Lukkari-Lax E, et al. A multicenter, open-label, single arm study exploring the safety of a new 13.5 mg total dose levonorgestrel intrauterine contraceptive system in postmenarcheal adolescents. Fertil Steril. 2014;102:e12–3.

    Article  Google Scholar 

  37. Secura GM, Madden T, McNicholas C, et al. Provision of no-cost, long-acting contraception and teenage pregnancy. N Engl J Med. 2014;371:1316–23.

    Article  CAS  PubMed  Google Scholar 

  38. Winner B, Peipert JF, Zhao Q, et al. Effectiveness of long-acting reversible contraception. N Engl J Med. 2012;366:1998–2007. This study describes a large prospective cohort of women offered all methods of reversible contraception at no cost. They documented a high uptake of LARC methods when evidence based counseling was provided. The authors noted contraceptive failure for those selecting a pill, patch, or ring was significantly higher than those selecting LARC.

    Article  CAS  PubMed  Google Scholar 

  39. Martinez G, Copen CE, Abma JC. Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2006–2010 national survey of family growth. Vital Health Stat 23. 2011;(31):1–35

  40. Reece M, Herbenick D, Schick V, et al. Condom use rates in a national probability sample of males and females ages 14 to 94 in the United States. J Sex Med. 2010;7 Suppl 5:266–76.

    Article  PubMed  Google Scholar 

  41. Trussell J. Contraceptive failure in the United States. Contraception. 2011;83:397–404.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Manlove J, Welti K, Barry M, et al. Relationship characteristics and contraceptive use among young adults. Perspect Sex Reprod Health. 2011;43:119–28.

    Article  PubMed  Google Scholar 

  43. Bastow B, Sheeder J, Teal S. Do adolescents who initiate LARC use condoms with new partners? Contraception. 2014;90:296. This prospective cohort study compared rates of condom use among women using LARC and women using short-term hormonal methods. LARC users were less likely to use condoms with new partners and more likely to decrease condom use over 6 months than women using short-term hormonal methods.

    Article  Google Scholar 

  44. Peipert JF, Zhao Q, Meints L, et al. Adherence to dual-method contraceptive use. Contraception. 2011;84:252–8.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Toivonen J, Luukkainen T, Allonen H. Protective effect of intrauterine release of levonorgestrel on pelvic infection: three years' comparative experience of levonorgestrel- and copper-releasing intrauterine devices. Obstet Gynecol. 1991;77:261–4.

    Article  CAS  PubMed  Google Scholar 

  46. Walsh T, Grimes D, Frezieres R, et al. Randomised controlled trial of prophylactic antibiotics before insertion of intrauterine devices. IUD Study Group. Lancet. 1998;351:1005–8.

    Article  CAS  PubMed  Google Scholar 

  47. Boardman LA, Allsworth J, Phipps MG, et al. Risk factors for unintended versus intended rapid repeat pregnancies among adolescents. J Adolesc Health. 2006;39(4):597.e1–8.

  48. Furstenberg Jr FF, Brooks-Gunn J, Morgan SP. Adolescent mothers and their children in later life. Fam Plan Perspect. 1987;19:142–51.

    Article  Google Scholar 

  49. Farr S, Folger SG, Paulen M, et al. U S. Medical Eligibility Criteria for Contraceptive Use, 2010: adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th edition. MMWR Recomm Rep. 2010;59:1–86.

    Google Scholar 

  50. Kapp N, Curtis KM. Intrauterine device insertion during the postpartum period: a systematic review. Contraception. 2009;80:327–36.

    Article  PubMed  Google Scholar 

  51. Hayes JL, Cwiak C, Goedken P, et al. A pilot clinical trial of ultrasound-guided postplacental insertion of a levonorgestrel intrauterine device. Contraception. 2007;76:292–6.

    Article  CAS  PubMed  Google Scholar 

  52. Chen BA, Reeves MF, Hayes JL, et al. Postplacental or delayed insertion of the levonorgestrel intrauterine device after vaginal delivery: a randomized controlled trial. Obstet Gynecol. 2010;116:1079–87.

    Article  PubMed Central  PubMed  Google Scholar 

  53. Dahlke JD, Terpstra ER, Ramseyer AM, et al. Postpartum insertion of levonorgestrel—intrauterine system at three time periods: a prospective randomized pilot study. Contraception. 2011;84:244–8.

    Article  CAS  PubMed  Google Scholar 

  54. Tocce K, Sheeder J, Python J, et al. Long acting reversible contraception in postpartum adolescents: early initiation of etonogestrel implant is superior to IUDs in the outpatient setting. J Pediatr Adolesc Gynecol. 2012;25:59–63.

    Article  CAS  PubMed  Google Scholar 

  55. Harper CC, Blum M, de Bocanegra HT, et al. Challenges in translating evidence to practice: the provision of intrauterine contraception. Obstet Gynecol. 2008;111:1359–69.

    Article  PubMed  Google Scholar 

  56. Biggs MA, Harper CC, Malvin J, et al. Factors influencing the provision of long-acting reversible contraception in California. Obstet Gynecol. 2014;123:593–602.

    Article  CAS  PubMed  Google Scholar 

  57. Madden T, Allsworth JE, Hladky KJ, et al. Intrauterine contraception in Saint Louis: a survey of obstetrician and gynecologists' knowledge and attitudes. Contraception. 2010;81:112–6.

    Article  PubMed Central  PubMed  Google Scholar 

  58. Tyler CP, Whiteman MK, Zapata LB, et al. Health care provider attitudes and practices related to intrauterine devices for nulliparous women. Obstet Gynecol. 2012;119:762–71.

    Article  PubMed  Google Scholar 

  59. Fleming KL, Sokoloff A, Raine TR. Attitudes and beliefs about the intrauterine device among teenagers and young women. Contraception. 2010;82:178–82.

    Article  PubMed Central  PubMed  Google Scholar 

  60. Stanwood NL, Bradley KA. Young pregnant women's knowledge of modern intrauterine devices. Obstet Gynecol. 2006;108:1417–22.

    Article  PubMed  Google Scholar 

  61. Barrett M, Soon R, Whitaker AK, et al. Awareness and knowledge of the intrauterine device in adolescents. J Pediatr Adolesc Gynecol. 2012;25:39–42.

    Article  PubMed  Google Scholar 

  62. Kaye K, Suellentrop K, Sloup C. The Fog Zone: how misperceptions, magical thinking, and ambivalence put young adults at risk for unplanned pregnancy. Washington, DC: The National Campaign to Prevent Teen and Unplanned Pregnancy; 2009.

    Google Scholar 

  63. Weiss E, Moore K. An assessment of the quality of information available on the internet about the IUD and the potential impact on contraceptive choices. Contraception. 2003;68:359–64.

    Article  PubMed  Google Scholar 

  64. Trussell J. Contraceptive failure in the United States. Contraception. 2004;70:89–96.

    Article  PubMed  Google Scholar 

  65. Committee on Adolescent Health Care, Committee on Gynecologic Practice. Committee Opinion No. 602: Depot medroxyprogesterone acetate and bone effects. Obstet Gynecol. 2014;123:1398–402.

  66. Bonny AE, Harkness LS, Cromer BA. Depot medroxyprogesterone acetate: implications for weight status and bone mineral density in the adolescent female. Adolesc Med Clin. 2005;16:569–84.

    Article  PubMed  Google Scholar 

  67. Bonny AE, Secic M, Cromer B. Early weight gain related to later weight gain in adolescents on depot medroxyprogesterone acetate. Obstet Gynecol. 2011;117:793–7.

    Article  PubMed Central  PubMed  Google Scholar 

  68. Le YC, Rahman M, Berenson AB. Early weight gain predicting later weight gain among depot medroxyprogesterone acetate users. Obstet Gynecol. 2009;114:279–84.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  69. Mosher WD, Jones J. Use of contraception in the United States: 1982-2008. Vital Health Stat 23. 2010;(29):1-44

  70. Brenner PF, Mishell Jr DR, Stanczyk FZ, et al. Serum levels of d-norgestrel, luteinizing hormone, follicle-stimulating hormone, estradiol, and progesterone in women during and following ingestion of combination oral contraceptives containing dl-norgestrel. Am J Obstet Gynecol. 1977;129:133–40.

    CAS  PubMed  Google Scholar 

  71. Meyer JL, Gold MA, Haggerty CL. Advance provision of emergency contraception among adolescent and young adult women: a systematic review of literature. J Pediatr Adolesc Gynecol. 2011;24:2–9.

    Article  PubMed  Google Scholar 

  72. Secura GM, Allsworth JE, Madden T, et al. The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception. Am J Obstet Gynecol. 2010;203:115e1–e7.

    Article  Google Scholar 

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Bliss Kaneshiro reports royalties for commissioned articles from Uptodate. Jennifer Salcedo declares that she has no conflict of interest.

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  1. Department of Obstetrics, Gynecology and Women’s Health, University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street #824, Honolulu, HI, 96826, USA

    Bliss Kaneshiro & Jennifer Salcedo

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Correspondence to Bliss Kaneshiro.

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Kaneshiro, B., Salcedo, J. Contraception for Adolescents: Focusing on Long-Acting Reversible Contraceptives (LARC) to Improve Reproductive Health Outcomes. Curr Obstet Gynecol Rep 4, 53–60 (2015). https://doi.org/10.1007/s13669-015-0112-4

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