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 The American College of Obstetricians and Gynecologists (ACOG) and
the American Academy of Pediatrics (AAP) have both endorsed IUDs as
first-line contraception for young women who have never had
children, but many providers, especially in the U.S., still are not
comfortable giving IUDs to these women, said lead author Dr.
Alexandra M. Hall of the University of Wisconsin in Menomonie.
“It all comes back to the 1970s with the Dalkon shield IUD, people
got terrible pelvic infections,” Hall told Reuters Health.
Soon after, IUDs were redesigned and now pelvic inflammatory disease
is no more common among IUD users than among women on the pill, she
said.
For reversible long-term contraception, the copper IUD, hormonal
Mirena IUD and hormonal Implanon rod inserted under the skin of the
arm are the most effective, with failure rates below 1%. They last
for 10, five and three years, respectively.
Short-term methods including the birth control pill, patch and
hormonal vaginal ring all have failure rates of 9%, according to the
Centers for Disease Control and Prevention. Failure rates are higher
for these methods because people may use them inconsistently or
incorrectly. The diaphragm, and male and female condoms all have
failure rates between 12 and 21%.
Despite the fact that IUDs are safe, effective and well-tolerated,
“some people are a little more cautious, and very afraid of doing
harm,” especially to young women who have not been pregnant, said
Hall, who worked on the study while at Cornell University in Ithica,
New York.
“Physicians and other healthcare practitioners who work more with
younger people are going with (the ACOG and AAP) recommendation,”
Hall said. “We view unintended pregnancy as significant harm.”
Researchers studied 109 students at Cornell who chose to have the
Paragard Copper T 380A or the Mirena levonorgestrel intrauterine
system placed in 2012 or 2013. The women, aged 18 to 30 years old,
had never had children.
Most chose Mirena, while only 21 chose the copper IUD.
At one month, six months, one year and 18 months after having the
IUD placed, they responded to online surveys about complications,
bleeding patterns, plans to continue with the device and overall
satisfaction.
Most women reported moderate to severe pain at the time of insertion
and mild to moderate pain in the first 24 hours. Pain had dissipated
for most by one week later.
Six months later, women with the copper IUD reported longer, heavier
and more painful periods than those with the hormonal version,
Mirena.
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Three of the women expelled their IUDs spontaneously and seven chose
to have theirs taken out, due to side effects like pain and bleeding
or lack of benefit.
One woman became pregnant during the study, but there were no cases
of uterine perforation, pelvic inflammatory disease, chlamydia or
gonnorhea, the researchers reported online April 8 in the Journal of
Family Planning and Reproductive Health Care.
After an average of 13 months of follow-up, 83% of women were happy
or very happy with their IUD and 75% said the insertion procedure
had gone “very well.’” Almost 90% were still using their IUD at the
one-year point, and 87% were likely to recommend it to a friend.
These results should help prepare young women for the experience of
having an IUD, Hall said.
“The copper T does make periods heavier and longer and crampier, you
really need to be prepared for that,” she said.
In this and previous studies, many women have stuck with their IUDs
likely because they were counseled about potential side effects
beforehand, so those who would not tolerate them did not choose to
have a device placed, she said.
“There is still a feeling among some providers and among a lot of
parents and people helping young women with decision making that
IUDs may not be right for them,” said Dr. Julie Strickland, chair of
ACOG’s Adolescent Health Care Committee, who was not involved in the
new study.
“The more we can get out there to show that it’s safe and
efficacious and really well tolerated and well liked among young
adults, the better,” Strickland told Reuters Health.
SOURCE: http://bmj.co/1aW4nWb J
Fam Plann Reprod Health Care 2015
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