Levonorgestrel Intrauterine System Continuation in Adolescents and Adult Women [14N

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INTRODUCTION: Up to 60% of women elect to remove the levonorgestrel intrauterine system (LNG-IUS) prematurely for side effects (SEs). Removal rates may differ between adolescents and adult women. We investigated the effect of age on removal patterns in first time LNG-IUS users. METHODS: We retrospectively reviewed women ages 15–44 undergoing LNG-IUS placement for contraception at an academic tertiary care center from 2006–2009. Women with previous LNG-IUS were excluded. Continuation rates without removal for SEs were estimated using the Kaplan-Meier method. Associations with time to removal were evaluated using Cox models. RESULTS: Of 1,062 eligible women, 79% had follow-up. Of these, 24.7% requested removal for SEs, most commonly bleeding. At 1, 3, and 5 years post-insertion, continuation rates without removal for SEs were 87%, 76%, and 71%, respectively. Each 1-year increase in age was associated with a 3% decrease in removal risk for SEs (HR 0.97, P=.004). Adolescents ages 15–21 (n=60) were compared to adult women ages 22–44 (n=778). Thirty five percent of adolescents and 23.9% of adult women requested removal for SEs. Continuation rates without removal for SEs at t 1, 3, and 5 years were 82%, 66%, and 49%, respectively, for adolescents and 88%, 76%, and 72%, respectively, for adults. Adolescents were 69% more likely to request removal for SEs (HR 1.69; P=.02) and chose less reliable alternative contraception (P=.001). CONCLUSION: Adolescents request LNG-IUS removal for SEs more frequently than adult women, though the method is overall well accepted across all age groups. Understanding removal patterns and patient expectations helps guide contraceptive counseling.