In the United States, 42% of adolescents aged 15–19 years have had sexual intercourse. Although almost all sexually active adolescents report having used some method of contraception during their lifetimes, they rarely select the most effective methods. Adolescents most commonly tend to choose contraceptive methods with relatively high failure rates such as condoms, withdrawal, or oral contraceptive (OC) pills.
Short-acting contraceptive methods, including condoms, oral pills, the contraceptive patch, the vaginal ring (Nuvaring), and depot medroxyprogesterone acetate (DMPA or depo) injections, are mainstays of adolescent contraceptive choices. However, these contraceptives have lower continuation rates and higher pregnancy rates than LARC methods.
IUDs are placed by a healthcare provider into the uterus through vagina and the cervix. Most are made of molded plastic and have a string that you can feel in the vagina, but does not extend outside the body. IUDs currently available in the United States do not increase a woman’s risk of ectopic pregnancy, infertility, or long-term risk of infection.
Two types of IUDs are currently available:
- Copper-containing IUD (brand name: Paragard) prevents pregnancy by preventing sperm from reaching the fallopian tubes. The copper-containing IUD lasts for at least 10 years and is highly effective in preventing pregnancy.
- Levonorgestrel-releasing IUDs or hormonal IUD’s (brand names Mirena and Skyla) prevent pregnancy by thickening the cervical mucus and thinning the endometrium (the lining of the uterus). They also decrease menstrual bleeding and pain. The Mirena IUD lasts for at least five years, and the Skyla IUD lasts for three years. Both are highly effective in preventing pregnancy.
Common concerns
1. Are Intrauterine devices are safe to use among adolescents?
Current evidence demonstrates the safety of modern IUDs. They have a very low complication rate and no toxic or poisonous effects.
2. Do Intrauterine devices increase an adolescent’s risk of infertility?
There is no increased risk of Infertility after discontinuation of IUD. In a large case–control study that examined determinants of tubal infertility, the presence of past or present chlamydial infection was associated with infertility irrespective of IUD use.
3. Is it difficult to introduce Intrauterine devices in adolescents and/or women who have not given birth?
Little evidence suggests that IUD insertion is technically more difficult in adolescents compared with older women. Appropriate counseling regarding pain and provision of pain relief during IUD insertion helps in alleviating the discomfort. Your doctor may recommend taking a NSAID (non steroidal anti-inflammatory drug like ibuprofen or Aleve) to minimize the pain at insertion. Your gynecologist may give a local anesthetic injection to minimize the pain at insertion (like a dental anesthetic injection before a tooth extraction).
4. Should girls be should be routinely screened for STIs (eg, gonorrhea and chlamydia) at the time of IUD insertion?
Women aged 15–19 years have the second highest rates of chlamydia and the highest rates of gonorrhea of any age group. Thus, all adolescents should be screened for STIs at the time of or before IUD insertion.
5. Do Intrauterine devices cause heavy periods?
Women using either copper IUDs or the levonorgestrel intrauterine system can expect changes in their menstrual bleeding especially in the first months of use. The copper IUD may cause heavier menses that can be treated with NSAIDs.
Women using the levonorgestrel intrauterine system (Mirena) will have a decrease in bleeding over time that will lead to light bleeding, spotting, or amenorrhea.
6. How effective are IUD’s in preventing pregnancy?
Intrauterine devices and the contraceptive implant are the best reversible methods for preventing unintended pregnancy, rapid repeat pregnancy, and abortion in women across all age groups. The risk of pregnancy with an IUD is below 1%.
7. What are the risks or complications expected with an IUD?
There is a small risk that the IUD will come out, sometimes during your period. You should check your IUD once per month, after your menstrual period, by finding the strings inside the vagina. If you cannot feel the strings, use a backup method (eg, condoms) until you can see a healthcare provider to be sure the IUD is still there. There is a very low risk of developing an infection after placement of the IUD, and of improper placement.
8. What if I get pregnant with an IUD?
If you become pregnant while using an IUD, you need an ultrasound of the uterus to be sure that the pregnancy is inside the uterus, rather than in the fallopian tube (called an ectopic pregnancy). The IUD should be removed, if possible, when the pregnancy is discovered.
9. How often do I need to get checked if I have an IUD?
You need to see your gynecologist at least once a year to make sure that the IUD is still in place. Your doctor may do an ultrasound to locate the IUD if there are any doubts.
10. What is the best time in the menstrual cycle to insert an IUD?
The best time for insertion of an IUD is right after periods. Your doctor may ask you to come in towards the end of the period to get the IUD inserted. This is to make sure that you are not pregnant at the time of insertion and also allow easier insertion because the cervix is softer and allows easy insertion at that time.
11. Is IUD also a method of emergency birth control?
Yes. It can be inserted within 5 days of unprotected intercourse. It does not cause an abortion.
If you have any further questions or concerns, please consult your gynecologist or feel free to see us at “Walk IN GYN Care”.