IUDs viable option for menstrual management in adolescents with disabilities

Intrauterine devices effectively manage menstrual pain and bleeding in adolescents with disabilities, according to research published in Pediatrics.

“Hormonal IUDs are a great option for women with disabilities, but patients, families and providers rarely consider them due to misconceptions about whether they are appropriate for use in this population,” Beth I. Schwartz, MD, of the department of obstetrics and gynecology at Thomas Jefferson University in Philadelphia, told Healio Primary Care. “Information from this study will hopefully raise awareness of the viability and safety of this option for both contraception and menstrual management in young women with disabilities.”

Although there many reasons why patients with disabilities and their families may request menstrual management, Schwartz said there is little published information about different treatment options.

Schwartz and colleagues completed a retrospective chart review of all nulliparous patients with physical, intellectual or developmental disabilities aged 22 years and younger who received levonorgestrel IUDs from July 2004 through June 2014. Participants presented at a single tertiary care children’s hospital.

A total of 159 patients with a mean age of 16.3 years were included in the study. Among them, 4% had been sexually active.

Schwartz and colleagues noted that most patients had previously tried at least one other menstrual management method, but this was the first method of menstrual management for 32% of the patients.

A total of 185 IUDs were placed in the participants, 96% of which were placed in an operating room. Of the IUDs placed in an operating room, 45% were placed at the time of another procedure, including dental, urologic and otolaryngologic procedures.

Twenty-six participants received two IUDs. Among them, 22 had a removal and replacement because they reached the full duration of IUD use at 5 years, two patients had a removal and replacement due to malposition, and two patients experienced IUD expulsions and wanted them replaced.

Schwartz and colleagues reported that the IUD continuation rate was 95% (95% CI; 93-100) at 1 year and 73% (95% CI; 66-83) at 5 years. Throughout the time of IUD use, the amenorrhea rate — when patients reported no current bleeding or spotting and no bleeding in the 3 months prior to a visit — was 60% in the 64 patients who had follow-up data available.

Among patients who had dysmenorrhea or pelvic pain before receiving IUD, 76% reported experiencing improvements at 1 year.

Schwartz said primary care physicians should “discuss IUDs as an option for menstrual management and contraception, in addition to other, better known options,” with adolescent patients with disabilities and their families.

She added that PCPs can use information from the study to advise them about the effectiveness of IUDs in reducing menstrual bleeding and pain along with the rarity of adverse events.

“These data can help dispel myths and misconceptions surrounding IUD use, especially in populations in which they have not traditionally been used, including younger women and those who have never been sexually active,” Schwartz said.