Wednesday, May 09, 2012

Push IUD's on them!

I've noticed in the literature on contraception there has been a major trends towards pushing IUD's as an effective, reversible and highly effective form of contraception.

Well, let's see what the realities are:


We searched our electronic clinic database to identify females ≤19 years old who underwent attempted IUD insertion between January 2007 and June 2009. This retrospective cohort study primarily compared the insertion and postinsertion experiences between nulliparous and parous teens.


Of the 307 charts reviewed, the majority of subjects were white (73.4%) and nulliparous (77.5%), with a median age of 18 years (range 15-19).

The vast majority (96.4%, 296/307) had a successful IUD insertion upon first attempt; all of the 11 unsuccessful IUD insertion attempts were among nulliparous teens.

Follow-up was available for 56% (172/307).

During the first 12 months of use, there were 2.9% (5/172) IUD expulsions and 24.4% (42/172) removals, with no differences between nulliparous and parous teens.

IUD continuation at 6 months was 83.3%.

Pelvic inflammatory disease was diagnosed in 4.6% (8/172) of post-IUD insertions.

There were no pregnancies reported in those teens with IUD continuation, while six were reported in subjects who underwent IUD removal.

Independent predictors of IUD discontinuation were a history of chronic pelvic pain or dysmenorrhea, and bleeding and/or pain complaints at any post-IUD visit.

So 24% of those teens had the IUD removed.

That says something about the method itself, aside from its actual effectiveness. Only 83% were still using it after six months. That's not a ringing endorsement in my book. One in six had a problem with it.

Six of the subjects reported pregnancies, after discontinuation. Now, if IUD was so wonderful, how come they didn't keep the IUD and prevent it in the first place?

And five per cent had pelvic inflammatory disease. Blecch. That's an acceptable level of a complication that serious for people so young. Really?

Contraception is the same darn thing over and over again: the false promise of risk-free sex. I know people MENTION the possibility of pregnancy, but they act like it's not.

Contraception. 2012 May 4. [Epub ahead of print]
Adolescent experience with intrauterine device insertion and use: a retrospective cohort study.
Bayer LL, Jensen JT, Li H, Nichols MD, Bednarek PH.