Original article
Adolescent Experiences With Intrauterine Devices: A Qualitative Study

https://doi.org/10.1016/j.jadohealth.2015.05.001Get rights and content

Abstract

Purpose

The purpose of this study was to improve understanding of adolescents' reasons for choosing an intrauterine device (IUD) and to explore experiences that led to continuation or discontinuation of the levonorgestrel intrauterine system (LNG-IUS) and the copper IUD (copper IUD).

Methods

We conducted focus groups (FGs) with adolescents and young women who were current or former IUD users stratified by IUD type and 12-month IUD continuation or discontinuation. All subjects were participants from the Contraceptive CHOICE Project. FG data were supplemented with in-depth interviews (IDIs). Data collection was continued until thematic saturation was reached. Transcripts were independently coded by two researchers, and interrater reliability was calculated using a Kappa coefficient. Analysis followed a standard text-analysis approach.

Results

Thirteen FGs and seven IDIs were conducted with 43 young women. Effectiveness, duration of use, convenience, and potential bleeding changes emerged as themes for both choosing and continuing IUDs. Some women chose the LNG-IUS to achieve amenorrhea, whereas copper IUD users wanted a nonhormonal method and continued menses. Copper IUD users cited expulsion and bleeding irregularities as reasons for discontinuation, whereas LNG-IUS users reported bleeding irregularities and continued pain as reasons for removal. IUD users noted an adjustment period of weeks to months in which side effects were present before lessening.

Conclusions

Effectiveness, duration of use, convenience, and potential changes in bleeding patterns drove adolescents' choice and continuation of an IUD. Bleeding changes and pain contributed to IUD discontinuation. Discussion of effectiveness, duration and convenience, and anticipatory guidance regarding post-insertion side effects may be important in counseling young women about IUDs.

Section snippets

Participants

We conducted a qualitative study utilizing focus groups (FGs) and in-depth interviews (IDIs) with young women enrolled in the Contraceptive CHOICE Project (CHOICE) who chose an IUD as an adolescent. CHOICE was a prospective cohort study in St. Louis, Missouri of 9,256 women designed to (1) promote the use of LARC; (2) remove financial barriers to contraception; (3) evaluate continuation and satisfaction for reversible methods; and (4) reduce unintended pregnancies in the region [19].

Potential

Results

We conducted 13 FGs with a total of 36 participants. Because of difficulty in recruiting copper IUD users and low show-rates for scheduled FGs, FGs were supplemented with seven IDIs for a total sample size of 43 participants. We conducted all FGs and IDIs between September 2013 and February 2014. We screened 112 young women of which 43 agreed to participate; 69 young women who did not participate failed to show up to their group or interview. The stratified groups were comprised 14 LNG-IUS

Discussion

In this qualitative study, we found that effectiveness, duration, and convenience were important reasons for adolescents selecting an IUD. Participants reported wanting a low-maintenance, highly effective, and long-lasting method. When choosing between an IUD and other methods of contraception, many young women in our study desired contraception that will last several years. We also found that changes in bleeding patterns may be perceived as an advantage of the LNG-IUS.

Changes in bleeding

Funding Sources

This study was supported by the Society of Family Planning Research Fund SFP13-20, award number K23HD070979 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Washington University Institute of Clinical and Translational Sciences grants UL1 TR000448 and TL1 TR000449 from the National Center for Advancing Translational Sciences, the Barnes-Jewish Foundation at Washington University, and the Siteman Cancer Center.

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Conflicts of Interest: J.P. serves on advisory boards for TEVA, Merck, Activis, and MicroChips. He receives research funding from Merck, Teva, and Bayer. T.M. serves on an advisory board for Bayer Healthcare Pharmaceuticals.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official view of National Institute of Child Health and Human Development or NIH.

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