Adolescent/Young Adult Long-Acting Reversible Contraception: Experience from a Multisite Adolescent Medicine Collaborative

Abstract

To report on long-acting reversible contraception (LARC) experience and continuation rates in the Adolescent Medicine LARC Collaborative. 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 1year of follow-up of this cohort. Continuation rates were calculated at 1, 2, and 3years, overall and by Adolescent Medicine site, as were descriptive statistics for LARC procedural complications and patient experience. 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 1year was 87% (range, 86%-91% across sites; P=.63), 66% at 2years (range, 62%-84%; P=.01), and 42% at 3years (range, 36%-60%; P=.004). The pooled IUD continuation rate at 1year was 88% (range, 87%-90% across sites; P=.82), 77% at 2years (range, 76%-78%; P=.94), and 60% at 3years (range, 57%-62%; P=.88). 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.