Given that intrauterine devices (IUDs) are effective not just for contraception but also with bleeding and menstrual pain, it would seem they might be of great value for adolescents and young adults with intellectual, developmental, and physical disabilities. Schwartz et al (10.1542/peds.2020-0016) shares with us the results of a retrospective chart review of 159 patients with various types of disabilities who were nulliparous and between the ages of 9 and 22 (with mean age of 16.3 years) –all of whom received placement of an IUD containing levonorgestrel between 2004 and 2014. Levonorgestrel was chosen to avoid estrogens that can cause thrombosis and because it is a lower potency progestin so as not to result in increased bone density or additional weight gain. 4% of these patients were sexually active around the time of IUD placement. The placement usually occurred in the operating room in association with other procedures such as dental work under anesthesia. 95% of those who received an IUD continued it at 1 year after insertion, and 73% wished to continue with the use of an IUD at 5 years after initial insertion with minimal side effects and complications.
The study by Schwartz et al is an important one, not just because it shows the safety and benefits of IUDs in adolescents and young adults with disabilities, but also because it reminds us of three key principles to keep in mind when caring for these patients as highlighted in an accompanying commentary by Drs. Cynthia Robbins and Mary Ott, adolescent specialists from the Indiana University School of Medicine (10.1542/peds.2020-006296). Drs. Robbins and Ott point out three key themes that can be derived from the Schwartz et al study—1) the rights of disabled youth for being knowledgeable about their sexuality and reproductive health; 2) IUD use can be considered in weighing the benefits versus risks of menstrual problems such as heavy bleeding and dysmenorrhea that can disrupt activities of daily life; and (3) the ability to maximize autonomy and dignity through shared decision making in these patients being part of the discussion if able regarding whether or not to get an IUD.
There is a lot to learn and reflect upon in this interesting study and commentary so link to both and learn more.
