Abstract
Introduction: High rates of unintended adolescent pregnancy in the United States (US) suggests the need for a highly effective, long acting, reversible contraception method that is safe for nulliparous women and adolescents. The American College of Obstetricians and Gynecologists (ACOG), American Academy of Pediatrics (AAP), and World Health Organization (WHO) have all released statements supporting the use of intrauterine devices (IUDs) as a safe and acceptable means of long acting, reversible contraception for women and adolescents. Despite this support, some health care providers are still resistant to recommend IUDs for use with adolescents and nulliparous women. Purpose: The purpose of this systematic literature review is to summarize and critically appraise the evidence surrounding the use of IUDs with nulliparous women and adolescents. Methods: A systematic, retrospective review of the literature pertaining to IUD use in adolescents, young women, and nulliparous women was performed. Results: The final sample consisted of 12 studies with publication dates from 1996-2014. Overall, IUD use in nulliparous and adolescents was not related to increased rates of uterine perforation, pregnancy, pelvic infections, or infertility. Age and parity was found in some studies to be associated with increased pain with insertion, IUD expulsion, pain after insertion, bleeding, and decreased IUD continuation rates. However, the association between age and parity and these potential IUD related side effects were not significant enough to discredit the use of these devices. Discussion: It is apparent that the use of IUDs with adolescents and nulliparous women is an effective, safe long-acting reversible contraceptive (LARC) option. Health care providers need to educate their adolescents and nulliparous women patients on the advantages of utilizing IUDs. Further research is warranted on potential prophylactic and symptomatic treatment which may decrease side effects associated with the use of IUDs with adolescents and nulliparous women.
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