To our knowledge, no studies have specifically sought to understand the use of long-acting reversible contraception (LARC) by gender diverse adolescents and young adults (AYA). We sought to describe the characteristics of gender diverse AYA seeking LARC, indications for placement, complications, side effects and continuation/removal rates.

This retrospective cohort study included gender diverse AYA age 13-26 years seeking LARC from three U.S. Adolescent Medicine clinics from January 2020 to March 2022. Baseline demographic information, procedural complications, patient experience and continuation rates were assessed. Descriptive statistics characterized the patient population and outcomes of those receiving an intrauterine device (IUD) or implant were compared. IRB approval was obtained at each institution.

There were 63 attempted LARC insertions with a mean participant age of 17.7 years. Over half of patients (54%) desired LARC for both contraception and menstrual management purposes, while 30% desired contraception only and 16% desired menstrual management only. The 52 mg levonorgestrel IUD was the most commonly placed IUD (78%, n=28). All implants (n=27, 100%) and 32 of 36 IUDs (89%) were successfully placed. Unsuccessful IUD placements were due to procedural pain. One IUD patient experienced known expulsion. Of the 59 successful insertions, 27 (46%) patients had their LARC in place for at least one year at the time of data extraction, and 28 (47%) returned for follow-up between two weeks and one year of insertion. No implant patients required early follow-up (i.e. within two weeks of insertion), while three (9%) IUD patients required early follow-up due to pain and/or bleeding. Of those with follow-up (n=28), 64% reported side effects (46% reporting unsatisfactory bleeding and 29% reporting pelvic pain/dysmenorrhea with similar rates for both the implant and IUD). Seven patients (12%, n=3 implant, n=4 IUD) received medical management of their side effect, including labs, imaging and/or medication initiation. Of all successful insertions, 5 (8%) devices were removed (n=2 implant; n=3 IUD) within the first year. Reasons for removal included pelvic pain (n=3), unsatisfactory bleeding (n=2), and dysmenorrhea (n=2). There was no difference in time to removal by device.

Gender diverse AYA experienced high rates of successful LARC insertion. Unsatisfactory bleeding and pelvic pain were reported side effects for both methods. Continuation rates were high and IUD expulsion uncommon, similar to findings reported in the general adolescent population. Additional research is warranted to understand the impact of gender-affirming testosterone therapy on the LARC experience of gender diverse AYA.