IUDs, implants urged for U.S. teen birth control

Teenage girls may prefer the pill, the patch or even wishful thinking, but their doctors should be recommending IUDs or hormonal implantslong-lasting and more effective birth control that you don't have to remember to use every time, aleading U.S. gynecologists group said Thursday.

The IUD and implants are safe and nearly 100 percent effective at preventing pregnancy, and should be "first-line recommendations," the American College of Obstetricians and Gynecologists said in updating its guidance for teens.

Both types of contraception are more invasive than the pill, requiring a doctor to put them in place. That, and cost, are probably why the pill is still the most popular form of contraception in the U.S.

But birth control pills often must be taken at the very same time every day to be most potent. And forgetting to take even one can lead to pregnancy, which is why the pill is sometimes only 91 per cent effective.

An IUD, or intrauterine device, is a small, T-shaped piece of plastic inserted in the uterus that can prevent pregnancy for up to 10 years. An implant is a matchstick-size plastic rod that releases hormones. It is placed under the skin of the upper arm and usually lasts three years.

The new guidelines don't tell teens not to use other methods, but "if your goal is to prevent a pregnancy, then using an implant or an IUD would be the best way to do this," said Dr. Tina Raine-Bennett, head of the committee that wrote the recommendations.

Condoms advised

The organization's previous guidelines, issued in 2007, also encouraged the use of IUDs and implants among teenagers. The new guidelines go further in saying physicians should discuss the two types of birth control with sexually active teens at every doctor visit.

The gynecologists group said condoms should still be used at all times because no other birth control method protects against AIDS and other sexually transmitted diseases.

While it may sound surprising that such invasive contraceptives are being endorsed for teenagers, 43 per cent of girls ages 15 to 19 have had sex, a government survey found. Most are using some kind of effective birth control, but only about 5 per cent use the long-lasting devices, the gynecologists group said.

In 21 states, all teenagers can get contraceptives without parental permission, according to the Guttmacher Institute, which tracks laws affecting women's health. A few other states allow it under certain circumstances.

The American Academy of Pediatrics has been more cautious and has not endorsed specific methods of birth control, but is updating its guidance. Some pediatricians have been reluctant to recommend IUDs for teens, partly because of concerns over infection risks; an older model was blamed for infertility.

Dr. Paula Braverman, a University of Cincinnati physician involved in updating the academy's position, said the gynecologists' advice does a good job of clarifying misconceptions about IUDs and implants.