September 22, 2012
IUDs, Implants Urged For Teen Girls’ Birth Control
April Flowers for redOrbit.com — Your Universe Online
The American College of Obsetricians and Gynecologists (ACOG) recently updated its guidelines for teen birth control, recommending that teens use IUD's and hormonal implants as a "first line of defense."
Both IUD's and hormonal implants, like the Implanon device, are long lasting and more effective birth control than the pill or the patch, the group says. However, they are more invasive, requiring a doctor to put them in place. They are also more expensive, which is probably why the pill is still the most popular form of contraception in the U.S.
The downside to birth control pills is that they must be taken every day, at the same time. Even one forgotten pill can lead to pregnancy, given that the pill only has a 91% effectiveness rating.
An IUD, or intrauterine device, can last between five and ten years, preventing unwanted pregnancy. It is a small, T-shaped plastic device which is inserted in the uterus and utilizes either hormones or copper. Conversely, the implant generally lasts about three years and is a small plastic rod-shaped cylinder that is inserted under the skin of the arm to release the hormone progestin.
The guidelines do not suggest that teens only use the IUD or implant because they will not prevent STI's or HIV, 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 previous guidelines, released in 2007, also recommended IUD's and implants for teens, however the new guidelines go further in stating that doctors should discuss these types of birth control at every visit with sexually active teens.
The latest statistics show that between 33% and 43% of girls ages 15 to 19 have had sex, and most are using some form of effective birth control but only about 5% have used the long-lasting devices. According to the CDC's National Center for Health Statistics, most probably don´t even know about these methods.
According to ACOG's research, over 80% of teen pregnancy is unintended. Teens are generally using the shorter-term methods of contraception, which have higher failure rates often due to incorrect usage. Teens are also more likely to stop using the shorter-term contraceptive methods.
"This recommendation is timely and essential," says Dr. Ellen Rome, head of the Center for Adolescent Medicine at Cleveland Clinic Children's Hospital. "Long-acting reversible contraceptive methods are twice as effective as shorter acting contraceptive methods at reducing teen pregnancy and could make a significant impact in preventing the 750,000 teen pregnancies occurring annually in the United States alone."
The Guttmacher Institute tracks laws affecting women's health and they report that in 21 states, all teenagers can get contraceptives without parental consent. A few other states allow it under certain circumstances.
The IUD and implants can cost hundreds of dollars, making them far more expensive than the patch or pill. The new healthcare reform law requires health insurance plans to cover birth control without co-payments and some publicly funded health clinics offer birth control for free or at a reduced cost.
Other groups, such as the American Academy of Pediatrics, have been more cautious. They do not endorse specific methods of birth control currently, but they are updating their guidelines as well. Some pediatricians have been reluctant to recommend IUDs for teens because of troubles with older models that caused infections and infertility.
The Dalkon Shield was an IUD sold in the 1970s that was linked to dangerous and sometimes deadly infections. Newer IUD's have been found to be safe, with the risk of pelvic infection only increasing slightly the first three weeks after insertion.
The new hormonal implant is an update as well. The old style used six rods, which sometimes didn´t stay in place. This style is no longer sold in the U.S. The new version uses just one thin rod. IUDs and implants can be removed at any time with no lasting effect on fertility.
"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."
Dr. Fournier already recommends IUDs for her patients and is receiving training in the insertion of the implant devices.
Dr. Raine-Bennett, who is the research director for women's health at Kaiser Permanente, 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.
The most important thing is for doctors to be sensitive and provide detailed information for their clients, dispelling any myths and allowing teens to make informed decisions. Dr. Debra Braun-Courville, from Mount Sinai Medical Center, says, "Even if adolescent health care providers cannot physically provide the IUD as a method of contraception for their patients because of training and insertion limitations, hopefully this report will encourage them to seek alternative clinical facilities and providers who can provide this option."