Trends in oral contraceptive and intrauterine device use among reproductive-aged women in the US from 1999 to 2017

Lauren A. King, Kara A. Michels, Barry I. Graubard, Britton Trabert

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Purpose: Since the 1960s, increasing oral contraceptive (OC) use has mirrored decreasing ovarian cancer incidence. The impact of intrauterine devices (IUDs) on cancer risk is less well established. With improved access and increased options, we must consider how changing usage can affect cancer risks. Methods: Nationally representative data from the National Health and Nutrition Examination Survey (NHANES, 1999–2016) and the National Survey for Family Growth (NSFG, 2006–2017) were used to evaluate contraceptive use over time in premenopausal women (NHANES n = 13,179; NSFG n = 26,262). Trends were assessed overall and by race, age, pregnancy history, education, and body mass index. Results: The average annual absolute increase in self-reported IUD use was 0.81% (NSFG), while OC use decreased 0.49% in NSFG and 0.47% in NHANES. This represents a significant decrease in OC use in NSFG [annual percent change (APC) − 2.2% (95% CI − 3.4, − 1.0%), p < 0.01]. Trends in OC use varied somewhat by pregnancy history in NHANES (p-interaction = 0.054). In contrast, IUD use increased 6.2% annually [(1.4, 11.2%), p = 0.03] and varied significantly by pregnancy history (p-interaction < 0.01). Nulligravid women increased IUD use 11.0% annually [(2.6, 20.1%), p = 0.02] compared to women with prior pregnancy at 5.2% [(0.4, 10.2%), p = 0.04]. In 2015–2017, IUD use was 76.5% hormonal (71.1, 81.8%) and 22.9% copper (17.4, 28.3%) with greater hormonal IUD use in obese women [89.4%, (82.9, 95.9%)]. Conclusion: Increasing IUD use outpaced declining OC use in premenopausal US women. There may be a resulting decreased gynecologic cancer risk as more women gain access to potentially risk-reducing contraceptives.

Original languageEnglish (US)
Pages (from-to)587-595
Number of pages9
JournalCancer Causes and Control
Issue number6
StatePublished - Jun 2021
Externally publishedYes


  • Cancer risk
  • Gynecologic oncology
  • Intrauterine devices
  • Oral contraceptives
  • Women’s health

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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