What is the current practice concerning insertion of intrauterine devices (IUDs) in nulliparous teens?—GERALDINE WALSH KIENINGER, PNP, New York City

A systematic review of the literature was published last year (Contraception. 2009;79:418-423). To date, only cohort and case-series level studies have been done and only with IUDs not available in the United States. Higher-level studies are obviously needed, but the results of those that have been done report that IUD use in adolescents is effective (similar to oral contraceptives) and that IUD expulsion rates may be inversely related to age. Bleeding and pain were the most common side effects. The authors recommend IUDs be considered as a first-line therapy in all women.—Julee B. Waldrop, MS, PNP (139-2)

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