What do young women know about IUDs?
The next patient in your exam room is an 18-year-old female. What do you think she knows about intrauterine contraception?
Not much, according to results of a recent cross-sectional survey.1 More than half of women between the ages of 14 and 24 who participated in the survey said they had never heard of an intrauterine device (IUD), and 97% had never used one. Eighty-four percent of the women had been sexually active; about 25% of those sexually active had been pregnant.1
This lack of knowledge may stem from providers who may not discuss the method during contraceptive counseling, says Lisa Johnson, MD, who presented results of the survey at the recent North American Society for Pediatric and Adolescent Gynecology annual meeting in Atlanta. Johnson, now an adolescent medicine physician with the Nassau (Bahamas) Department of Public Health, worked with researchers from Chicago and Pittsburgh during her fellowship at the Children's Hospital of Pittsburgh's Division of Adolescent Medicine.
Health care providers do not offer IUDs as a routine method of contraception to adolescents because of their own misinformation about the safety of the method, observes Melanie Gold, DO, an associate professor in the Department of Pediatrics at the University of Pittsburgh School of Medicine and in the Department of Behavioral and Community Health Sciences at the Graduate School of Public Health. Teens also get misinformation from their mothers and grandmothers about the "dangers" of IUDs, says Gold, a co-author of the paper. Some have been told IUD use leads to infertility or causes infections, she notes.
Check the survey
In performing the survey, researchers looked to determine:
- What do young women know about intrauterine contraception, and how do they feel about it?
- How much do they like the idea of an IUD for themselves after they are informed about intrauterine contraception?
- What IUD characteristics are appealing to this group?
- What participant characteristics are associated with a positive view of IUDs?
Participants were given a 20-minute, 44-item semi-structured interview assessing demographics, sexual history, contraceptive use and attitudes, and IUD knowledge and attitudes if they had heard of the method. Researchers provided a two-minute description and demonstration of IUDs followed by a test of knowledge for all participants.
Most (80% and above) of participants agreed or strongly agreed they would consider a birth control method where they would experience less painful and lighter periods, as well as one they could initiate and stop. About 60% said they would be willing or very willing to use a birth control method that causes irregular vaginal bleeding if it were to deliver a high effectiveness rate. However, only 30% of the respondents said they would consider a birth control method that involved placing a small plastic object in the uterus, and only 27% said they would be interested in a device that had to be placed and removed by a health care provider.
Following the two-minute presentation, 65% of survey participants said they liked the idea of an IUD for themselves; most of those who answered in this manner were sexually active. What were the most appealing characteristics of the IUD? The most popular survey responses included: "It does not affect ability to have children in the future" (81%), "It is not necessary to use every day" (71%), and "It is not necessary to remember with each sex act"(67%).
Take the time
Two intrauterine contraceptives are available in the United States: the Mirena levonorgestrel intrauterine system (Mirena LNG IUS; Bayer HealthCare Pharmaceuticals; Wayne, NJ) and the Copper T 380A intrauterine device (ParaGard IUD; Barr Pharmaceuticals, NY). The ParaGard IUD is approved for 10 years of contraception; the Mirena is approved for five years of birth control.
The World Health Organization eligibility criteria classes use of IUDs in young women ages 20 and younger, as well as for nulliparous women, as a "2" — for a situation in which the advantages of using the method generally outweigh the theoretical or proven risks.2 The ParaGard IUD is now approved for use for nulliparous women in stable relationships from ages 16 through menopause. Women with a history of sexually transmitted diseases or pelvic inflammatory disease (PID) are no longer contraindicated for use of ParaGard, unless a patient currently has acute PID or engages in sexual behavior suggesting a high risk for the disease, the labeling states.
More providers need education on intrauterine contraception, says Allan Rosenfield, MD, dean of the Mailman School of Public Health at the New York City-based Columbia University. Several obstetrics and gynecology residencies fail to include IUD insertion/removal training, yet the Copper T 380A and the Mirena are probably the most effective, reversible methods of contraception available, he notes.
"The IUD should be much more highly recommended as a major contraceptive in family planning programs and most particularly by OB-GYNs," states Rosenfield.
- Johnson L, Whitaker A, Harwood B, et al. Adolescent and young women's knowledge and attitudes toward using intrauterine contraceptive devices (IUDs). J Pediatr Adolesc Gynecol 2007; 20:S115-S116.
- World Health Organization. Medical Eligibility Criteria for Contraceptive Use. Geneva: World Health Organization; 2004.