Medical group says teens should use IUDs, implants as first contraceptive method

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(CBS/AP) Teenage girls considering contraception should opt for hormonal implants or IUDS first over more traditional methods, the country's leading group of gynecologists said Thursday.

While some may prefer the pill, the long-lasting implants are more effective don't need to be taken daily, making them a "first-line" recommendation for teens from the American College of Obstetricians and Gynecologists said in its updated 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.

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The group is not recommending against teen girls using the pill if they want to avoid pregnancy. 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.

A recent study in a May issue of the New England Journal of Medicine found that compared to women using IUDs, unplanned pregnancies were 20 times more likely among women taking birth control pills, the patch or ring. For women under 21, the risk for unplanned pregnancy when using the pill, patch or ring doubled that of risk for older women.

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.

"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 birth control methods, but is updating its guidance. Some pediatricians have been reluctant to recommend IUDs for teens, partly because of concerns over infection risks or risks for infertility from older models.

Dr. Paula Braverman, director of community programs in the division of adolescent medicine at Cincinnati Children's Hospital who is 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."

Risks from using an IUD include menstrual problems, noncancerous cysts, perforation of the uterus in one out of 1,000 women and expulsion of the device from the uterus to the vagina for about two to 10 out of 100 IUDs, according to WebMD.

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 added.

[Laewin]

Why is the stock photo of the Dalkon Shield? That medical device caused infertility, birth defects, and even death of some women in the seventies. They should not be making a connection between that device and the modern FDA-approved and VERY SAFE IUDs.

[Nixxie71]

No no no no no! The Mirena is toxic. Thousands upon thousands of women, including myself, have been poisoned by this thing. It raises blood pressure to stroke level, causes full body convulsions, hair loss, facial hair growth, it suppresses the body's natural progesterone production which then causes toxins to build up in the liver. It causes brain fog and disorientation. It makes it hard to concentrate and makes you detached from the world so you either have no emotions at all or cry constantly. It lowers your immune system's ability to fight off infections. This this is horrible. It should not, under ANY CIRCUMSTANCES be given to teenage girls. Hell, it should be taken off the market and Bayer should be sued for every penny they have.

[timaiday]

Doctors are simply a***. Remember 'breast cancer self exam' recommendation? The recommendation is based on current the administration. First it's good. Then it's mostly useless. I see yes/no recommendation all the time.

[wizardlady]

Why is it that the WOMEN are the ones to assume responsibility for 'unwanted pregnancy' prevention, and the men (who largely make the laws and do the implants) reap all the benefits, physically and financially? Women can vote and had better exercise that privilege very prudently in their own best interest this time around.

[kds1942]

True, true ,true. But do you want to leave it up to men? VOTE and cya (so to speak).

[BillFromFlorida]

I love Obamacare: Free birth control for all minorities! The GOP should have thought of this years ago!

[lesserof2evil]

There is a big difference between teens/minors and minorities, just so you know.

[Nixxie71]

There is always one who has to make this political. This has nothing, and let me repeat that, NOTHING to do with Obama's health care reform and it has nothing to do with politics so stop trying to make everything in the world about your hatred for "Obamacare."

[Tina900]

I was under the impression that a IUD was most suited to post childbirth as the uterus has been stretched, to reduce chances of scar tissue. These methods don't do anything against STD's like HPV, herpes, syphyllis, etc.....So how does that work for proper birth control? People won't use both unless the girl lies and tells the boy she is using nothing, even then boys don't like condoms....

[midwestkris]

I used an IUD from age 21 to age 35. Each time I had it removed, I was pregnant in .1-3 months.

There is a higher incidence of PID among users of an IUD. There is no reliable data, however, on wehther that is caused by the IUD or whether is is a function of the sexual activities of IDU users.

It is about BIRTH control. It has the lowest failure rate, you can't "forget" to use it, and it is in the woman's control. For birth control, it is the best there is For STDs, a condom is better...and there is no reason a woman's partner can't use a condom even if she has an IUD.

[jt92202]

1) Our doctor told us that my Daughter and any woman that has not had a child should not get an IUD! It could create problems down the road when she is trying to get preganent!

2) NO COPAY IS A LIE for some! Most insurance companies do not have to give Free Birth Control or No Copay until the plan comes up for renewal, most plans renew on the 1st of January UNLESS you bought the policy AFTER 8-1-12!

If you live in the State of Washington and you are on Medicaid (the poorest of the poor) you are not going to get Free Birth Control or no co-payment as it looks like they received a waiver from the Federal Government on this part of ObamaCare! So the poorest of the poor that we would like to not get preg because of the cost of maternity care is exempt from getting FREE Birth Control! GO FIGURE!!

I know this is true because my Daughter called her plan, she is on Basic Health and they told her she did not qualify to not pay a co pay for her pills! She pays a small insurance premium as she is not of full blown Medicaid!!

So once again we were miss-informed, You got to read the bill since they passed it!! If you can get through it and also get info on who got waivers and who didn't!!

IUD's should only be used if you have had children!! Don't hurt the chances of your daughter being able to have children of her own!!

[Tina900]

Absolutely in agreement, scar tissue will create infertility in young girls, and doesn't prevent STD's.

[midwestkris]

You do understand that when insurance companies do not charge their customers for birth control, it still isn't FREE, don't you? What insurers charge in premiums, minus hat they pay out in claims is their profit. Providing birth control without increasing their premiums should result in HIGHER profts, so it isn't "free" . Pregnancy prevention should lower the overall cost to the insurer as the cost of birth control is much less than the cost of pregnancy, birth, and covering a child from birth to adulthood..and there is no additional cost for adding a child to a policy after you are already on the family plan. So providing birth control as part of their policies should reduce the payout ratio and increase their profits (unless they lower their premiusm, which is unlikely). There is nothing "free" about it...unlike the coverage for multiple children after the first one is covered (and yes, I think covering an entire family for a single cost is still a good strategy...but talk about subsidized health care!_

Doctors are of different opinions as to whether a woman who has not had children should use an IUD. I used one for 15 years with no problems...regular doctors appointments, good health habits, etc. THere is a higher incidence of PID with an IUD, but whether that is caused by an IUD or not has not been determined. There is also a mortality rate with pregnancy, and complications associated with pregnancy that may be a greater risk to a young woman than the possibility of PID.

[saltymango]

My understanding of an IUD is that it is not a contraception device. Rather it is implanted on the uterus so that a FERTILIZED egg does not embed, essentially tricking the uterus into thinking it already has an attached fertilized egg. It has been some time since I took sex ed so please, if someone knows, correct me if I am wrong (perhaps an IUD prevents ovulation). If I am right, however, the headline is, at best, misleading, at worst incorrect and dangerous.

[zenjennn]

Pregnancy begins at implantation, not fertilization. A fertilized egg is not a conception/pregnancy. The IUD prevents implantation = contraception.

[lisalete]

There are two types of IUDs: the Copper IUD and the Hormonal IUD. The Hormonal IUD contains the same hormones as the pill/other hormonal contraceptive methods. The Copper in the Copper IUD kills the sperm and works by preventing fertilization, although, it might also work by preventing implantation as well - but there is not enough evidence to support that at the moment.

[queenofclubs]

Teenagers shouldn't be having sex at all. Whatever happened to staying pure until marriage????

[Wintersandman]

The reality is they are. So now instead of telling a teenager you shouldn't be having sex you are teaching a teenager to raise a kid. Would you rather enable them to have access to birth control and teach them practices of safe sex or dismiss it and say they should stay pure which leads to you having a grandkid.

[Tina900]

Virginity was written out of the tv episode a long time ago,....if you want your child to "stay pure" you better keep them off of media/movies/magazines etc and talk to them a lot. Virginity is not supported in our throw away society, sadly.

[cntrygirl3]

Nothing comes without some risk, if I had a teenager I would probably council for the hormonal implant because it has the added benefit of regulating periods, and a small glass vial in the arm seems way less invasive to me. Either way it is much less risk than pregnancy. If teenage girls are having sex at this rate then contraceptives as effective as possible are imperative. Yea affordable health care.

[azfalcon55]

"Yea, affordable health care." Sorry... ObamaCare is not about afforable health care - it is a mandate that everyone buy health insurance or pay a penalty for not having it.