News and Media

Pediatric Academy Encourages IUDs and Implants for Sexually Active Teens

September 30, 2014 – Article by Martha Kempner

From RH Reality Check ( www.rhrealitycheck.org )

http://rhrealitycheck.org/article/2014/09/30/pediatric-academy-encourage-iuds-implants-sexually-active-teens/

5 reasons why IUDs are making a comeback

by Jennifer Goldberg – Canadian Living magazine

http://www.canadianliving.com/health/prevention/5_reasons_why_iuds_are_making_a_comeback.php

Intrauterine devices (IUDs) as a form of birth control have been frowned upon for many decades. However, recent studies indicate that they’re making a comeback among Canadian women.

Have you thought about using an intrauterine device (IUD) for birth control? For decades, North American women (and their doctors) associated these contraceptives with health risks. Now IUDs are beating that bad reputation and enjoying something of a renaissance among Canadian women.

What’s an IUD?
IUDs are small T-shaped devices that are inserted into the uterus to prevent pregnancy. The two types available on the market are the copper IUD, a nonhormonal device that turns your uterus into a place sperm just don’t want to be, and the Mirena, which prevents pregnancy by releasing small amounts of the hormone progestin. Their use among Canadian women who use birth control rose from 1.5 per cent in 2003 to 2.3 per cent in 2009 (most recent data available). While that may not seem like a huge jump, health-care practitioners are fielding many more requests for IUDs.

“We are certainly seeing an increase in demand [for IUDs], especially over the last few years,” says Nicole Pasquino, a registered nurse and the director of clinical services at British Columbia’s Options For Sexual Health (OPT) clinic. There have been so many requests that the OPT clinic in Vancouver has started offering IUD-only services once a week, and Pasquino says there’s always a waiting list.

Why are a growing number of women turning to this form of birth control? Here are five reasons why IUDs are making a comeback.

1. More women are learning that IUDs are safe
IUDs got a bad rap in the 1970s because a particular brand called the Dalkon Shield was associated with pelvic inflammatory disease and infertility. It was subsequently pulled from the Canadian market.

“The products that were out in the 1970s and the products that are available today are completely different,” says Pasquino, adding that research shows current IUDs are safe to use for most women. (All medications carry some risk, so talk to your doctor about whether an IUD is right for you.)

However, misconceptions about IUDs still linger. A United States study published in an April 2012 issue of Obstetrics and Gynecology suggests that 30 per cent of health-care providers surveyed had mistaken beliefs about the safety of IUDs. Pasquino says more women are educating themselves about this form of birth control.

2. They’re more effective than birth control pills
Many women appreciate that IUDs are a set-it-and-forget-it form of birth control: You’re protected from pregnancy immediately after your doctor inserts the device and you don’t have to think about contraception again for up to five years. Plus, both types of IUDs are more than 99 per cent effective as long as they are in place.

“There’s no forgetting to take it on time, so it eliminates patient error,” Pasquino explains. Some women also like that Mirena can reduce or even stop menstruation.

3. IUDs are reversible
There is a common misconception that IUDs aren’t suitable for women who have not previously been pregnant, but the World Health Organization states that they’re an appropriate form of birth control for moms and non-moms alike. In fact, IUDs may be especially attractive during childbearing years because they’re a low-maintenance contraceptive choice that gives women more control over spacing the births of their children.

“As with oral contraception, you can be fertile within a month or two after removing an IUD,” says Pasquino.

4. They’re cost effective
IUDs may seem like a significant investment upfront – Vancouver’s OPT clinic charges $100 for the copper IUD and about $400 for Mirena – but they can give you value over time.

“If you compare five years of birth control with the IUD versus oral contraceptives, you’ll find that IUDs are much cheaper,” Pasquino explains.

At the prices that OPT offers, the copper IUD provides birth control for about $2 per month and the Mirena works out to be about $6 per month. “When you consider buying a $30 pack of oral contraceptives each month, [IUDs cost] much less,” says Pasquino.

5. They may provide health benefits beyond contraception
Reports that IUDs may protect against certain types of cancer could be fuelling their surge in popularity. Recent research suggests that women who use IUDs for just one year have a 50 per cent lower risk for cervical cancer than those who do not. The study, published in the journal Lancet Oncology, reviewed research from 26 other studies involving more than 20,000 women. Other studies suggest that IUDs may decrease the risk for endometrial cancer and may even be used to treat the disease.

Feb. 26, 2013 – From MSN NEWS

Many women misunderstand IUD birth control: Study

http://news.msn.com/science-technology/many-women-misunderstand-iud-birth-control-study

Many women don’t know that IUDs are more effective contraceptives than the birth control pill, and that the devices don’t increase the risk of getting a sexually transmitted disease, a study shows.

NEW YORK — In a new survey, most women had inaccurate perceptions about the safety and effectiveness of intrauterine devices (IUDs) in preventing pregnancy, say U.S. researchers, who urge doctors to talk more about the benefits of the devices.

In particular, many of the study participants didn’t know that IUDs are more effective contraceptives than the birth control pill and that the devices don’t increase the risk of getting a sexually transmitted disease.

RELATED: What every woman needs to know about the IUD

“It’s not clear whether women have an overly optimistic view of the effectiveness of the birth control pill or an overly pessimistic view of the IUD,” said Dr. Lisa Callegari, the study’s lead author and a clinical assistant professor at the University of Washington.

Whatever their source, these misperceptions lead to underuse of “one of the most safe and effective methods” of birth control, said Dr. Jeffrey Peipert, an obstetrics and gynecology professor at Washington University, who was not part of the study.

IUDs, which include the brand-name products ParaGard and Mirena, are small plastic or copper-and-plastic objects inserted into the uterus. They can be left implanted for years, and are more than 99 percent effective at preventing pregnancy.

In contrast, the birth control pill has been found in real-world practice to be about 95 percent effective.

RELATED: IUD, implants best for long-term birth control: Study

SURVEY RESULTS

Callegari said that earlier studies have highlighted some of the mistaken beliefs women have about IUDs, and she and her colleagues wanted to get a better sense of how common they are among average women visiting primary care clinics.

They surveyed more than 1,600 women between the ages of 18 and 50 who had visited one of four clinics in Pennsylvania.

Five percent of the women were currently using an IUD, and another 5.8 percent had used one previously.
Only about one in five of the women correctly stated that IUDs are more effective at preventing pregnancy than the pill.

And just 28 percent knew that an IUD is more cost-effective than the pill when it is used for more than three years, the researchers report in the medical journal Contraception.

According to Planned Parenthood, the upfront costs of an IUD are between $500 and $1,000, whereas birth control pills can cost between $15 and $50 a month, so they become more expensive over time.

The women in the study were considerably more knowledgeable about the risk of disease related to an IUD, with 57 percent answering correctly that there is no greater risk of contracting a sexually transmitted disease with an IUD compared with the pill.

NEGATIVE ASSOCIATIONS

Still, Peipert said he’s not surprised that women might view IUDs less favorably.

“There’s been a LOT of bad press about IUDs in the past,” Peipert wrote in an email to Reuters Health.

For instance, thousands of women have sued the makers of the Dalkon Shield, an IUD sold in the 1970s, because of injuries sustained from infections.

“It’s not surprising, because of the history of the IUD in the United States, that people still have inaccurate perceptions of the device,” said Dr. Rebecca Allen, an assistant professor of obstetrics and gynecology at Brown University, who was not involved in the study.

Currently available devices are considered to be much safer, said Allen.

Indeed, women over age 36 tended to have more misperceptions than younger women who took the survey, the researchers noted in their report.

It’s likely, too, that many women are simply not as familiar with the devices as they are with the pill, said Callegari.

THE PILL IS MOST COMMON METHOD

According to a 2012 study by the Centers for Disease Control and Prevention, 28 percent of women of reproductive age use oral contraception, making the pill the most common form of birth control, followed closely by sterilization methods like getting the fallopian tubes “tied,” used by 27 percent of women.

The same CDC study found that IUD use had risen from 0.8 percent of reproductive-age women in 1995 to 5.6 percent in 2010.

To correct widespread misconceptions about IUDs, Allen said, health care providers should be encouraged to talk to their patients about the devices.

Among women who have never used an IUD, Callagari’s study found that those who had been counseled about the device by a health care provider were more knowledgeable than women who hadn’t discussed it.

“I think it helps to give more evidence that providers should be talking with patients about IUDs,” she told Reuters Health. “Women hear it and it affects their perceptions.” Providers themselves might need to be educated, too.

One recent survey of physicians found that 30 percent had outdated ideas about IUDs, including thinking they are unsafe for women who had never had a baby or being unsure about their safety.

“We need to educate more primary care providers about the facts about IUDs so that they can counsel their patients,” said Allen.  –  MSN NEWS

Teens Should Be Offered IUDs, Top Doctors’ Group Says

By DR. MAUREEN BRAUN, ABC News Medical Unit

Sept. 21, 2012

A leading group of physicians who advise on women’s health has issued new guidelines recommending for the first time that doctors offer intrauterine devices (IUDs) and implantable contraception — methods commonly referred to as long-acting reversible contraception — to teenage patients.

An IUD is a small device placed in the uterus to prevent pregnancy. One type releases small doses of a hormone and can be used for five years; the other lasts 10 years and does not use hormones. Implantable contraception, or an implant, is a flexible, match-stick- sized rod placed under the skin that prevents pregnancy by releasing a hormone used in some birth control pills called progestin.

More than one third of young people ages 15 to 19 are sexually active, yet most teens are not using, and may not even know about, these birth control methods, according to statistics from the CDC’s National Center for Health Statistics.

The American College of Obstetrics and Gynecology (ACOG) issued a paper Thursday evening containing new guidelines to offer IUDs and implants as first-line birth control options for teens.

The paper explains that over 80 percent of teen pregnancies are unintended, and although most teens report having used some form of birth control, they are usually put on short-acting methods, like the birth control pill, patch, ring or shot. All of these short-acting methods have higher failure rates than long-acting methods, often due to incorrect use. Teens are also likely to stop using the short-acting 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.”

Despite the sobering stats on teen pregnancy, many doctors do not offer long-acting methods to teens as their first option for birth control, possibly due to misconceptions about these options.

“It’s such a common thing,” said Dr. Rachel Phelps, medical director of Planned Parenthood’s Rochester/Syracuse Region. “I see teens and women every week who are pregnant because their doctors aren’t well educated in contraception.”

Phelps told the story of one young woman who had her IUD removed when she broke up with her boyfriend because her doctor said IUDs could only be used by women in monogamous relationships. The woman became pregnant and had an abortion.

“When I put the IUD in after the abortion and told her she didn’t have to have it removed in the first place, tears were streaming down her face,” Phelps said. “None of this would have happened if her doctor had been better educated.”

Phelps said she has seen many similar stories.

“All of those abortions and all the emotional turmoil those patients went through could have been prevented if they had been offered long-acting methods earlier,” she said.

Although the guidelines now recommend long-acting reversible contraception as the first-line option, some doctors said short-acting methods may still be the best option for certain patients.

“I can’t say [long-acting methods are the] first line in every case,” said Dr. Rollyn M. Ornstein, associate professor of pediatrics at Penn State Hershey Children’s Hospital. “I love the fact that they’re recommending it, but I don’t think it’s 100-percent-across-the-board the right method for everyone.”

Ornstein noted that many of the doctors teens first see for contraception — pediatricians and adolescent medicine doctors like herself — may not insert IUDs and implants, which can limit these patients’ ability to get these options.

But Dr. Debra Braun-Courville, adolescent medicine fellowship program director at The Mount Sinai Medical Center, said she hopes the new recommendation will encourage such doctors to refer their patients to those who can offer these methods.

“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,” she said.

Published, May, 2012, Health section, page 124, Medical News:

IUDs may be more than just contraception. A large review of over 20 years of studies suggest they may also help protect against cervical cancer. The research, which involved nearly 20,000 participants and spanned the globe, found using the devices reduced a woman’s risk of the disease by nearly 50 percent, possibly by boosting the body’s immune response.

Published Thursday, May 10, 2012

by Paul Taylor, Health Editor The Globe and Mail

(News article, excerpt from the “Human Reproduction” Journal)

Intrauterine devices, commonly known as IUDs, are normally used for long-term birth control. But, in a pinch, they can serve as emergency contraception if inserted into the womb within five days of unprotected intercourse. In fact, a new study suggests these small devices made of plastic and copper coil are more effective than Plan B (levonorgestrel), the medication most frequently used by Canadian women for emergency contraception.

The researchers reviewed data from 42 studies carried out in the United State, Europe and China between 1979 and 2011. “We found IUDs are very, very effective for preventing pregnancy after intercourse,” said Kelly Cleland, a staff researcher at the Office of Population Research at Princeton University.

“The pregnancy rate was .09 per cent – so less than one out of every 1,000 women got pregnant.” By contrast, the failure rate is between 2 and 3 per cent for Plan B, which must be taken within three to five days after sex. “I think women want the most effective option and the safest option. And I think the IUD is that option,” said Ms. Cleland, the lead author of the study which was published in the journal Human Reproduction. But she acknowledges there is “a huge barrier to increasing the uptake of IUDs” – they have to be placed in the womb by qualified health-care providers.

In Canada, gynecologists usually perform this job, although a limited number of primary-care physicians are trained to do so, noted Edith Guilbert, a senior adviser to the National Institute of Public Health of Quebec.

Given the challenge of quickly booking an appointment with a gynecologist, it’s often easier for women to pick up Plan B at a local pharmacy. “It really is too bad because the IUD is an excellent contraceptive – and it can be left in place to ensure ongoing contraception,” said Dr. Guilbert.

It works in several ways. The copper creates a toxic environment for the sperm. Even if the sperm survives, it appears to prevent the fertilized egg from attaching to the lining of the uterus. According to the latest statistics, only about 6 per cent of Canadian women use an IUD as their main method of birth control.

Do you put too much faith in your birth control?

From the Globe and Mail Blog – Posted Monday, Apr. 30 2012, 7:51 PM EDT – By Adriana Barton

http://www.theglobeandmail.com/life/the-hot-button/do-you-put-too-much-faith-in-your-birth-control/article2418522/?utm_medium=Feeds%3A%20RSS%2FAtom&utm_source=Life&utm_content=2418522

Women who think accidental pregnancy only happens to losers who run around having unprotected sex may need a refresher in Birth Control 101.

A surprising number of women are overconfident about contraception, Reuters reports. Of more than 4,100 women seeking birth control, about 45 percent overestimated the effectiveness of the Pill and condoms, according to a new study published in the American Journal of Obstetrics and Gynecology.

Women also put too much stock in hormonal birth-control patches, vaginal rings and injections, researchers found.

Despite its popularity, the Pill has a pregnancy rate of nine per cent a year. Condoms are less effective, with an annual pregnancy rate of 18 to 21 per cent. “We need to do a better job of educating the public – women and men – on the failure rates with typical use,” study leader David L. Eisenberg told Reuters. Condoms fail when they break, leak or are used too late in a sexual interlude.

The efficacy of the Pill drops dramatically when women forget to take it each day or go on medications that reduce the Pill’s effectiveness, such as antibiotics. In contrast, unplanned pregnancies occur in just 0.2 to 0.8 per cent of women who use IUDs, which are implanted in the uterus and release either small amounts of copper or the hormone progestin to prevent pregnancy. The contraceptive implant, which is inserted under the skin of the arm (and is unavailable in Canada), has a failure rate of 0.05 per cent.

Nevertheless, only five to six per cent of American women using birth control choose contraceptive implants or IUDs.

The New York Times noted the IUD is making a comeback in the United States, “after decades of sloppy research, bad publicity, lawsuits and widespread fears of health hazards.” And in the study of 4,100 women, researchers discovered that after a medical professional helped them weigh the options, 71 per cent chose an IUD or implant.

Both methods are expensive. The Mirena IUD – which releases progestin, resulting in lighter periods – costs about $350 in Canada.

Nevertheless, Dr. Eisenberg said that IUDs and implants should be the “default” options offered to women seeking reversible birth control because they do the job so well.

What kind of birth control do you or your partner use? Are you confident you can avoid a pregnancy?

What is the place of the IUD within the different methods of contraception?

A clarification to begin, we need to talk about IUD and no longer stérilet (French common name for IUD), this word evokes sterilization when this is a reversible contraception method. In France, it is used by about 16% of women of childbearing age, at a much higher rate than the European average (12%) which brings this contraceptive method to the 2nd rank in our country.

In general, we need to reconsider the place of IUDs within contraception methods, especially in comparison to the estroprogestatives. These are very effective, with an efficiency rate next to 100%, but in the absence of drug interference and especially provided that compliance is perfect, which is far from always being the case. This problem obviously does not exist with the IUD, where the principal failure reason depends a lot on the doctor: choice of an inappropriate model, incorrect insertion….

We must also consider the cost/efficiency ratio which is very in favor of IUDs. On average, a copper IUD costs 0.45€/ month against 3€/ month for the least expensive pill! The WHO considers that IUDs are, by far, the most efficient contraceptive method in terms of cost/efficiency, even compared to sterilization.

Are the 2 types of IUDs (copper and LNG) comparable at the indication levels?

In principle, the 2 IUD categories are suitable for all women, with nuances thought. Their efficiency and tolerance (evaluated by the rate of continuity) are about the same. Regarding the copper IUDs, for which we have a lot of different models, the efficiency is optimal with those who have more copper (surface between 375 and 380 mm²). The IUD of reference on the global scale is the TCU 380 A, very close to the TT 380 available in France.

These 2 IUDs have the copper wire but also copper sleeves at the level of their horizontal arms. These copper sleeves insure a higher stability of the copper in time. Certain women correspond better to one type of IUD than another.

The copper IUDs are better adapted for women who, for a reason or another, do not want to have hormones and those who want to keep the regularity of their cycles. On the other hand, it is less adapted for women whose menstruations are very heavy, last very long or are very painful.

The LNG IUD is better for these women, and also or women who have had a fibroma or anemia. On the other hand, it is not advisable for women with acne, seborrhea or breast or ovaries cystic dystrophy and those who want regular cycles. Indeed, an adaptation period of about 3 months is necessary, during which spotting may occur and it can induce amenorrhea. This exists in 25% of women during the first 6 months of use and on over 40% afterwards. It can be a reason for its removal. On the other hand, it can be an advantage for women under contraception wanting an amenorrhea.

When should we remove an IUD?

In France, the official life term of a copper IUD is 5 years. It is in fact much longer. Therefore, for the TCU 380 A, which is not commercialized in France but very close to the TT 380, the recommended life is of 8 years in the UK, and even 12 years for certain North American authors.

Also to consider, the age of women. After 40 years of age, the British believe that, with the reduction of fertility, it is not necessary to remove a copper IUD if it is well tolerated and they recommend to leave it until menopause. For my part, I would push back this limit to 45 years of age, but this is a precaution and I believe that the future will bring me to adopt the British position.

These notions do not apply to the LNG IUD: we need to respect the 5 years lifespan, which we can reasonably push to 7 years after the age of 45 years old.

When should the IUD be removed on a menopausal woman?

In principal, all contraception is stopped 1 year after the definitive stop of the periods. However, in a woman of less than 50 years of age, it is more prudent to continue the contraception method during 2 years, false menopausal diagnostics not being rare.

When the menopause is over 1 year, an administration of estrogen for 10-15 days is desirable before the removal of the IUD which might more or less be incarcerated in a uterus becoming atrophied.

Is the contra-indication of IUDs for nulliparous women still justified?

Absolutely not, the recommendations given by the AFSSAPS, ANAES and INPES in December of 2004 are very clear: IUDs are a very efficient contraceptive method of first intention. We should not reserve them only for women who have had 1 or more children. These recommendations are only revolutionary in France, everywhere else, they have been applied for a very long time, following the WHO recommendations.

The PID rate due to an IUD has been revised down year by year. It is estimated by the IPPF at around 1 per 1000, for 1 year of use by nulliparous or multiparous women. This is if it is a modern device, inserted correctly in a woman without ITS (Infection Transmitted Sexually, term preferred to STD) or at low risk of ITS.

Furthermore, it seems now accepted that the risk of subsequent tubal infertility due to a pelvic infection is no higher among women who had an IUD than in others.

In the nulliparous women, especially for those under 25, the real risk is linked to ITS. In young women, we should systematically sought lower genital infection, namely Chlamydia trachomatis, which is the most common cause of pelvic inflammatory disease in our country. When the conditions of a microbiological examination are not met, for a reason or another, and that the insertion of an IUD is desirable, some authors propose preventive antibiotics, guided by the prevalence of pathogens in the geographical area where the patient resides.

The recommendations do not mean that we should largely prescribe IUDs in nulliparous women, in particularly in teens, but these need to be informed that they are a valuable alternative in contraception, especially in those who do have big issues in following procedures with other methods (not only the pill!) or who do not want implants. In the nulliparous wearing IUDs, ITS prevention must therefore be of high importance.

Are actinomycosis more frequent with IUDs?

Actinomycetales are commensal bacteria of the vaginal flora. Their presence on a smear does not mean that there is an infection. If there are no associated symptoms, there is no reason to remove the IUD. A smear to monitor should be done every 6 months for some time, two years according to certain publications, and inform the patient of the warning signs of infection. In the case of associated symptoms, removal and antibiotic treatment should be systematic. In the case of totally asymptomatic patients, the device can be left in place under surveillance. The decision also depends on the woman’s age, parity and desire for children.

Is there an increased risk of infection with IUDs?

This risk exists during the 3-4 weeks following the insertion of the device, without doubt by the transportation of germs from the vaginal cavity. This only highlights the importance of prophylactic measures which we have spoken about and the interest of not changing IUDs too often, which is the best prevention of these infections.

What is the risk of ectopic pregnancy?

A meta-analysis based on 42 studies shows that, not only do IUD not increase the risk of ectopic pregnancy, but that they have a protective effect in that matter! There is, in fact, a 90% reduction of the risk of ectopic pregnancy with women who have IUDs in comparison with women without contraception. On the other hand, when a pregnancy happens, which is rare or really rare with the modern IUDS, the risk of ectopic pregnancy is higher than for women pregnant without IUDs.

Should we contra-indicate non-steroidal anti-inflammatories with women wearing an IUD?

This is only a contra-indication which existed in France and in no other countries. It was based on studies containing a lot of bias. A recent French report, currently under press, having included near 300 women has just demonstrated that NSAIs are not a failure factor of the IUD as a contraception method, like no other medicine. On the other hand, it brings new data: the risk is higher with women who have has prior IUD expulsions.

What is the future of IUDs?

I believe excellent! A lot of taboos need to fall concerning IUDs, especially on the risk of PID, ectopic pregnancies, and NSAIs, nulliparous women, and to avoid succumbing to blindness, without discerning the lures of novelty. The diversity of the models existing allows the prescription of an effective IUD, well tolerated and adapted to each women who would want this contraception method.