Intrauterine devices (IUDs) are as safe for teenagers -- including those who have never given birth -- as they are for adults, according to research from the University of Texas Medical Branch at Galveston.
Published in the May issue of Obstetrics & Gynecology, the findings disprove concerns that have persisted for more than 30 years, since the removal of a harmful IUD from the market in the 1970's, and open the door for many more women -- teens included -- to benefit from the highly effective, long-lasting form of contraception.
"Today's IUDs are not the same as the ones that existed decades ago and are undeserving of the outdated stigma they carry," said lead author Dr. Abbey Berenson, Director of the Center for Interdisciplinary Research in Women's Health at UTMB. "Modern IUDs are safe, cost-effective and provide years of worry-free birth control. Though more research is needed, this study shows that IUDs should be among the options considered to address teen pregnancy rates."
The researchers used private insurance claims from approximately 90,000 IUD users ages 15 to 44 to examine complications, failures and discontinuation rates. Results were compared by age and type of IUD -- hormonal (LNG-IUS) and copper (CuT380A). Specifically, they sought to investigate whether teenage IUD users were more likely to experience such complications as dysmenorrhea (painful menstruation), amenorrhea (very light to no menstruation) or IUD failure. Among the major findings:
- Serious complications resulting from the IUD, including ectopic pregnancy and pelvic inflammatory disease, occurred in less than one percent of women regardless of age;
- Early discontinuation did not differ between teenagers and older women, inferring that the IUD was not associated with greater complications among this age group; and
- Hormonal IUDs were associated with fewer complications and lower rates of discontinuation than copper IUDs in all age groups.
IUDs have evolved significantly since the 1970s, when a popular IUD known as the Dalkon Shield was found to have grave side effects, including bacterial infections, septic miscarriages and even death. However, a pervasive stigma against IUDs has persisted among physicians and patients. The devices are recommended by the American College of Obstetricians and Gynecologists (ACOG), but many clinicians remain especially reluctant to prescribe them to teens for fear of serious complications -- specifically the rare risk of infertility caused by IUD-related pelvic inflammatory disease.
"An IUD is a virtually effortless form of contraception, as it doesn't require remembering to take a pill at the same time each day," said Berenson. "Thus, increasing young women's access to this effective birth control could have a tremendous impact on reducing unintended pregnancies."
Other authors who contributed to the study include: Dr. Alai Tan, assistant professor, Department of Preventive Medicine and Community Health; Dr. Jacqueline Hirth, assistant professor at CIRWH; and Dr. Gregg Wilkinson, professor of epidemiology, Department of Preventive Medicine and Community Health and senior fellow, CIRWH. Funding support came from the Society of Family Planning. In addition, federal support was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).
- Abbey B. Berenson, Alai Tan, Jacqueline M. Hirth, Gregg S. Wilkinson. Complications and Continuation of Intrauterine Device Use Among Commercially Insured Teenagers. Obstetrics & Gynecology, 2013; DOI: 10.1097/AOG.0b013e31828b63a0
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