24:291. 6. Contraceptive Use, Pregnancy Testing and Intimate Partner ... emergency contraception are not uncommon methods of contraception among these ...
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intervention made no impact, alternative strategies should be explored.
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7. Knowledge of and Experiences With Emergency Contraception Among Canadian Adolescent Females
Reference 1. Turnbull K, Nguyen LN, Jamieson MA, Palerme S: Seasonal Trends in Adolescent Pregnancy Conception Rates. J Pediatr Adolesc Gynecol 2011; 24:291. 6. Contraceptive Use, Pregnancy Testing and Intimate Partner Violence Among Adolescent and Young Adult Women Ages 16-24 1
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Heather L. McCauley ScD , Jay G. Silverman PhD , Michele R. Decker ScD , Gina Sucato MD 1, Elizabeth Miller MD, PhD 1 1 Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA 2 UC San Diego School of Medicine, La Jolla, CA, USA 3 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Purpose: Intimate partner violence (IPV) is common among adolescent and young adult women utilizing family planning clinics and is associated with inconsistent use of contraception. We surveyed such clients to examine associations of IPV with contraceptive method choice, patterns of repeated pregnancy testing, and emergency contraceptive (EC) use in order to understand whether contraceptive method and care seeking patterns may be risk markers for histories of IPV. Methods: A cross-sectional survey was administered to adolescent and young adult women seeking care at five family planning clinics in Northern California. Analyses were restricted to 965 females ages 16-24 years old with data on contraceptive use. Results: Fifty one percent of respondents reported a lifetime history of IPV and 20% reported IPV in the past 3 months. Young women reporting IPV ever were more likely than those with no IPV to report using withdrawal (OR 1.75; 95% CI 1.18, 2.60) and EC (OR 1.68; 95% CI 1.14, 2.48) as their primary method of birth control. Young women with recent exposure to IPV were more likely to repeatedly request pregnancy tests and EC. Repeated EC use (2 or more times in the past 3 months) was more common in young women whose primary method of birth control was EC (OR 2.98; 95% CI 1.86, 4.77) or the contraceptive ring (OR 1.22; 95% CI 4.29) compared to users of other methods (Tables 1 and 2). Conclusion: Supporting a growing body of literature on inconsistent contraceptive use among women with histories of IPV, withdrawal and emergency contraception are not uncommon methods of contraception among these young women. Repeated requests for pregnancy tests and EC are also more common among young women with recent IPV exposure. Contraceptive counseling with adolescents and young adult women, especially those seeking pregnancy testing or EC, should include assessment for IPV and recommendations for longer acting reversible contraceptives (LARC) which are less susceptible to partner interference.
Trisha Tulloch MD, MSc, Kristy Hackett MSc, Gillian Thompson MN, NP, Nicole Gibson RN, Sarah Maxwell BSc, Sara Baum, Karen Leslie MD, MEd, FRCPC, Katherine Hick MD, FRCPC University of Toronto Department of Paediatrics, Hospital for Sick Children, Toronto, ON
Background: To date, the literature examining Canadian adolescents’ knowledge and experiences with the emergency contraceptive pill (ECP) is limited. Canadian adolescents have access to ECP (levonorgestrel pills) without prescription, free of charge or at a low cost. Given the known benefits of timely access to ECP, this study sought to: 1) assess the knowledge of, experience with and perceived barriers to ECP use; and 2) examine whether these domains vary depending on educational status among Canadian adolescent females. Methods: In this cross-sectional study, a convenience sampling approach was used to recruit participants from three Toronto-based adolescent clinics. Participants aged 13-21 years provided informed consent and completed a self-administered survey. The 21-question survey included both open-and closed-ended questions assessing demographic data, knowledge, experience and perceived barriers to ECP use. Statistical analysis was performed using SPSS software. Ethics Review Boards at the University of Toronto and the Hospital for Sick Children granted approval for this study. Results: A total of 75 individuals were recruited, 65 of whom participated in the study. The mean age of participants was 18.3 years and over one third (35%) had a history of pregnancy. The majority (87%) were attending school and 38.5% reported their highest level of education as postsecondary. Eighty-nine percent (89%) reported knowledge of ECP and 93% knew they did not need a prescription. Fifty-six percent (56%) did not know the correct time period for ECP initiation and 18% believed that ECP causes abortion. One third of participants (34%) had previously used ECP and of this group, 95% said their partner supported their decision. The majority (96%) reported being comfortable using ECP, however 18% stated they would not use it again. The most commonly reported barriers to ECP use were perceived side effects (36%), cost (30%), and low risk of pregnancy (16%). When participants were stratified based on educational status, 84% of university students and 93% of high-school students knew about ECP (p¼0.41). There were no significant differences between groups when asked about whether ECP causes abortion, protects against STIs, requires parents’ permission or requires a prescription. Seventy-two percent (72%) of university students knew which scenarios would warrant ECP use compared to 40% of high-school students (p¼0.02). Sixty percent of university students knew the correct timing for ECP initiation compared to 33% of high school.
Table 1 Prevalence of Contraceptive Use and Associations With Intimate Partner Violence (IPV) and Care Seeking Across Contraceptive Users Ages 16-24 Intimate Partner Violence % using method No method of contraception Withdrawal Emergency Contraception Condoms Birth Control Pills Patch Nuva Ring LARC (IUD, Depo)
13.6% 12.2% 12.8% 46.0% 26.3% 4.2% 6.6% 16.3%
(131) (118) (123) (444) (254) (40) (64) (157)
Repeat pregnancy testing (2 or more)
OR (95% CI) 1.14 1.75 1.68 1.16 0.89 0.79 1.56 0.93
OR (95% CI)
(0.79, 1.64) (1.18, 2.60) (1.14, 2.48) (0.90, 1.50) (0.66, 1.18) (0.42, 1.49) (0.93, 2.63) (0.66, 1.30)
1.34 0.82 1.38 0.72 1.20 1.71 0.93 1.17
(0.83, (0.46, (0.84, (0.50, (0.81, (0.80, (0.45, (0.74,
2.18) 1.45) 2.26) 1.04) 1.78) 3.67) 1.94) 1.86)
Repeat EC use (2 or more) OR (95% CI) 0.53 1.03 2.98 1.20 1.26 1.97 2.29 0.84
(0.26, 1.07) (0.57, 1.86) (1.86, 4.77) (0.81, 1.78) (0.82, 1.93) (0.88, 4.38) (1.22, 4.29) (0.45, 1.47)
n¼965 LARC, long acting reversible contraception; IUD, intrauterine device
Table 2 Associations of Repeated Pregnancy Testing, EC Use and IPV
Repeated pregnancy testing Repeated EC use
Total %
% Among IPV YES
% Among IPV NO
P Value
% Among Recent IPV YES
% Among Recent IPV NO
P Value
14.8% (143) 11.6% (112)
16.6% (81) 13.1% (64)
13.1% (62) 10.1% (48)
0.12 0.15
21.9% (41) 16.6% (31)
13.1% (102) 10.5% (81)
0.002 0.02
IPV, intimate partner violence; EC, emergency contraception
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Poster Abstracts / J Pediatr Adolesc Gynecol (2013) e55ee71
Conclusion: Despite awareness of ECP and knowledge of over the counter availability, a large proportion of participants were misinformed about the appropriate timing for ECP initiation. Additionally, many reported perceived side effects and cost as barriers to use. This pilot study suggests that ECP education and provision of ECP in "advance of need" by health care providers may potentially improve utilisation in this population of adolescents. 8. Young Adolescence (Age Ten to Fourteen) Is Not a Contraindication to the Use of the Levonorgestrel Intrauterine System Anne-Marie Amies Oelschlager MD 1, Kate Debiec MD 1, Elizabeth Micks MD 2, Tiana Nizamic 2, Malica Deepti Mantrala MPH 2, Sarah Prager MD 2 1 Department of Obstetrics and Gynecology, University of Washington, Seattle Children’s Hospital, Seattle, WA 2 Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
Background: Although intrauterine devices (IUDs) are recommended as first-line contraceptive options for adolescents given their high efficacy for pregnancy prevention, there are very few publications regarding the safety and efficacy of IUDs in adolescents under age fifteen. In addition, there is very limited evidence with the use of levonorgestrel intrauterine system (LNG-IUS) as treatment for heavy menstrual bleeding, endometriosis, and dysmenorrhea in very young adolescents. The purpose of this study is to describe our experience with use of the IUD in patients 14 and younger. Methods: We completed a retrospective chart review of patients 14 and younger who had an IUD placed at Seattle Children’s Hospital between January 1, 2009 and March 1, 2012. Patient characteristics, contraindications for other methods, indications for placement of the IUD, and complications including perforation, pregnancy, expulsion and pelvic infection were collected and analyzed. Institutional review board approval was granted for this study. Results: All of the forty-one postmenarchal adolescents aged 14 and under who opted to have an IUD placed during the study period had one inserted. Only the LNG-IUS was inserted; there were no copper IUDs placed in young adolescents during the study period. The average age at insertion was 13.3 years (range 10-14). None of the patients had been pregnant before. The indications for placement were menorrhagia (30 patients 73.2%), menstrual regulation (23 patients, 56.1%), dysmenorrhea (9 patients, 22.0%). Five patients (12.2%) were using the LNG-IUS for contraception. The average depth of the uterine cavity at the time of placement was 7.2 cm (range 5.5 to 9 cm). Only one patient had a uterine depth of less than 6 cm. There were no perforations. One patient was diagnosed with pelvic inflammatory disease 32 months after IUD placement. Three patients experienced expulsion (7.3%) from 3 to 709 days after placement. All three patients opted for replacement, however, two patients experienced expulsion of the second IUD. Three patients (7.8%) opted for removal for persistent cramping and irregular bleeding. Thirtysix patients (87.8%) were continuing the IUD at their last follow up. Conclusions: In young adolescents, the LNG-IUS can be used safely for menorrhagia, dysmenorrhea, and contraception. Our case series does not suggest that the young adolescent’s uterus is too small to accommodate an IUD; however, expulsion rates may be higher. 9. Use of the Levonorgestrel Intrauterine System in Adolescents With Known Uterine Didelphys or Unicornuate Uterus Anne-Marie Amies Oelschlager MD 1, Kate Debiec MD 1, Elizabeth Micks MD 2, Sarah Prager MD 2 1 Department of Obstetrics and Gynecology, University of Washington, Seattle Children’s Hospital, Seattle, WA 2 Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
Background: The levonorgestrel-releasing intrauterine system (LNGIUS) is a highly effective reversible contraceptive and provides effective treatment for heavy menstrual bleeding, endometriosis, and
dysmenorrhea. There are very few case reports of the copper intrauterine device (IUD) in patients with uterine anomalies, and these are mostly reports of complications where the uterine anomaly was discovered after a pregnancy occurred. A uterine anomaly is considered a relative contraindication to the use of an IUD; however, some case reports have suggested that IUDs may be safely used in this setting. The objective of this case series is to describe our experience using the LNG-IUS in adolescents with known uterine didelphys or unicornuate uterus. Cases: We completed a retrospective chart review of patients who had known uterine didelphys or unicornuate uterus who had a LNG-IUS placed at Seattle Children’s Hospital or the University of Washington Medical Center between January 1, 2009 and March 1, 2012. Patient characteristics, medical conditions, indications for placement of the LNG-IUS, and complications were collected and analyzed. Four patients were identified, one with a unicornuate uterus and 3 with uterine didelphys. Patient A was a nulliparous 15 year-old who had a non-communicating uterine horn and a contralateral unicornuate uterus. She reported severe dysmenorrhea and had contraindications to estrogen containing contraceptives. She had the LNG-IUS placed in the operating room at the time of the resection of her obstructed uterine horn. Her dysmenorrhea completely resolved. Patient B was a parous 21year-old adolescent born with a cloaca who had conceived two pregnancies on oral contraceptive pills (OCPs). She had post-placental insertion of two LNG-IUS devices (one in each horn) at the time of her cesarean section. She experienced spontaneous expulsion of one LNG-IUS from the horn which had carried the pregnancy. She opted for replacement of the device. Patient C was a parous 19-year-old female who had a uterine didelphys discovered at the time of cesarean delivery. She had previously used depot medroxyprogesterone acetate (DMPA) for contraception but stopped using it due to side effects. She had two LNG-IUS devices placed, one in each uterine horn, at the time of a longitudinal vaginal septum resection. She experienced prolonged irregular bleeding post placement but opted to continue this method of contraception. Patient D was an 18 year-old nulligravida with uterine didelphys who had difficulty remembering to take OCP’s. She also opted for placement of two LNG-IUS devices at the time of her longitudinal vaginal septum resection. She experienced partial expulsion of one of the devices 18 months after placement. She opted to have both removed and chose to resume OCPs. All uterine horns measured within the recommended 6-9 cm range. There were no uterine perforations and no reported pregnancies. Comment: In a small case series of patients with uterine anomalies, the levonorgestrel intrauterine system appears to be a safe option for contraception and menstrual suppression. There may be a higher rate of expulsion and further studies are warranted.
10. The Content of Maternal Communication About Birth Control and Condoms: An Analysis of Dyad Conversations Penelope Morrison PhD, MPH, Kasey Dickenson BA, Aletha Akers MD, MPH Magee-Womens Hospital, Pittsburgh, PA
Background: Most studies on mother-adolescent communication about sex simply denote whether a topic was discussed and do not characterize the range of messages covered. We directly observed conversations between mothers and their adolescents to explore the diversity of messages regarding birth control (hormonal or intrauterine) and condoms and how these messages vary by adolescent gender and age. Methods: Between June 2011 and December 2012, we enrolled 21 mother-adolescent dyads. Dyads were recruited from two university research registries and an outpatient OB/GYN clinic at an academic women’s hospital. Eligible mothers were aged >18 years, and the biological parent, legal guardian, or primary maternal caregiver for participating adolescents. Eligible adolescents were age 10 -14 years of either sex. Dyads completed an anonymous questionnaire that assessed demographic and family characteristics and engaged in a semi-structured conversation about three topics: every day issues (e.g., hobbies), abstinence, and condoms/birth control. Dyads were asked to discuss each topic for 7-10 minutes in a private room. All conversations were audio-recorded and transcribed verbatim. Two coders used a grounded theory approach to content analysis and the constant comparison method to identify key messages regarding birth control and condoms in the transcripts. The University of Pittsburgh’s Institutional Review Board approved this study.
