(77) Long-acting Reversible Contraception Use in Adolescents with an Eating Disorder Diagnosis: Do Weight Concerns Interfere?

Background: Eating disorders have become increasingly prevalent in adolescents. Like their peers without eating disorders, many of these adolescents are sexually active and require contraception. There is a paucity of data on long-acting reversible contraception (LARC) use by those with an eating disorder diagnosis (EDO). We hypothesized that weight concerns may lead to lower acceptance and higher device removal rates in adolescents with an EDO compared to peers.

Methods: We conducted a secondary analysis of data from a prospective cohort study from 2017-2021 of LARC insertions from 4 academic U.S. Adolescent Medicine practices. Each of the 4 practices obtained IRB approval at their institutions. We compared groups with and without an EDO, by participant characteristics, selected device type, one-year continuation rate, and reasons for insertion & removal.

Results: Overall, 2361 LARCs were inserted; 80 (3.4%) in adolescents with a pre-existing EDO (mean time from diagnosis 1.8 ± 1.8 years). Of these, 27 (34%) had anorexia nervosa, 17 (21%) unspecified feeding or eating disorder, 13 (16%) binge eating disorder, 12 (15%) other specified feeding or eating disorder, 6 (8%) bulimia nervosa, & 5 (6%) avoidant restrictive food intake disorder. Mean age at insertion was 18.6 ± 2.2 years for those with an EDO & 18.8 ± 2.5 for those without. Of those with an EDO, 85% had LARC inserted for contraception as did 84% of those without. Of those with an EDO, 56 (70%) had an IUD inserted & 24 (30%) had an implant vs. 1144 (50%) & 1137 (50%), respectively of those without an EDO, (p < 0.001). Most IUDs inserted in both groups were levonorgestrel releasing, 52 (93%) in those with an EDO and 1087 (95%) in those without an EDO. One-year continuation rate for all LARCs was 77% for both groups. No devices in the EDO group were removed due to concern for weight changes.

Conclusions: Overall, the IUD was preferred over implants by adolescents with an EDO when compared to those without an EDO. This may be an indicator of their interest in a more localized hormonal delivery method, IUDs are often cited by clinicians as associated with less weight gain than implants. One-year continuation of LARC methods was similar for adolescents with and without an EDO suggesting these are satisfactory methods of contraception for adolescents with an EDO.