番茄社区

Intrauterine devices (IUDs) were effective at managing menstrual cycles in young adults with physical, intellectual, or developmental disabilities, according to a retrospective study.

Of nearly 200 young women with such disabilities who had a levonorgestrel IUD placed, 96% continued use after 1 year, reported Beth Schwartz, MD, of Jefferson University Hospital in Philadelphia, and colleagues in .

About 60% of patients reported amenorrhea while using the device, defined as no bleeding for at least 3 months, and approximately 75% were still using their IUD at 5 years.

"This is a really effective method for young women with disabilities or other medical conditions," Schwartz told 番茄社区. "I think we are slowly taking down some of the barriers around who can and should use IUDs."

Schwartz, a gynecologist who specializes in adolescent care, said that many families of her patients with disabilities often come in prior to the start of puberty with concerns about managing period cramps, mood changes, or interactions between menstruation management and other comorbidities.

She explained that IUDs are a long-term menstrual management method, and hormonal effects are localized to the uterus, making the devices attractive to families and caregivers of adolescents in this group.

The American College of Obstetricians and Gynecologists has for menstrual management among adolescents with physical or intellectual disabilities. However, Schwartz said, high-quality data to support the recommendation were relatively sparse. Her group's study is the largest to investigate IUD use in adolescents with a physical, intellectual, or developmental disability.

Gabriela Aguilar, MD, a family planning specialist at the Yale School of Medicine in New Haven, Connecticut, who was not involved with the research, told 番茄社区, "IUDs are particularly safe for people with medical comorbidities, especially if they are taking multiple medications, as there isn't a systemic hormonal effect with the levonorgestrel IUDs."

For the study, the researchers conducted a retrospective chart review of successful IUD placements at Cincinnati Children's Hospital Medical Center between 2004 and 2014. All study participants were nulliparous, under age 22, and had a physical, cognitive, or developmental disability. If a participant had more than one IUD placement over the 10-year period of the study, each was counted separately.

Patients who had a previous pregnancy longer than 20 weeks, as well as those with uterine anomalies, were excluded, and unsuccessful IUD placements were not included in the analysis.

The team collected information on continuation and amenorrhea at each year of IUD use. All complications after the 6-week follow-up appointment were recorded.

There were 185 IUD placements occurring in 159 patients. Nearly all IUDs were placed in the operating room, many concurrent with other surgical procedures. Patients were an average 16 years old at the time of IUD placement; about 4% of participants were sexually active.

A total of 26 patients received two devices, the majority reaching the 5-year duration and getting a second device placement. In addition, 26 patients used their device off-label for longer than 5 years.

About 65% of patients reported less menstrual bleeding 1 year after placement, with only 7% reporting worse bleeding.

Side effects and complication rates were rare, with device malposition and expulsion at a combined rate of 5%, the investigators stated.

Study limitations, they noted, included that it was retrospective, with full 5-year follow-up data available for only about one-third of patients; in addition, the analysis did not include unsuccessful IUD placement attempts, which may also have skewed the findings.

"This should really open up people's eyes to [IUD use] being a viable and safe option, for both contraception and menstrual management in this population," Schwartz said, adding that she hopes more providers offer IUDs for menstrual management among youth with disabilities.

Aguilar, however, said further research around extended use of IUDs in this population is an important next step, as clinicians may place IUDs for up to 7 years in some patients.

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