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Trends in oral contraceptive and intrauterine device use among reproductive-aged women in the US from 1999 to 2017

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Abstract

Purpose

Since the 1960s, increasing oral contraceptive (OC) use has mirrored decreasing ovarian cancer incidence. The impact of intrauterine devices (IUDs) on cancer risk is less well established. With improved access and increased options, we must consider how changing usage can affect cancer risks.

Methods

Nationally representative data from the National Health and Nutrition Examination Survey (NHANES, 1999–2016) and the National Survey for Family Growth (NSFG, 2006–2017) were used to evaluate contraceptive use over time in premenopausal women (NHANES n = 13,179; NSFG n = 26,262). Trends were assessed overall and by race, age, pregnancy history, education, and body mass index.

Results

The average annual absolute increase in self-reported IUD use was 0.81% (NSFG), while OC use decreased 0.49% in NSFG and 0.47% in NHANES. This represents a significant decrease in OC use in NSFG [annual percent change (APC) − 2.2% (95% CI − 3.4, − 1.0%), p < 0.01]. Trends in OC use varied somewhat by pregnancy history in NHANES (p-interaction = 0.054). In contrast, IUD use increased 6.2% annually [(1.4, 11.2%), p = 0.03] and varied significantly by pregnancy history (p-interaction < 0.01). Nulligravid women increased IUD use 11.0% annually [(2.6, 20.1%), p = 0.02] compared to women with prior pregnancy at 5.2% [(0.4, 10.2%), p = 0.04]. In 2015–2017, IUD use was 76.5% hormonal (71.1, 81.8%) and 22.9% copper (17.4, 28.3%) with greater hormonal IUD use in obese women [89.4%, (82.9, 95.9%)].

Conclusion

Increasing IUD use outpaced declining OC use in premenopausal US women. There may be a resulting decreased gynecologic cancer risk as more women gain access to potentially risk-reducing contraceptives.

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Acknowledgements

This research was made possible through the NIH Medical Research Scholars Program, a public–private partnership supported jointly by the NIH and contributions to the Foundation for the NIH from the Doris Duke Charitable Foundation, Genentech, the American Association for Dental Research, the Colgate-Palmolive Company, and other private donors.

Funding

This research was funded in part by the intramural research program of the National Cancer Institute, National Institutes of Health.

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Authors and Affiliations

  1. Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9774, USA

    Lauren A. King, Kara A. Michels, Barry I. Graubard & Britton Trabert

  2. University of Virginia School of Medicine, Charlottesville, VA, USA

    Lauren A. King

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  1. Lauren A. King
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  2. Kara A. Michels
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Contributions

LK contributed to conceptualization, methodology, formal analysis, investigation, resources, data curation, writing––original draft, writing––review and editing, and visualization. KM was involved in writing––review and editing. BG contributed to writing––review and editing, methodology, and resources. BT performed supervision, conceptualization, methodology, and writing––review and editing, funding acquisition.

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Correspondence to Lauren A. King.

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King, L.A., Michels, K.A., Graubard, B.I. et al. Trends in oral contraceptive and intrauterine device use among reproductive-aged women in the US from 1999 to 2017. Cancer Causes Control 32, 587–595 (2021). https://doi.org/10.1007/s10552-021-01410-8

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