In an updated policy statement published in the October 2014 Pediatrics, the American Academy of Pediatrics recommended that a long-acting reversible contraceptive (LARC) – either an intrauterine device (IUD) or a subdermal implant (Nexplanon) – be the first-line contraceptive choice for sexually active adolescents.
Dr. Kate Debiec, a pediatric and adolescent gynecologist at Seattle Children’s, provides answers to frequently asked questions.
Q: Are IUDs safe and tolerated in adolescents?
A: Yes and yes. Older IUDs were associated with a greater risk for pelvic infections, but current IUDs are very safe. The rate of pelvic infection increases only 0% to 2% immediately following placement. After 21 days, there’s no increase in infection rates.1
IUDs also do not increase infertility risk. I tell my patients I can’t guarantee their future fertility because there are many factors involved, but I can assure them that IUDs themselves do not cause infertility.
IUD placement can be uncomfortable or even painful, but I’m astonished at how well adolescents tolerate it. I provide a lot of guidance before insertion so patients know what to expect. I also provide pain medication for patients who request it. We can even do the procedure under anesthesia if a patient is unable to tolerate clinic placement.
While expulsion rates are higher for adolescents, that’s not a contraindication for IUDs.
Q: What follow-up is necessary after IUD placement?
A: We give our patients an aftercare handout that tells them what to expect, under what circumstances they should call us and who they should call if they have concerns. If the IUD is strictly for contraception, we offer a follow-up appointment at one month, but some of our patients choose not to come to a follow-up visit if everything is going well.
In general, we see our gynecologic patients once a year to touch base, though an exam is not necessarily performed at each of these visits.
Q: How do you counsel patients about choosing an IUD versus a Nexplanon implant?
A: The choice that works best is usually the one they’re most comfortable with. Some patients are more uncomfortable with the idea of an implant in their arm. Others feel more uncomfortable with having something placed in their uterus.
The unintended pregnancy rate in the first year of use is 0.05% for implants and 0.2% to 0.8% for IUDs.1 More patients stop their periods with IUDs (20% to 40%) than with implants (20%).2 For those whose periods continue, IUDs typically make them lighter. Implants don’t necessarily do that.
Overall, similar numbers of patients decide to take out their IUDs or implants early.
Q: Do IUDs increase the risk for sexually transmitted diseases (STDs) because they increase sexual activity?
A: IUDs and other contraceptives do not increase promiscuity. I am very clear with patients that IUDs do not protect against STDs. I tell them the only way to protect against STDs is to use a condom. Condoms should not be their sole form of birth control, but they should always use condoms in addition to other forms of contraception to protect against STDs.
- Ott M, Sucato G, et al. American Academy of Pediatrics Contraception for Adolescents policy statement. Pediatrics 2014;134;e1244.
- Hidalgo M, Bahamondes L, Perrotti M, Diaz J, Dantas-Monteiro C, Petta C. Bleeding patterns and clinical performance of the levonorgestrel-releasing intrauterine system (Mirena) up to two years. Contraception 2002 Feb;65(2):129-32.