TY - JOUR
T1 - Adolescent/Young Adult Long-Acting Reversible Contraception
T2 - Experience from a Multisite Adolescent Medicine Collaborative
AU - Pitts, Sarah
AU - Milliren, Carly E.
AU - Borzutzky, Claudia
AU - Maslyanskaya, Sofya
AU - Berg, Grace
AU - DiVasta, Amy D.
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2022/4
Y1 - 2022/4
N2 - Objective: To report on long-acting reversible contraception (LARC) experience and continuation rates in the Adolescent Medicine LARC Collaborative. Study design: LARC insertion data (682 implants and 681 intrauterine devices [IUDs]) were prospectively collected from January 1, 2017, through December 31, 2019, across 3 Adolescent Medicine practices. Follow-up data through December 31, 2020, were included to ensure at least 1 year of follow-up of this cohort. Continuation rates were calculated at 1, 2, and 3 years, overall and by Adolescent Medicine site, as were descriptive statistics for LARC procedural complications and patient experience. Results: Implant and IUD insertion complications were uncommon and largely self-limited, with no IUD-related uterine perforations. Uterine bleeding was the most frequently reported concern at follow-up (35% implant, 25% IUD), and a common reason for early device removal (45% of implant removals, 32% of IUD removals). IUD malposition or expulsion occurred following 6% of all insertions. The pooled implant continuation rate at 1 year was 87% (range, 86%-91% across sites; P =.63), 66% at 2 years (range, 62%-84%; P =.01), and 42% at 3 years (range, 36%-60%; P =.004). The pooled IUD continuation rate at 1 year was 88% (range, 87%-90% across sites; P =.82), 77% at 2 years (range, 76%-78%; P =.94), and 60% at 3 years (range, 57%-62%; P =.88). Conclusions: LARC is successfully provided in Adolescent Medicine clinical settings, with continuation rates analogous to those of well-resourced clinical trials. Uterine bleeding after LARC insertion is common, making counselling imperative. Future analyses will assess whether the medical management of LARC-related nuisance bleeding improves continuation rates in our Adolescent Medicine patient population.
AB - Objective: To report on long-acting reversible contraception (LARC) experience and continuation rates in the Adolescent Medicine LARC Collaborative. Study design: LARC insertion data (682 implants and 681 intrauterine devices [IUDs]) were prospectively collected from January 1, 2017, through December 31, 2019, across 3 Adolescent Medicine practices. Follow-up data through December 31, 2020, were included to ensure at least 1 year of follow-up of this cohort. Continuation rates were calculated at 1, 2, and 3 years, overall and by Adolescent Medicine site, as were descriptive statistics for LARC procedural complications and patient experience. Results: Implant and IUD insertion complications were uncommon and largely self-limited, with no IUD-related uterine perforations. Uterine bleeding was the most frequently reported concern at follow-up (35% implant, 25% IUD), and a common reason for early device removal (45% of implant removals, 32% of IUD removals). IUD malposition or expulsion occurred following 6% of all insertions. The pooled implant continuation rate at 1 year was 87% (range, 86%-91% across sites; P =.63), 66% at 2 years (range, 62%-84%; P =.01), and 42% at 3 years (range, 36%-60%; P =.004). The pooled IUD continuation rate at 1 year was 88% (range, 87%-90% across sites; P =.82), 77% at 2 years (range, 76%-78%; P =.94), and 60% at 3 years (range, 57%-62%; P =.88). Conclusions: LARC is successfully provided in Adolescent Medicine clinical settings, with continuation rates analogous to those of well-resourced clinical trials. Uterine bleeding after LARC insertion is common, making counselling imperative. Future analyses will assess whether the medical management of LARC-related nuisance bleeding improves continuation rates in our Adolescent Medicine patient population.
KW - IUD
KW - LARC
KW - birth control
KW - contraceptive implant
KW - intrauterine device
KW - menstrual management
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U2 - 10.1016/j.jpeds.2021.11.077
DO - 10.1016/j.jpeds.2021.11.077
M3 - Article
C2 - 34952007
AN - SCOPUS:85122921602
SN - 0022-3476
VL - 243
SP - 158
EP - 166
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -