(119) The LARC Experience in AYA with PCOS

Background: Long-acting reversible contraception (LARC) devices, including the levonorgestrel IUD and etonogestrel implant, are safe and effective contraceptive and menstrual management options for adolescents and young adults (AYA). Little is known regarding the LARC experience of AYA with polycystic ovary syndrome (PCOS).

Methods: The Clinical Adolescent Polycystic Ovary (CALICO) database is a retrospective, national, multi-center longitudinal data set of adolescents diagnosed with PCOS per 2023 international guidelines. Individuals were defined as “ever users” of LARC if they underwent placement of an implant or levonorgestrel IUD following PCOS diagnosis. Those never using a LARC device were used as a comparator cohort. Univariate comparisons were performed using t-tests for continuous variables and Pearson’s Chi-squared test for categorical variables. For each continuous outcome, we fit a linear mixed effects model with random effects for participant and time, and an interaction effect between time and LARC status. To evaluate the effect of starting LARC on each outcome, we also fit a linear spline model with a single knot at LARC start. If models did not converge, only the random effect for participant was included.

Results: Among the 857 AYA with PCOS included in this analysis, 42 were ever-LARC users. Ever- and never-LARC users with PCOS were similar in terms of age at diagnosis, race, gender identity, insurance status, and sexual activity (Table). Patients self-reporting Hispanic ethnicity were less likely to use LARC (p=0.01). AYA with PCOS who never used LARC gained an average 0.11kg more per month following their PCOS diagnosis compared to ever-users of LARC (p=0.007). Weight gain over time changed after LARC insertion. On average, LARC users gained 2.3kg per year prior to LARC insertion and 0.7kg per year thereafter (p=0.05). No differences in changes in hemoglobin, lipid parameters (HDL, LDL), or blood pressure over time were seen between ever- and never-users of LARC (p>0.05 for all).

Conclusions: LARC provides excellent menstrual management and contraception for AYA, including those with PCOS. Our findings suggest that weight gain following LARC insertion in patients with PCOS may be lower on average than in those who never use LARC. No negative impact on measured metabolic parameters was observed. Further analyses will evaluate differences in bleeding profile, glucose control, and quality of life between LARC users and non-users.