25 September 2012

IUDs, implants encouraged for teenage girls

Teenage girls looking for birth control should be encouraged to consider the long-lasting "set and forget" methods.


Teenage girls looking for birth control should be encouraged to consider the long-lasting "set and forget" methods, according to the American College of Obstetricians and Gynecologists (ACOG).

In new guidelines, ACOG says IUDs and contraceptive implants should be considered "first-line" birth control options for teenagers. The group issued similar advice for adult women last year.

'Treat teens the same as adults'

"Nearly all women who are sexually active are good candidates for long-acting reversible contraception," said Dr David L Eisenberg, an assistant professor of obstetrics and gynaecology at Washington University in St. Louis School of Medicine.

"It's exciting that ACOG is being so declarative that we should be treating adolescents the same as adults" when it comes to birth control options, said Dr Eisenberg, who was not involved in writing the new statement.

The hormonal IUD Mirena can prevent pregnancy for five years, while the copper version, sold as ParaGard, is effective for about 10 years. The contraceptive implant (Implanon) works for three years.

IUD's appear more effective

Research shows that 0.8% of US women using a copper IUD have an unplanned pregnancy within a year. The rate for those on the hormonal IUD was 0.2%. Contraceptive implants, meanwhile, are even more effective - with a one-year pregnancy rate of just 0.05%.

In contrast, about 9% of women on birth control pills can expect to have an unintentional pregnancy in a year - owing largely to imperfect use. With condoms, about 2% of women will become pregnant, but that's only if a couple uses them correctly, every time they have sex.

Both IUDs and implants can have side effects, ACOG points out. With the implant, irregular menstrual bleeding is most common; some women stop having their periods altogether.

The Mirena IUD may also cause menstrual irregularities. But it generally makes periods lighter, which is why it is also approved as a treatment for heavy bleeding. The ParaGard IUD has the opposite effect: menstrual bleeding and cramping can increase, although that may go away over time.

In about one in 1 000 cases, ACOG says, the IUD can perforate the wall of the uterus.

‘Breaking the barrier’

When they first came out, IUDs were considered an option mainly for women who'd already had children. That was based on worries that IUDs raised the risk of pelvic inflammatory disease (PID), which can cause infertility. So doctors were reluctant to place IUDs in younger women who had not yet had a baby.

That "myth" might be one reason that health providers are even less likely to talk about IUDs and implants to teenagers than to adult women, according to Dr. Eisenberg.

But he said another barrier for teenagers is the type of health provider they typically see. Teens may see a family doctor or paediatrician - who may be less likely to be knowledgeable about IUDs and implants, or less comfortable placing them.

Cost could be another problem. Even if a teenager is covered by her parents' insurance, she might not want her parents finding out about her birth control payment. So, Dr Eisenberg said, it may well seem easier to pay for condoms or birth control pills.

Healthcare providers, ACOG says, should do their best to make IUDs and implants available to young women who want them. The devices, the group writes in Obstetrics & Gynecology, "are the best reversible methods for preventing unintended pregnancy, rapid repeat pregnancy, and abortion in young women."

Dr Eisenberg said that when providers don't know much about the contraceptives, they should refer their teen patients to someone who does.

"All adolescents should be educated on all their birth control options," he said.

(Reuters Health, September 2012)

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