Intrauterine devices (IUDs) are a 99 percent effective, insertable form of long-acting contraception (lasts for years), which use copper or hormones to block sperm from fertilizing eggs. They have become an increasingly popular form of contraception, but many pediatricians providing birth control for teens haven’t been trained to insert them.
Gynecologists are up-to-date with the device, but some teenage girls don’t see a gynecologist until they are 18-years-old, even if they are sexually active. For some young women, IUDs would not only be ideal because they likely won’t plan to get pregnant in the near future, but it also doesn’t require remembering to take a pill or apply a patch.
“So many kids never pick up the pills, or pick up the pills and don’t take them right,” said Melanie Gold, the medical director of Columbia University’s School-Based Health Centers. “Clearly, an IUD is a better choice.”
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Kaiser Health News detailed the current status of IUD use and approval:
Last fall, the American Academy of Pediatrics for the first time recommended IUDs as a first-line form of contraception for adolescents who have sex, though condoms and the pill are also accepted options. This recommendation builds on support from the American College of Obstetricians and Gynecologists, which in 2011 termed it the most effective form of birth control and noted that it posed minimal risks. A year later, the group recommended it specifically for teens. Rare problems reported include disruption of menstrual cycles and, in rarer instances, perforation of the uterus. The IUD also can occasionally be expelled by a woman’s body, meaning it no longer prevents pregnancy.
Pediatric residents only spend one month studying “adolescent medicine.” That includes learning about contraception, and Julia Potter, a doctor based in New York-Presbyterian Hospital’s pediatric department, says often times the instructors of this portion of training doesn’t even know how to insert an IUD.
Gold says it could take a resident up to 10 times inserting an IUD to be comfortable administering it.
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Pediatricians who aren’t comfortable with the insertion procedure might refer a patient to a gynecologist, but that gets complicated for privacy reasons. A teen might want to have safe sex but might not want a gynecologist visit to show up on her parents’ insurance bill. In cases like this, Planned Parenthood is an option (no insurance bill sent to the parents), but teens are generally less likely to follow up with referrals for a variety of logistical reasons.
It isn’t clear how residency curricula might change in the future to prepare pediatric residents for IUD insertion, among other forms of contraception, but it could make a big difference for sexually active teenage girls.
Mandy Coles, co-author of a JAMA editorial on the subject and an adolescent medicine physician and assistant professor of pediatrics at Boston University School of Medicine, said it’s hard to know when or how this will happen.
“The bottom line is this is going to take more time and advocacy and research to improve training,” she said.
