Factors Predicting LARC Continuation in Adolescent/Young Adults vs. Adult Women

The primary aim of this study was to determine factors contributing to 12 month continuation of long-acting reversible contraception (LARC) methods in adolescent/young adult women compared to adult women. A retrospective observational study was conducted of 303 women with continuous health plan coverage in a managed care organization. Women were chosen randomly by proportional stratified sampling by age group (adolescent/young:15-24, adult:25-34) and LARC type (intrauterine: IUC vs. subdermal: SCI) inserted between 1/1/2007 and 12/31/2008. Demographic (age, race, marital status) and clinical factors (BMI, gravidity, parity, post-insertion counseling, method complications and side effects) that may have contributed to retention of LARC were included. Bivariate and multivariate analyses were used to compare retention differences stratified by LARC methods, age and race. Regardless of age, continuation at 12 months was significantly higher among IUC users compared to SCI users (83.7% vs. 69.3%, p=0.004). There was no significant difference between levonorgestrel IUC and copper-T IUC continuation (84.2% vs. 83.2%, p=0.85) between age groups. There were no significant differences in 12 month continuation of any LARC method by race, BMI, gravidity, parity or marital status. The greatest predictors of early removal of all LARC methods were bleeding (OR=2.9) or pain complaints (OR=3.0) during LARC method use. Complaints of bleeding or pain were the greatest predictors of early removal of LARC methods regardless of method type. Post-insertion counseling did not significantly affect LARC continuation regardless of age group or method type. IUC use by adolescent/young and adult women alike had higher continuation compared to SCI.