IUD as teen girls’ first choice for birth control

Pediatricians recommend intrauterine devices over the pill for contraception

TORONTO Teen girls who are considering contraception should look to intrauterine devices as their first-line choice, as they provide the greatest protection against an unplanned pregnancy, the Canadian Paediatric Society recommends.

Known as an IUD or IUS, the small and often T-shaped device is placed inside the uterus and is more than 99 per cent effective in preventing pregnancy, compared to 91 per cent for birth control pills and 82 per cent for condoms, the pediatric society says.

An IUD, or intrauterine device, typically incorporate copper in its design, which is toxic to sperm. An IUS, or intrauterine system, releases a small amount of hormones over time. Both act continuously over the course of several years, but can be removed at any time by a health-care provider.

“Intrauterine contraception and the long-acting reversible contraceptives in general ... those should be your first line because they’re the most effective,” said Dr. Giosi Di Meglio, a co-author of the paper and a specialist in adolescent medicine at the Montreal Children’s Hospital.

That doesn’t mean young women shouldn’t choose the pill or other forms of birth control like a skin patch or injectable contraceptive, she said.

“What we’re saying is this should be an option and this should be something that we think about that leads our list of options.”

Di Meglio said that depending on the particular type, copper-based IUDs may not need to be replaced for five to 10 years, while the protective lifespan of an IUS ranges from three to five years.

The devices do carry a small risk of tissue perforation during insertion through the vagina, and doctors also monitor patients for possible bacterial infection for a few weeks after the device is implanted. But Di Meglio said such an occurrence is rare and can be treated with antibiotics.

Studies suggest IUDs are not a direct conduit for infection, and there is a theoretical possibility that IUSs may actually decrease the risk of infection, she said.

Still, the idea of having a device inserted may cause anxiety for some teen girls, and Di Meglio concedes the procedure can initially be somewhat uncomfortable.

“You get a few pretty intense cramps, but nothing more than you would have with a really bad period,” she said. “It subsides pretty quickly and then for the next few days, you might have a few cramps on and off.”

Di Meglio said a girl can get an IUD or IUS any time after getting their first period and ideally prior to becoming sexually active. By age 17, about half of Canadian youth are having sex, the CPS says.

“We’re not recommending that this be used the minute the kid has their first period, but there are certain benefits in using the hormonal IUS — one of them being that it can reduce the amount of bleeding or also reduce cramping a lot,” she said.

“We have even used it for that reason instead of for contraception in kids who have not even had sex.”

Andrew Townsend of Planned Parenthood Toronto welcomed the CPS recommendation, saying the clinic gets a lot of questions from young people who “still view the pill as the first kind of birth control that they should start on or that they have to start on.”