• Original Articles By Dr. Lavin Featuring Expert Advice & Information about Pediatric Health Issues that you Care the Most About

    Long-Acting Reversible
    Contraception for Adolescents

    By Dr. Jessica Katz

    Long -acting reversible contraception (LARC) devices have been used very successfully and safely in women for both contraceptive concerns as well as to control menstrual irregularities for decades. It has more recently been used in adolescents with similar results and backed by both the American College of Obstetricians and Gynecologists as well as the American Academy of Pediatrics. It is important for adolescents to understand all their options regarding their contraceptive decisions, as well as ways to help relieve painful and unpredictable periods.

    LARCs provide effective contraception for an extended time period without requiring any further action once they are placed. Devices include intrauterine devices (IUDs) and implantable subdermal rods. There are three different types of IUDs available in the US currently and last between 3-10 years depending on which version you choose. The implant is removed after three years. Advantages include cost -effectiveness, long-lasting, safe, convenient and are well-liked by patients. All are placed in an office setting with minimal discomfort in a very short amount of time. Although they are effective for years, they can be removed easily at any time. Studies have shown that out of all the reversible contraceptive options, they have the lowest pregnancy rates (less than 1% per year) as well as highest rates of satisfaction. While LARCS have the highest rates of satisfaction, only 5% of US teens report using them.

    Not only are LARC methods one of the best options for birth control, but they can also be used successfully to treat extremely painful periods in the adolescent population. It is extremely common for adolescents to experience very heavy, painful and irregular menstrual cycles. This can not only lead to missed school and a disruption in their normal daily activities due to excruciating pain and discomfort, but also medical conditions, such as anemia. When over the counter pain medications fail to alleviate menstrual associated pain, the next step is often initiating a type of birth control to decrease the severity of bleeding and pain. Often, the first step is oral contraceptive pills. While this is a great first step and very effective, due to the fact that you must remember to take these pills every single day in order for them to work, some patients would benefit from a LARC.

    Another reason one might choose a LARC over an oral contraceptive pill, patch or ring is that the LARCs have less serious risks associated with them. The pills, patch and ring are made up of two hormones, progesterone and estrogen. The estrogen component may increase the chance of serious complications, such as stroke or blood clots in the legs or lungs. Although there is a very low chance of these complications happening to a healthy adolescent, the risks are still there. The Skyla and Mirena IUDs as well as the Nexplanon implant are made up of only progesterone, a hormone that is not associated with an increased risk of stroke or blood clots. The copper IUD is hormone free and while it lasts for 10 years and is an excellent contraceptive option, it will not have any effect on your menstruation.

    Questions you might ask

    1. Do IUDs increase an adolescent’s risk of infertility?
    No, infertility is not more likely after discontinuing the IUD than after discontinuing the other forms of contraception. Return to baseline fecundity returns rapidly after the removal of an IUD. This similarly applies to the implant.

    2. Should adolescents be screened for STDs at the time of IUD insertion?
    Yes, since women aged 15-19 have high rates of chlamydia and gonorrhea compared to other age groups, all adolescents should be screened for STIs at the time of or before IUD insertion.

    3. Will the IUDs or implants cause bleeding pattern changes?
    Yes, you can expect changes in menstrual bleeding, especially in the first few months after insertion. However, in women using the Mirena or skyla IUD or implant, there will be an expected decrease in bleeding over time that will lead to either light bleeding, spotting or amenorrhea.

    4. Do the LARCS have an effect on weight gain?
    Currently, there are no conclusive studies that document that LARC devices cause weight gain. Although some people do discontinue these devices for reported weight gain, there is no solid evidence of this relationship.

    5. Will the procedure be painful?
    You might have some discomfort during the insertion of the IUD or implant. If you choose the implant, the skin will be injected with local anesthetic so the rest of the procedure should be painless. If you choose the IUD, you will take a medication the evening before to make the device easier to insert and you may take some over the counter analgesics an hour prior to the procedure. Although you might have some discomfort, this will only last for a few minutes and knowing that the device will last between 3-5 years may outweigh the momentary discomfort. Adolescents who are virginal might want to consider the implant over the IUD, but both can be safely inserted.

    Conclusion

    There are many options of medication used for both birth control as well as menstrual irregularities. It is very important to discuss the different options with your physician in order to choose the one that is best for you.

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