Fear of having something in uterus deters teen girls from using intrauterine devices for birth control

Very few teenage girls in the United States use intrauterine devices for birth control, even though studies show they are safe, effective and extremely low-maintenance, according to researchers at Lucile Packard Children's Hospital and the Stanford School of Medicine.

“It's just the fear of having something in your uterus”

In a paper published June 2010, in the Journal of Pediatric and Adolescent Gynecology, lead author Sophia Yen, MD, MPH, a board-certified specialist in adolescent medicine at Packard Children's, and her co-authors report that more than a dozen studies show teenagers with intrauterine devices (IUDS) were as likely or more likely to continue using them compared with teens using birth-control pills. Furthermore, IUDs can work for as long as five or 10 years, depending on the type; are cost-effective; and are more than 99-percent effective at preventing pregnancy, the authors note.

And while the popularity of IUDs appears to be growing, the percentage of teens who use them is still tiny. From 2006 to 2008, 1 percent of U.S. girls ages 15-19 used IUDs for birth control — up from 0.1 percent in 2002 — while 15.2 percent used birth-control pills, according to the National Survey of Family Growth. (Among U.S. women ages 15-44, 3.4 percent used IUDs and 17.3 percent used the pill from 2006 to 2008.)

"The IUD has an undeserved bad reputation both in the public and among physicians," said Yen, who is also a clinical instructor in pediatrics at the medical school. "There's the myth that they're not appropriate for women who haven't yet given birth, and the myth that they increase the risk of pelvic inflammatory disease."

The first myth, she said, is probably a vestige of early medical liability fears: Doctors wanted to make sure a woman had already had a baby to avoid possible lawsuits alleging that IUDs had rendered them infertile.

Countering this myth, the authors highlight the 2006 British adaptation of World Health Organization Medical Eligibility Criteria for contraception, which states that previous IUD use is not associated with reduced fertility.

The second myth likely stems from the notoriety of a popular brand of IUD marketed in the 1970s. "Some mothers of today's teenagers remember the Dalkon Shield, which was associated with a significant risk of infection and basically gave IUDs a bad name," said Paula Hillard, MD, senior author of the paper. "So there is some of that lingering concern."

Studies show a slightly increased risk of pelvic inflammatory disease during the first month after IUD insertion. This risk is likely due to bacteria — either those normally living in the vagina or those from a sexually transmitted disease — that can be carried into the uterus when the IUD is inserted. But beyond that initial interval, women who have IUDs are at no greater risk for PID than women who don't have them.

And IUDs are as effective as sterilization but entirely reversible, noted Hillard, a pediatric gynecologist at Packard Children's and a professor of obstetrics and gynecology at the medical school.

According to the paper, however, many adolescents either don't know about the option or else have serious reservations about it. "In one survey, 60 percent of adolescents were unaware of IUDs as a contraceptive option," the authors write. "Anecdotally, size is one of the most frequent questions asked at the first IUD evaluation visit."

IUDs are slender, T-shaped objects — about half the length of your index finger. The placement of the device is probably one source of trepidation for adolescents. "It's just the fear of having something in your uterus," Yen said.

For a couple of months after insertion, some women may feel uterine tenderness akin to menstrual cramps. For some young women, the insertion can cause moderate discomfort and, in some cases, severe pain, the researchers say. Physicians can administer a painkiller or local anesthetic to make the process more tolerable.

Both Yen and Hillard emphasized that IUDs should be used in tandem with condoms to prevent the acquisition and spread of sexually transmitted diseases. On the whole, the authors assert that IUDs are especially well-suited for teen-agers.

"Adolescents may have difficulty with consistent oral contraceptive use, and are at a particularly high risk for unintended pregnancy with resultant negative consequences to their lives," the authors conclude. "Thus, IUDS are appropriate for adolescents, as many would like to avoid pregnancy for 5 or more years to allow completion of educational or career goals."

SOURDE Lucile Packard Children's Hospital and The Stanford University School of Medicine