This Isn't Your Mom's IUD

IUD use by teens found to be safe with lower complications for hormonal IUD

(RxWiki News) Back in the early days of intrauterine devices, or IUDs, complications were more common. But today, IUDs are a safer method of birth control for all women, including younger ones.

A recent study found that IUDs were just as safe for girls aged 15 to 19 as for older women.

In the past, doctors had been hesitant to insert IUDs into teens. However, this study showed that the rate of complications was no greater for teens than for women aged 20 to 24 or aged 25 to 44.

The study also found the hormone-released IUD had fewer complications than the copper IUD.

"Talk to your OB/GYN about effective birth control methods."

The study, led by Abbey B. Berenson, MD, PhD, of the Department of Obstetrics and Gynecology at the University of Texas Medical Branch in Galveston, looked at the safety of IUDs for teenagers.

An IUD is a Y-shaped device inserted into a woman's uterus. It prevents pregnancy by agitating the uterine lining so an egg cannot be implanted.  Some IUDs also release localized hormonal birth control as a second method. Depending on the type, IUDs can be left in place for five to ten years.

The researchers used data from health insurance claims at a private insurance company to identify 90,489 women who had an IUD inserted between 2002 and 2009.

Then the researchers looked at how many women were likely to experience complications from the IUD, to become pregnant (device failure) or to stop using the IUD within the first year of its insertion.

The researchers found fewer than 1 percent of patients experienced a serious complication, including pelvic inflammatory disease or an ectopic pregnancy, regardless of which kind of IUD they had.

Ectopic pregnancies are pregnancies that occur in the fallopian tubes. They are not viable (the embryo cannot survive) and can be fatal to the woman.

Those patients aged 15 to 19 who had an IUD were about 40 percent more likely than those aged 25 to 44 to also have seen their doctor for painful periods. The teenagers were 30 percent more likely to have seen their doctor because their periods had stopped entirely, which is one known possible side effect of an IUD.

Other possible but uncommon side effects of the copper IUD include anemia (poor production of red blood cells), backache, bleeding between periods, cramps, inflammation of the vagina, pain during sex, severe menstrual pain and vaginal discharge.

Possible but uncommon side effects of the hormonal IUD include headache, acne, breast tenderness, mood changes, weight gain, ovarian cysts and abdominal or pelvic pain.

The adolescents were also 40 percent more likely to experience device failure (and become pregnant) vs. older patients.  Overall this chance is still very low in all groups.

The researchers found almost no difference between the teens and the older women in terms of discontinuing IUD use early. While 13 percent of the teens had the IUD removed early, 11 percent of the older women had it removed early.

"Adolescents are an incredibly important age group for consideration of long acting, reversible contraceptives (LARCs), including IUDs," said Stephanie Tillman, MSN, a Certified Nurse Midwife and a dailyRx expert. "This study adds to the growing body of evidence that IUDs are safe and effective methods for this age group and other women [who have never been pregnant]."

Tillman said she has inserted IUDs in many patients, including teenagers, and that any risks are usually more likely to occur at the time a person first gets an IUD.

"As has always been the case, the greatest risk of infection is at time of insertion," Tillman said. She also noted that IUDs cannot prevent sexually transmitted infections, so condoms should be used to reduce the risk of STIs.

One difference the researchers found in this study was related to the IUD types. The IUDs that released hormones were linked to fewer complications than the copper IUDs. Women were also less likely to have the hormonal IUDs removed early compared to the copper ones.

The most common US brand name for the hormonal IUD is Mirena. The common US brand name for the copper IUD is ParaGuard.

"The IUD is as appropriate for teenagers to use as it is for older women, with serious complications occurring infrequently in all groups," the researchers concluded. "The levonorgestrel-releasing intrauterine system may be a better choice than a copper IUD as a result of lower odds of complications, discontinuation, and failure."

The study was published in the May issue of the journal Obstetrics and Gynecology. The research was funded by the Society of Family Planning with additional support from the Institute for Translational Sciences at UTMB, the National Center for Research Resources, the National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The authors declared no conflicts of interest.

Review Date: 
April 9, 2013