Reasons for selection, continuation and discontinuation of the levonorgestrel intrauterine system and the copper T380A IUD among adolescent participants in the CHOICE project
Awarded 2013
Complex Family Planning Fellowship Research
Elizabeth Schmidt, MD
The Washington University

Background: With less than 5% adolescents using IUDs, there is limited information on young women’s contraceptive decision making around choosing IUDs and their experiences with IUDs.  Prior qualitative studies have largely utilized in-depth interviews and centered around the time of pregnancy.  The purpose of this qualitative study is to explore why adolescents who were enrolled in the Contraceptive CHOICE Project chose an IUD and to examine experiences that led to continuation or discontinuation of the IUD.  
Purpose: To better understand why adolescents enrolled in the CHOICE Project chose an IUD, and to explore experiences with the device that led to selection, continuation or discontinuation of the levonorgestrel intrauterine system (LNG-IUS) and the copper T380A IUD (Copper IUD).  
Methods: We conducted focus groups with adolescents who had IUDs and divided the groups by what type of IUD and if they continued or discontinued their IUD.  Focus group information was then supplemented with one-on-one interviews. We collected data until no new ideas were brought up in focus groups. Transcripts were independently analyzed by two researchers and we compared the differences between the two researchers. 
Results: Thirteen focus groups and 7 in-depth interviews were conducted with 43 adolescents. Effectiveness, approved duration of use, and convenience emerged as dominant reasons for choosing and continuing IUDs. Themes involving bleeding changes were important with both the LNG-IUS and copper IUD users. Young women chose the LNG-IUS to achieve amenorrhea (or the cessation of having a period) while copper IUD users wanted to continue to have a period and a non-hormonal method of contraception.  Copper IUD users cited the IUD falling out and bleeding irregularities from the IUD as reasons for discontinuation, and LNG-IUS users found bleeding irregularities and continued pain a reason for device removal. IUD users noted an adjustment period of weeks to months in which side effects were present then lessened.
Conclusions: Effectiveness, duration of use, convenience, and bleeding changes drove adolescents’ choice and continuation of an IUD. Bleeding changes and pain contributed to IUD discontinuation.  Discussion of effectiveness, duration, convenience and anticipatory guidance regarding the adjustment period post-insertion may be important during counseling young women.