Postinsertional Pain after Intrauterine Device Placement among Nulliparous Adolescents

To quantify the "normal" adolescent experience after intrauterine device insertion, to provide appropriate counseling for future adolescents.

Prospective cohort study.

Marshall University Department of Obstetrics and Gynecology generalist and adolescent gynecology clinics.

Nulliparous adolescents age 13-18 years and parous adults 18 years of age or older who received a levonorgestrel intrauterine system (LNG-IUS).

Visual analogue scale (VAS) pain score and medication log was used for data collection for 2 weeks after LNG-IUS insertion. A separate chart review was completed for demographic factors and indications for procedure.

VAS pain scores and medication use was compared between groups.

Ninety-three subjects returned the VAS record and medication log (46 adolescents and 47 adults). There was no difference in the incidence of endometriosis or dysmenorrhea, but there was a higher prevalence of menorrhagia among adolescents (30/46, 65.2% vs 10/47, 21.3%; P < .001). Forty-five of forty-seven (95.7%) adults vs 25/46 (54.3%) adolescents had contraception as an indication for intrauterine device use (P < .001). Pain scores were statistically higher among the adolescent group each day (P < .05) in the 2-week study period. The greatest mean differences occurred in the first 4 days. More adolescents (15/46, 32.6%) than adults (6/47, 12.8%) had a pain score greater than 5 during the first 3 days (P = .022). A statistical difference in amount of ibuprofen recorded was only noted on day 1 (P = .023) and day 4 (P = .046).

Nulliparous adolescents who undergo LNG-IUS placement experience more postinsertional discomfort compared with parous adults; however, this method should still be considered first-line treatment in this age group.