<p>Bunsenburner, I could link to the studies the articles cited, I was looking for something a little more user friendly.</p>
<p>calmom, I’m fine with Medline and scientific papers. When the drug maker itself does not recomment it to a certain slice of the population, it makes you wonder…</p>
<p>Volume 23, Issue 3, Pages 123-128 (June 2010)</p>
<p>IUDs and Adolescents—An Under-Utilized Opportunity for Pregnancy Prevention</p>
<p>Sophia Yen, MD MPH1, Tammy Saah, MA2, Paula J. Adams Hillard, MD3
published online 06 November 2009.</p>
<p>Abstract
Most pregnancies in adolescents are unintended and preventable if contraception were utilized. IUDs provide an under-utilized highly effective form of contraception. IUDs are appropriate for nulliparous women, including adolescents. IUDs do not increase: the incidence of Pelvic Inflammatory Disease after the 1st month of insertion, the odds of infertility, nor rate of ectopic pregnancy. Adolesecnts need more education about and increased access to IUDs. Practical points regarding IUD selection and insertion in adolescents are reviewed, including pain prophylaxis, anticipatory guidance, side effects and complications. In summary, IUDs are safe for contraception in most adolescents. IUDs are effective and eliminate the need for ongoing adherence and thus have the potential to decrease unplanned pregnancies.</p>
<p>Source: [Elsevier[/url</a>]</p>
<p>Journal of Women’s Health
Advances in Contraception: IUDs from a Managed Care Perspective</p>
<p>Abstract</p>
<p>Contraceptive use in the United States is virtually universal among women of reproductive age. However, unplanned pregnancies continue to occur and can be largely attributed to the nonuse and misuse of contraception. Reducing unintended pregnancies constitutes a critical goal for managed care and the public. This can be achieved in part with intrauterine devices (IUDs), which are an effective method of contraception that require a one-time insertion and stay in place for 5–10 years. Therefore, compliance issues are largely mitigated, and actual use efficacy is the same as perfect use efficacy. The IUD is also reversible, unlike tubal ligation, and could potentially be the contraceptive of choice in today’s environment. Unfortunately, safety concerns surrounding the use of older IUDs have precluded many women from recognizing the benefits of their use. Currently, the only approved IUDs in the United States are ParaGard®, the copper IUD, and Mirena®, the levonorgestrel-releasing intrauterine system (LNG-IUS). These devices offer superior safety profiles compared with those products that were withdrawn from the market in the 1970s. In addition to a favorable safety and tolerability profile, the LNG-IUS offers an advantage over copper IUDs, demonstrating improved efficacy in preventing intrauterine and ectopic pregnancies. Successful communication between patients and providers regarding the improved safety and efficacy of newer IUDs will ensure an appropriate place in therapy. Thus, greater numbers of women will recognize the IUD as a safe, cost-effective means to contraception, thereby reducing the economic and social burdens associated with unplanned pregnancies</p>
<p>Source: [url=<a href=“http://www.liebertonline.com/doi/abs/10.1089/jwh.2008.0814]Mary”>http://www.liebertonline.com/doi/abs/10.1089/jwh.2008.0814]Mary</a> Ann Liebert, Inc. - Journal of Women’s Health - 17(6):987](<a href=“http://www.jpagonline.org/article/S1083-3188(09)00305-2/abstract]Elsevier[/url”>http://www.jpagonline.org/article/S1083-3188(09)00305-2/abstract)</p>
<p>The levonorgestrel intrauterine system in nulliparous women</p>
<p>Sarah Prager, Philip D. Darney
Received 4 December 2006; received in revised form 22 January 2007; accepted 24 January 2007. published online 05 April 2007.</p>
<p>Abstract
The levonorgestrel intrauterine system (LNG-IUS) has been used internationally for over 15 years by 7 million women. Concern about providing the LNG-IUS to nulliparous women still exists, despite growing evidence of its safety and efficacy in this population.</p>
<p>Expulsion rates do not vary by parity and, although evidence in nulliparas is scant, perforation rates are low in all women. Efficacy of the LNG-IUS is excellent regardless of parity, with less than 1 pregnancy per 100 woman-years of use. Efficacy with immediate post-abortal insertion is also excellent and unvaried by parity. The presence of an LNG-IUS does not increase the risk of PID or infertility in either parous or nulliparous women and the LNG may be protective against infection. Acceptability is high in nulliparous women when compared either to parous LNG-IUS users or to nulliparous users of combined oral contraceptive pills.</p>
<p>In conclusion, LNG-IUS is both safe and extremely efficacious for use in nulliparous women.</p>
<p>Source: [url=<a href=“http://www.contraceptionjournal.org/article/S0010-7824(07)00078-9/abstract]Elsevier[/url”>http://www.contraceptionjournal.org/article/S0010-7824(07)00078-9/abstract]Elsevier[/url</a>]</p>
<p>I find this statement pretty clear:</p>
<p>The levonorgestrel intrauterine system (LNG-IUS) has been used internationally for over 15 years by 7 million women…The presence of an LNG-IUS does not increase the risk of PID or infertility in either parous or nulliparous women and the LNG may be protective against infection.</p>
<p>If you would read the Slate and Newsweek articles rather than treating them with disdain, you would find a pretty clear explanation as to the Mirena marketing strategy. Partly its dictated by the history of FDA approval.</p>
<p>EK, if you had the Dalkon Shield, then the mechanics are very different. The size and shape of the device is different, and type of plastic used is different.</p>
<p>calmom, thank you - I’m very hesitant to rely on uncontrolled, *international *studies. Drug safety standards in Europe are more lax than ours. It will take me a while to do a Scifinder search of my own, but I’m curious about this issue because both of our young ladies have expressed some interest in IUDs at some point…</p>
<p>Here is some food for thought:</p>
<p><a href=“http://www.uptodate.com/home/content/abstract.do?topicKey=gen_gyne%2F16221&refNum=13%2C15%2C17-21[/url]”>Evidence-Based Clinical Decision Support System| UpToDate | Wolters Kluwer;
<p>It’s going to be pretty hard for you to find a US study if the product was not approved for use in the US during the 15+ years it was being used in Europe. Apparently after the Dalkon Shield fiasco, US medical providers & the FDA shied away from IUDs. </p>
<p>I can tell you from practical experience that there are enough side effects to the pill & devices such as Nuvaring to make them unattractive to many. </p>
<p>I also know from real-world experience with my son that the result of an ineffective or unused type of birth control is a baby. (He’s very cute, but I don’t particularly want to see my daughter have one of her own any time soon).</p>
<p>So all I am saying is that ultimately the decision on form of bc rests with the user, and no matter what form is chosen, the medical risks of an unplanned pregnancy or an abortion tend to be significantly greater. I think that condoms are next to useless, not because of problems with the actual device, but because they rely on two human beings acting rational at the precise moment when they are least likely to be thinking rationally.</p>
<p>“I think that condoms are next to useless…”</p>
<p>Sadly, I agree. If properly used, condoms are very effective at preventing not just unwanted pregnancies. The keyword is “properly”.</p>
<p>Unfortunately, it has been my experience that the need for a condom often arises at a time when the participants have a blood alcohol content that would render them incapable of operating a motor vehicle. The rationale given later tends to be, “we only did it once”. </p>
<p>I understand that there are some risks with IUD’s. I just think that the risks are pretty minimal. Its one of those decisions that really needs to be made by the young woman, in consultation with her medical provider.</p>
<p>On the page you linked, the first abstract said The incidence of intrauterine device perforation is 0.87 per 1000 insertions. That is a very, very tiny risk of that particular complication. I mean – that means that 999 1/8 of the time, there is no problem with insertion. (I realize that article doesn’t deal with other possible side-effects – but my point is that it a very small risk).</p>
<p>I didn’t have the dalkon shield, but I did have progesterone shots for 15 weeks ,(through the 2nd trimester), hard to find if there was any problems related to that for her. ( but low progestetone may be why I have osteoporosis)</p>
<p>Not that familiar with Mirena, but I wonder if the reason they don’t market to teens or women who haven’t had a child, yet…is because she hasn’t had a child, yet.</p>
<p>The risk of being sued by a woman made infertile by an IUD might be enough to keep the companies from wanting to take that particular risk. Can you see the potential for lawsuits - 5, 10, 15 or 20 years down the road?</p>
<p>Only have anecdotal information about IUDs: D2
Now, we’re very grateful.</p>
<p>The Mirena emits a low dose of progesterone.</p>
<p>Whatever the “marketing” of Mirena, college health centers are regularly recommending the device for young, college age women who have never had children. In practice, they would’t recommend it if they were seeing a high frequency of problems – so whatever issues are arising, they are probably rare enough that the health providers are becoming increasingly comfortable with the IUD. </p>
<p>Part of the issue is cost. A couple of years ago, because of changes in the law, colleges lost funding to subsidize birth control pills. So instead of being able to offer pills at low cost to students – such as $10/month – the students were suddenly faced with charges in the range of $40-$50/month for the bill, perhaps even more for for proprietary devices such as Nuvaring. IUD’s present a one-time cost, which is covered by some college health plans. So it saves money over time.</p>
<p>One practical impact of cost is that, on a student budget, a woman might be tempted go off the pill simply to save money. For example – the woman breaks up with her boyfriend, then realizes that she is paying $45/month for a prescription she doesn’t need, since she isn’t having sex with anyone. Being short of money, she decides to stop taking the pill. Then, she meets someone new, and starts having sex earlier than anticipated, or resumes taking the pill but makes the mistake of having sex too soon after resumption (you have to be on it for awhile before it kicks in). Another scenario is that to save money the young woman does not take the pill regularly, but takes extra pills immediately after sex, under the mistaken belief that bc pills can be used as a make-shift morning-after pill.</p>
<p>So basically the problem with the pill is the same as I outlined above with the condom – it works pretty well if used properly, but the pills are pretty useless if they aren’t taken regularly or if the person hasn’t gotten around to refilling her prescription. </p>
<p>The IUD, once inserted, is simply there and it is difficult and inconvenient to remove – plus it probably costs at least the copay for an office visit to a medical professional, so the economic incentives are reversed. It is more expensive and inconvenient to get rid of it, so even during periods when the young woman doesn’t think she needs bc, the device remains.</p>
<p>As to the issue of use by women who have never been pregnant or had children, it may be because insertion is more difficult and in some cases the uterus is too small for the device to be implanted, or the woman may experience more discomfort with the device. I am thinking that the current widespread availability of ultrasound might make it easier for medical professionals to make a predetermination of whether the woman’s uterus is large enough to accommodate the IUD. (I don’t know - but it seems to me that its just a matter of taking some sort of measurement).</p>
<p>Actually women who have never been pregnant of had children are given a dose of misoprostol (a pill inserted in the vagina) prior to insertion, to soften the cervix.</p>
<p>EK: Any idea why she wants to use an IUD? Perhaps there’s another method that would be effective too that you wouldn’t be so concerned with. If she’s never used birth control before, maybe she was just reading about all her available options and decided somewhat randomly to start with an IUD without fully researching it. She might find that another form would work well for her. Or, doing more research might solidify her desires to use an IUD. Either way, it seems like weighing all her options would probably be a good idea. That way she’ll know she’s making an educated decision. </p>
<p>If she’s tried other methods in the past–like OCPs, for example–and didn’t like them, maybe she should try a variation on that method before switching methods altogether. I know I had to try a few different prescriptions before I found an OCP that I liked, and in the process of finding a pill that worked for me I did become pretty frustrated and thought about switching methods. It worked out in the end though, and for what it’s worth, I’ve really liked Yaz.</p>
<p>My D was living a miserable life ruled by her hormones. Huge depressive mood swings, severe cramping to the point of missing out on life and school. Plus her mood swings made her a person that you did not want to be around. Her Dr recommended a traditional birth control pill that she takes as Pizzagirl pointed out in a earlier post continuously for 3 months. She does not take the sugar pills. She has four periods a year. This along with a low dose of prozac has given her back her life. She hates having to remember to take the pill each morning and having to remember to refill her prescription every 3 weeks but it is a small price to pay for a happier life.</p>
<p>
</p>
<p>Because most 30 year old research is worthless.</p>
<p>Do you use 30 year old research to select a car? I doubt it. Why in the world would you want your child to use it for their medical care? I truly am baffled by that.</p>
<p>
</p>
<p>Yeah, but my other pills did nothing for the severity of my periods. I was even taking naproxin…and it was doing nothing. As far as I was concerned, my other pills were useless. And yes, I know you can take them continuously without the period every month. I did it for a long time. But the periods I did have weren’t worth it.</p>
<p>So I switched to seasonique. First period on seasonique? Light, with mild cramps.</p>
<p>First time in my life I could describe my cramps as “mild.”</p>
<p>*
Why alarmed?
Because most 30 year old research is worthless.*</p>
<p>Has human anatomy or biology changed in some way that I am not aware of?</p>