“WHAT’S THE GIST OF A NEW FDA LABEL FOR THE LNG-IUS?” ANITA L. NELSON, MD, AND RAQUEL ARIAS, MD (FEBRUARY 2009)
Dr. Nelson and Dr. Arias did not mention the recent trend among some parents of requesting the levonorgestrel-releasing intrauterine system (LNG-IUS) for their young teenage daughters. I would appreciate their comments on use of this system in adolescents up to 18 years old. In my opinion, this group is at high risk of having multiple partners (who themselves have multiple partners) and, therefore, is more likely to contract a sexually transmitted disease (STD).
A recent report from the CDC revealed that, among women 15 to 25 years old, only 6.8% were tested for Chlamydia trachomatis during a routine visit.1 That percentage rose to 16% during a preventive visit, and to 23% during a visit for Pap testing. Clearly, most teenagers and young adults are not being tested at all.
What is the evidence for or against the LNG-IUS in this age group as it relates to pelvic infection?
Aly A.M. Gorrafa, MD, MS
- Hoover K, Tao G, Kent C. Low rates of both asymptomatic chlamydia screening and diagnostic testing of women in US outpatient clinics. Obstet Gynecol. 2008;112:891-898.
Dr. Nelson and Dr. Arias respond:
It is laudable that the parents are involved and want their children to have accurate information about their contraceptive options, but requests for contraception should be made by the adolescent women themselves. The most effective methods for sexually active women are the IUD and implant.
Dr. Gorrafa’s question about LNG-IUS use among teens is important. Nulliparity has never been a contraindication to IUD use in the United States. The IUD will not cause STD-related pelvic inflammatory disease or infertility. In their classic study, Hubacher et al found no increase in infertility among nulliparous women who used the copper IUD, compared with nonusers.1 However, infertility was associated with antibodies to Chlamydia trachomatis.
The point about inadequate screening of teens is well taken but should not preclude IUD use. The IUD does not cause the STD or increase the risk that a sexually transmitted cervical infection will ascend into the upper genital tract. Nor is it necessary to remove the IUD to treat salpingitis.