IUDs for Teenage Girls, What You Should Know
New guidelines from the American Congress of Obstetricians and Gynecologists (ACOG) recommend implantable contraception and IUDs for teen girls, which may help reduce some of the more than 80% of teenage pregnancies that are unintentional, as noted in the ACOG paper. But how much do you, and especially teenage girls, understand about IUDs? Here's a review of what you should know about today's IUDs.
IUDs have come a long way
The predecessor to today's modern IUD (intrauterine device) was invented in the late 1920s by Dr. Ernst Grafenberg, whose version of the IUD was shaped like a ring, unlike today's "T" shaped device. (By the way, the G-spot is named for Grafenberg.)
As different scientists worked to improve the IUD over the decades, the device not only changed shape but the materials used to make it evolved as well, from silver filaments to stainless steel, plastic, and copper. In the 1960s and 1970s, researchers worked on various hormonal IUDs, which eventually gave us one of the two types of IUDs available today.
Today, the two types of IUDs are hormonal and copper. Both of them prevent fertilization of an egg by killing or damaging sperm, but they do this in different ways.
- Hormonal IUDs (e.g., Mirena®) contains the hormone levonorgestrel, which is a type of progesterone. A hormonal IUD prevents pregnancy in several ways: killing or harming the sperm, making the mucus in the cervix thick so sperm can't reach the uterus, and helping make the uterine lining an unappealing place for a fertilized egg to implant itself. About 2 in 1,000 women become pregnant during the first year of getting a hormonal IUD.
- Copper IUDs (e.g., ParaGard®) consists of copper wire wrapped around the stem portion of the T-shaped device. It can stay in place at least twice as long as a hormonal IUD--for at least a decade. A copper IUD works by causing a woman's uterus and fallopian tubes to produce a fluid that kills sperm. About 6 in 1,000 women become pregnant during the first year of getting a copper IUD.
An IUD is inserted by a doctor in his or her office or clinic and takes only a few minutes. Patients are instructed on how to feel for the string attached to the IUD, which is how a female can check her IUD periodically to be sure it is still in place.
After an IUD has been placed, it is common to experience some mild spotting or cramping for a day or two. Females should see their doctor once a year for a checkup.
Advantages of an IUD
An additional benefit of the copper IUD is that it can be used as a form of emergency contraception by a female if she has it inserted within a few days of having unprotected sex. In fact, a recent study published in the Cochrane Database of Systemic Reviews rated it the most effective form of emergency contraception. However, emergency contraception use of a copper IUD is only for females who will continue using the IUD for birth control.
An IUD can do more than prevent pregnancy. For example, a hormonal IUD
- Reduces heavy menstrual bleeding by as much as 90% within a few months of use
- Reduces cramping and, in some women, cause menstrual periods to stop altogether
- Helps prevent ectopic pregnancy, endometrial hyperplasia (abnormal thickening of the uterine lining that causes pain and heavy bleeding), and endometrial cancer
- Provides relief from endometriosis
- Eliminates the need to remember to take daily birth control pills
In addition, unlike birth control pills, a hormonal IUD does not cause women to gain weight.
Disadvantages of an IUD
As with any medical procedure or product, there are also downsides. For example:
- A copper IUD may increase a female's chances of menstrual bleeding, cramps, or spotting between periods
- The risk of the IUD being pushed out of the uterus into the vagina ranges from 5 to 22 percent among adolescents. This is not a dangerous or harmful event, but a doctor will need to reinsert the IUD if this occurs.
- An IUD does not protect against sexually transmitted diseases; however, neither do birth control pills, spermicides, or implantable contraception
- Cost is a significant factor: an IUD costs $500 or more, plus the cost of insertion, although in the long run the cost is less than if a female used birth control pills every month. The cost may be covered by insurance, while uninsured females may get assistance from Medicaid or various health clinics.
- Hormonal IUDs may cause side effects similar to those associated with the use of the pill, such as mood swings, headache, and tender breasts, although they are rare.
The ACOG guidelines encourage healthcare providers to counsel adolescent users of IUDs about the changes in menstruation they can experience after insertion of a device. Overall, the ACOG notes that "adolescents should be encouraged to consider LARC [long acting reversible contraception] methods," that "complications of IUDs...are rare," and that healthcare providers should make IUDs and implantable contraception available to teenage girls for effective birth control.
American Congress of Obstetricians and Gynecologists, Committee on Adolescent Health Care Long-Acting Reversible Contraception Working Group
Cheng L et al. Interventions for emergency contraception. Cochrane Database Systemic Reviews 2012 Aug 15; 8:CD001324
Image: Wikimedia Commons