Use of hormonal intrauterine device and quarterly injection for contraception in adolescents with mental disorders

Objective: To evaluate the continuity and satisfaction rate with contraceptive methods over 12 months in female adolescents with mental disorders (MD). Material and Methods: Prospective cohort study carried out at a reference center for care for adolescents with MD. Adolescents with mild and moderate MD who opted for the hormonal intrauterine device (IUD) or a quarterly injectable contraceptive were included. Sociodemographic data were collected, such as age, education and gynecological data. Follow-up was quarterly for 12 months, with assessment of symptoms, desire to continue and satisfaction with the use of the quarterly injectable or hormonal IUD. Results: One-hundred and three adolescents participated in the study, 34 (33%) of whom chose to use the hormonal IUD and 69 (67%) the quarterly injectable with depot medroxy-progesterone acetate (DMPA). After 12 months, 26 adolescents (76.5%) continued to use the IUD and 34 (49.3%) maintained the use of DMPA. During IUD follow-up, one teenager (2.9%) wanted to have it removed after three months, three (8.8%) developed spontaneous expulsion of the IUD and four (11.7%) were lost to follow-up. Regarding satisfaction after 12 months of use, of the 30 who maintained the method, 29 (96.6%) adolescents were satisfied. Among the 69 adolescents who chose to use DMPA, after 12 months of follow-up, 34 (50.7%) said they were satisfied. Among the 30 (44.7%) who discontinued use, the most frequent causes were irregular bleeding and weight gain. When comparing the two methods, a significant difference was demonstrated for IUD users in terms of continuity (p=0.0001), and satisfaction (p=0.00002). Conclusion: Adolescents using the IUD exhibited significantly higher rate of continuity and reported greater satisfaction at 12 months compared to DMPA users. This result corroborates evidence of the preference for long-acting reversible methods for adolescents, especially for those who are most vulnerable.