IUDs, implants urged for teen girls' birth control

    

Teens Should Be Offered IUDs, Top Doctors' Group Says

 

Teenage girls may prefer the pill, the patch or even wishful thinking, but their doctors should be recommending IUDs or hormonal implants - long-lasting and more effective birth control that you don't have to remember to use every time, the nation's leading gynecologists group said Thursday.
The IUD and implants are safe and nearly 100 percent effective at preventing pregnancy, and should be "first-line recommendations," the American College of Obstetricians and Gynecologists said in updating its guidance for teens.
Both types of contraception are more invasive than the pill, requiring a doctor to put them in place. That, and cost, are probably why the pill is still the most popular form of contraception in the U.S.
But birth control pills often must be taken at the very same time every day to be most potent. And forgetting to take even one can lead to pregnancy, which is why the pill is sometimes only 91 percent effective.
An IUD, or intrauterine device, is a small, T-shaped piece of plastic inserted in the uterus that can prevent pregnancy for up to 10 years. An implant is a matchstick-size plastic rod that releases hormones. It is placed under the skin of the upper arm and usually lasts three years.
The new guidelines don't tell teens not to use other methods, but "if your goal is to prevent a pregnancy, then using an implant or an IUD would be the best way to do this," said Dr. Tina Raine-Bennett, head of the committee that wrote the recommendations.
The organization's previous guidelines, issued in 2007, also encouraged the use of IUDs and implants among teenagers. The new guidelines go further in saying physicians should discuss the two types of birth control with sexually active teens at every doctor visit.
The gynecologists group said condoms should still be used at all times because no other birth control method protects against AIDS and other sexually transmitted diseases.
While it may sound surprising that such invasive contraceptives are being endorsed for teenagers, 43 percent of girls ages 15 to 19 have had sex, a government survey found. Most are using some kind of effective birth control, but only about 5 percent use the long-lasting devices, the gynecologists group said.
In 21 states, all teenagers can get contraceptives without parental permission, according to the Guttmacher Institute, which tracks laws affecting women's health. A few other states allow it under certain circumstances.
The IUD and implant cost hundreds of dollars. The new health reform law requires health insurance plans to cover birth control without co-payments. Also, some publicly funded health clinics offer birth control free or at a reduced cost.
The American Academy of Pediatrics has been more cautious and has not endorsed specific methods of birth control, but is updating its guidance. Some pediatricians have been reluctant to recommend IUDs for teens, partly because of concerns over infection risks; an older model was blamed for infertility.
Dr. Paula Braverman, a University of Cincinnati physician involved in updating the academy's position, said the gynecologists' advice does a good job of clarifying misconceptions about IUDs and implants.
An IUD called the Dalkon Shield that was sold in the 1970s was linked to dangerous and sometimes deadly infections. Newer IUDs have been found to be safe, and the gynecologists group said the risk of pelvic infections increases only slightly during the first three weeks after insertion.
The hormonal implant has been updated, too. The newest kind uses just one thin rod; an older type no longer sold in the U.S. used six rods that sometimes didn't stay in place. IUDs and implants can be removed at any time with no lasting effect on fertility, the gynecologists group said.
"The ones on the market today are extremely safe," said Dr. Mary Fournier, an adolescent-medicine specialist at Chicago's Ann & Robert H. Lurie Children's Hospital, who praised the new recommendations. "That is what everybody should be telling their patients."
She said she already recommends IUDs for her patients and is being trained in how to insert birth control implants.
Raine-Bennett, research director for women's health at Kaiser Permanente in Oakland, Calif., said she gets mixed reactions from her patients about both methods.
"Some of them say, `Great! Something that I don't have to think about.' Others are, like, `Hmmm, something in my body?' It really varies," she said.
Doctors need to be sensitive to that and provide detailed information to dispel any myths and allow teens to make informed decisions, Raine-Bennett said.

Read more: http://www.foxnews.com/health/2012/09/21/iuds-implants-urged-for-teen-girls-birth-control/#ixzz277fLLQ6H

IUDs, implants more reliable than birth control pills

While birth control pills are the most commonly used reversible contraceptive in the United States, a new study has found that women who use the pill are actually 20 times more likely to have an unintended pregnancy than women who use longer-acting birth control methods such as intrauterine devices (IUD) or hormonal implants.
The study, published in the New England Journal of Medicine, was conducted over a period of three years. It involved more than  7,500 sexually active women between the ages of 14 and 45, who did not want to become pregnant within the next 12 months.  The women were either not using birth control or were planning to switch birth control methods.
The researchers counseled the women on their birth control options, which included IUDs, implants, pills, patches, rings and injections, then followed up with the women every six months through the remainder of the study.  Participants who became pregnant during the study were asked if the pregnancy was intended and what contraceptive method they were using, if any, at the time.
During the course of the study, 334 of the women became pregnant, and 156 of the pregnancies were due to contraceptive failure.  Out of those women, 133 (4.5 percent) of the women had been using pills, the patch or ring at the time, compared to 21 women (.27 percent) who had been using IUDS or implants.
For women under 21, the discrepancy was even more pronounced: Adolescents and young adults who used birth control pills, the patch or ring had almost double the risk of having an unplanned pregnancy than older women in the study.
Dr. Jeffery Peipert, senior author of the study, and Robert Terry, professor of obstetrics and gynecology at the University of Washington, told FoxNews.com the study results called for a shift in the way doctors and patients consider and discuss birth control options, and in particular, IUDs – which had less than a 1 percent failure rate in the study but are only chosen by 5.5 percent of women in the U.S.
“When patients talk to their doctors about birth control, their first concern is always efficacy,” Peipert said.  “So why don’t we offer the most effective methods first? And if they choose not to have the most effective method [IUDs, implants], then move to second tier methods like the birth control pill, patch and ring.”
While all the birth control methods in the study boasted a 98 to 99 percent effectiveness in preventing pregnancy, the shorter-acting methods are often subject to ‘user error,’ such as forgetting to take pills, which can greatly reduce their effectiveness, Peipert said.
“The pill is 99 percent effective as long as you remember to take it every day, which to me, it’s ridiculous to talk about a ‘perfect’ user rate because that’s not real life,” Peipert said.  “In real life, there is user error.  The longer-acting methods remove that error.  Once they’re in place, you can forget about them.”
Meanwhile, according to Peipert, there are important ramifications to missing the pill as little as once or twice – and nearly 25 percent of women miss two or more pills a month.
“That’s a lot,” he said. “Depending on when the pills are missed in the cycle, it can make a difference as to whether or not a woman makes an egg or ovulates.”
Though IUDs and implants have a much lower failure rate, Peipert said there are three main barriers keeping women from pursuing these forms of birth control: knowledge, cost of the procedure -- which can be upward of $500 -- and access to clinicians who will perform the procedure.
He added it was also important to dispel certain myths surrounding IUDs, such as the beliefs that they can cause infertility or infections or that they do not work well for women who have already had children – all of which are untrue, according to Peipert.
Approximately 3 million – or 50 percent – of pregnancies each year are unplanned in the U.S.  The rate of unintended pregnancies is much higher than other developed nations, such as France, which have a higher rate of IUD or implant usage.
“My hope is that some people will say this study will be a game-changer shift in the U.S. to more effective methods,” Peipert said.  “Unintended pregnancy is a costly health problem in this country.  One dollar invested in family planning can save $3 to $4 down the road.”

Read more: http://www.foxnews.com/health/2012/05/24/iuds-implants-more-reliable-than-birth-control-pills/#ixzz1voPLeQka