Addressing IUD Efficacy, Eligibility, Myths, and Satisfaction with Adolescents and Young Adults

  • Mandy S. ColesEmail author
  • Aisha Mays


While IUDs are incredibly safe and highly effective forms of birth control for all individuals, including adolescents and young adults, and have higher continuation rates compared to non-LARC methods, many medical providers still believe that they are inappropriate for use with adolescent and young patients. This lack of knowledge has the potential to negatively impact an adolescent’s or young adult’s reproductive autonomy. In addition, patients and families continue to have concerns around IUD safety based on myths of previous decades and complications from devices no longer available. This chapter will address some of the potential gaps in patient and provider knowledge, including a review of IUD efficacy and eligibility based on resources from the Center for Disease Control and Prevention, a list of resources for evidence-based guidelines, and a discussion of common IUD myths.


IUD Adolescent Young adult Efficacy Eligibility Myth Satisfaction Copper IUD Levonorgestrel IUD Safety 



American College of Obstetrics and Gynecology


Adolescents and Young Adults


Centers for Disease Control and Prevention


Intrauterine Device


Long-Acting Reversible Contraception




Medical Eligibility Criteria


Pelvic Inflammatory Disease


School-Based Health Center


Selected Practice Recommendations for Contraceptive Use


Sexually Transmitted Infection


  1. 1.
    Ott MA, Sucato GS. Committee on adolescence. Contraception for adolescents. Pediatrics. 2014;134:e1257–81.Google Scholar
  2. 2.
    Society for Adolescent Health and Medicine, Burke PJ, Coles MS, Di Meglio G, Gibson EJ, Handschin SM, et al. Sexual and reproductive health care: a position paper of the society for adolescent health and medicine. J Adolesc Health. 2014;54:491–6.Google Scholar
  3. 3.
    ACOG Committee Opinion No. 735: adolescents and long-acting reversible contraception: implants and intrauterine devices. Obstet Gynecol. 2018;131:e130–e139.Google Scholar
  4. 4.
    Contraceptive use in the United States. In: Guttmacher Institute [Internet]. Jul 2018 [cited 29 Nov 2018]. Available:
  5. 5.
    Luchowski AT, Anderson BL, Power ML, Raglan GB, Espey E, Schulkin J. Obstetrician-gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations. Contraception. 2014;89:572–7.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Tyler CP, Whiteman MK, Zapata LB, Curtis KM, Hillis SD, Marchbanks PA. Health care provider attitudes and practices related to intrauterine devices for nulliparous women. Obstet Gynecol. 2012;119:762–71.PubMedGoogle Scholar
  7. 7.
    Rubin SE, Davis K, McKee MD. New York city physicians’ views of providing long-acting reversible contraception to adolescents. Ann Fam Med. 2013;11:130–6.PubMedGoogle Scholar
  8. 8.
    Whitaker AK, Sisco KM, Tomlinson AN, Dude AM, Martins SL. Use of the intrauterine device among adolescent and young adult women in the United States from 2002 to 2010. J Adolesc Health. 2013;53:401–6.PubMedGoogle Scholar
  9. 9.
    Biggs MA, Kaller S, Harper CC, Freedman L, Mays AR. “Birth Control can Easily Take a Back Seat”: challenges providing IUDs in community health care settings. J Health Care Poor Underserved. 2018;29:228–44.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Schreiber CA, Barnhart K. In: Strauss JF, Jerome F, Strauss III, Barbieri RL, editors. Yen and Jaffe’s reproductive endocrinology. Philadelphia, PA. Elsevier Health Sciences; 2013.Google Scholar
  11. 11.
    Polis CB, Bradley SEK, Bankole A, Onda T, Croft T, Singh S. Typical-use contraceptive failure rates in 43 countries with Demographic and Health Survey data: summary of a detailed report. Contraception. 2016;94:11–7.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Jatlaoui TC, Riley HEM, Curtis KM. The safety of intrauterine devices among young women: a systematic review. Contraception. 2017;95:17–39.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Mohllajee AP, Curtis KM, Peterson HB. Does insertion and use of an intrauterine device increase the risk of pelvic inflammatory disease among women with sexually transmitted infection? A systematic review. Contraception. 2006;73:145–53.PubMedGoogle Scholar
  14. 14.
    Grimes DA. Intrauterine device and upper-genital-tract infection. Lancet. 2000;356:1013–9.Google Scholar
  15. 15.
    Curtis KM, Tepper NK, Jatlaoui TC, Berry-Bibee E, Horton LG, Zapata LB, et al. U.S. medical eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep. 2016;65:1–103.Google Scholar
  16. 16.
    CDC – Summary – USMEC – Reproductive Health [Internet]. 28 Sep 2017 [cited 30 Nov 2018]. Available:
  17. 17.
    World Health Organization, Reproductive Health and Research, World Health Organization, World Health Organization, Family and Community Health. Selected practice recommendations for contraceptive use. Geneva: World Health Organization; 2005.Google Scholar
  18. 18.
    CDC – Summary – USMEC – Reproductive Health [Internet]. 2 Nov 2018 [cited 6 Jan 2019]. Available:
  19. 19.
    Summary chart of U.S. medical eligibility criteria for contraceptive use. In: CDC [Internet]. [cited 1 Dec 2018]. Available:
  20. 20.
    CDC – Summary – US SPR – Reproductive Health [Internet]. 27 Sep 2017 [cited 30 Nov 2018]. Available:
  21. 21.
    Yen S, Saah T, Hillard PJA. IUDs and adolescents--an under-utilized opportunity for pregnancy prevention. J Pediatr Adolesc Gynecol. 2010;23:123–8.PubMedGoogle Scholar
  22. 22.
    Alton TM, Brock GN, Yang D, Wilking DA, Hertweck SP, Loveless MB. Retrospective review of intrauterine device in adolescent and young women. J Pediatr Adolesc Gynecol. 2012;25:195–200.Google Scholar
  23. 23.
    Hubacher D, Lara-Ricalde R, Taylor DJ, Guerra-Infante F, Guzmán-Rodríguez R. Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women. N Engl J Med. 2001;345:561–7.Google Scholar
  24. 24.
    Toivonen J, Luukkainen T, Allonen H. Protective effect of intrauterine release of levonorgestrel on pelvic infection: three years’ comparative experience of levonorgestrel- and copper-releasing intrauterine devices. Obstet Gynecol. 1991;77:261–4.Google Scholar
  25. 25.
    Ravi A, Prine L, Waltermaurer E, Miller N, Rubin SE. Intrauterine devices at six months: does patient age matter? Results from an urban family medicine federally qualified health center (FQHC) network. J Am Board Fam Med. 2014;27:822–30.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Aoun J, Dines VA, Stovall DW, Mete M, Nelson CB, Gomez-Lobo V. Effects of age, parity, and device type on complications and discontinuation of intrauterine devices. Obstet Gynecol. 2014;123:585–92.PubMedGoogle Scholar
  27. 27.
    Heinemann K, Reed S, Moehner S, Minh TD. Comparative contraceptive effectiveness of levonorgestrel-releasing and copper intrauterine devices: the European Active Surveillance Study for Intrauterine Devices. Contraception. 2015;91:280–3.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Ortiz ME, Croxatto HB. Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action. Contraception. 2007;75:S16–30.Google Scholar
  29. 29.
    Stanford JB, Mikolajczyk RT. Mechanisms of action of intrauterine devices: update and estimation of postfertilization effects. Am J Obstet Gynecol. 2002;187:1699–708.PubMedGoogle Scholar
  30. 30.
    Videla-Rivero L, Etchepareborda JJ, Kesseru E. Early chorionic activity in women bearing inert IUD, copper IUD and levonorgestrel-releasing IUD. Contraception. 1987;36:217–26.PubMedGoogle Scholar
  31. 31.
    Facts are important emergency contraception (EC) and intrauterine devices (IUDs) are not abortifacients. The American College of Obstetricians and Gynecologists [Internet]. Jun 2014 [cited 6 Jan 2019]. Available:
  32. 32.
    Fleming KL, Sokoloff A, Raine TR. Attitudes and beliefs about the intrauterine device among teenagers and young women. Contraception. 2010;82:178–82.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Kavanaugh ML, Frohwirth L, Jerman J, Popkin R, Ethier K. Long-acting reversible contraception for adolescents and young adults: patient and provider perspectives. J Pediatr Adolesc Gynecol. 2013;26:86–95.Google Scholar
  34. 34.
    Allen RH, Carey MS, Raker C, Goyal V, Matteson K. A prospective cohort study of pain with intrauterine device insertion among women with and without vaginal deliveries. J Obstet Gynaecol. 2014;34:263–7.PubMedGoogle Scholar
  35. 35.
    Akers AY, Harding J, Perriera LK, Schreiber C, Garcia-Espana JF, Sonalkar S. Satisfaction with the intrauterine device insertion procedure among adolescent and young adult women. Obstet Gynecol. 2018;131:1130–6.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Tracey I. Getting the pain you expect: mechanisms of placebo, nocebo and reappraisal effects in humans. Nat Med. 2010;16:1277–83.Google Scholar
  37. 37.
    Krauss BS. “This may hurt”: predictions in procedural disclosure may do harm. BMJ. 2015;350:h649.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Kavanaugh ML, Jerman J, Finer LB. Changes in use of long-acting reversible contraceptive methods among U.S. women, 2009–2012. Obstet Gynecol. 2015;126:917–27.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Secura GM, Allsworth JE, Madden T, Mullersman JL, Peipert JF. The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception. Am J Obstet Gynecol. 2010;203:115.e1–7.Google Scholar
  40. 40.
    Madden T, Mullersman JL, Omvig KJ, Secura GM, Peipert JF. Structured contraceptive counseling provided by the Contraceptive CHOICE Project. Contraception. 2013;88:243–9.PubMedGoogle Scholar
  41. 41.
    Mestad R, Secura G, Allsworth JE, Madden T, Zhao Q, Peipert JF. Acceptance of long-acting reversible contraceptive methods by adolescent participants in the Contraceptive CHOICE Project. Contraception. 2011;84:493–8.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Stanback J, Steiner M, Dorflinger L, Solo J, Cates W Jr. WHO tiered-effectiveness counseling is rights-based family planning. Glob Health Sci Pract. 2015;3:352–7.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Gilliam ML, Neustadt A, Whitaker A, Kozloski M. Familial, cultural and psychosocial influences of use of effective methods of contraception among Mexican-American adolescents and young adults. J Pediatr Adolesc Gynecol. 2011;24:79–84.PubMedGoogle Scholar
  44. 44.
    Kusunoki Y, Upchurch DM. Contraceptive method choice among youth in the United States: the importance of relationship context. Demography. 2011;48:1451–72.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Gomez AM, Fuentes L, Allina A. Women or LARC first? Reproductive autonomy and the promotion of long-acting reversible contraceptive methods. Perspect Sex Reprod Health. 2014;46:171–5.PubMedPubMedCentralGoogle Scholar
  46. 46.
    Diedrich JT, Zhao Q, Madden T, Secura GM, Peipert JF. Three-year continuation of reversible contraception. Am J Obstet Gynecol. 2015;213:662.e1–8.Google Scholar
  47. 47.
    Usinger KM, Gola SB, Weis M, Smaldone A. Intrauterine contraception continuation in adolescents and young women: a systematic review. J Pediatr Adolesc Gynecol. 2016;29:659–67.PubMedGoogle Scholar
  48. 48.
    Diedrich JT, Klein DA, Peipert JF. Long-acting reversible contraception in adolescents: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017;216:364.e1–364.e12.Google Scholar
  49. 49.
    Friedman JO. Factors associated with contraceptive satisfaction in adolescent women using the IUD. J Pediatr Adolesc Gynecol. 2015;28:38–42.PubMedGoogle Scholar
  50. 50.
    Schmidt EO, James A, Curran KM, Peipert JF, Madden T. Adolescent experiences with intrauterine devices: a qualitative study. J Adolesc Health. 2015;57:381–6.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Society for Adolescent Health and Medicine. Improving knowledge about, access to, and utilization of long-acting reversible contraception among adolescents and young adults. J Adolesc Health. 2017;60:472–4.Google Scholar
  52. 52.
    Gubrium AC, Mann ES, Borrero S, Dehlendorf C, Fields J, Geronimus AT, et al. Realizing reproductive health equity needs more than long-acting reversible contraception (LARC). Am J Public Health. 2016;106:18–9.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of PediatricsBoston University Medical CenterBostonUSA
  2. 2.UC Berkeley School of Public Health, UC Berkeley/UCSF Joint Medical ProgramBerkeleyUSA

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