Birth Control: New Research Gives Boost to IUD Effectiveness

PHOTO: An intrauterine device (IUD) is the best type of emergency contraceptive.
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Twenty-seven-year-old Julie Vonder Haar of St. Louis describes herself as a smart and responsible person, but like many women, she found it difficult to remember taking her birth control pills while juggling four jobs. That was until she discovered the IUD.

"Having it and not having to worry about it, taking that off my plate helped immensely," she said.

As it turns out, Vonder Haar's choice may not only be more convenient but more effective as well. Long-acting reversible contraception like intrauterine devices and progestin implants can prevent unwanted pregnancy up to 20 times better than birth control pills, patches and vaginal rings, according to a study from Washington University School of Medicine, published today in the New England Journal of Medicine. Of the 3 million unwanted pregnancies in the United States, almost half of those are due to incorrect use of the most commonly prescribed forms of birth control -- pills, patches and rings.

An intrauterine device, or IUD, is a small copper or hormonal implant that is placed in the uterus. The insertion can be done in a doctor's office, and it works for 10 years to prevent pregnancy. Bayer's brand-name IUD Mirena, approved in 2009, is one such device. A progestin implant, meanwhile, is inserted in the upper arm and can prevent pregnancy for up to three years. Merck's Nexplanon is the only such implant currently available in the U.S.

Once in place, these devices prevent unwanted pregnancy as effectively as sterilization, but unlike permanent sterilization, when a woman wants to become pregnant she simply has the device removed.

So why aren't more women using long-acting reversible contraception -- and specifically IUDs?

Cost could be one reason. Since it is not covered by many insurance plans, women might find themselves forking out $700 to buy an IUD and have it inserted. Compare this to $10 to $20 per month for birth control pills, which are generally covered by insurance. Over the long term, however, IUDs are cost-effective; when you break the cost down over a five year period, IUDs cost about $11 a month, the same as birth control pills.

Still, for Vonder Haar, cost was a big factor.

"There was no way I could have gotten the Mirena before the study because I couldn't afford the cost up front," she said.

Dr. Jeff Peipert, one of the study authors and vice chair for clinical research at Washington University, said this big initial cost discourages women, since insurance usually does not cover this type of birth control. In the study he conducted, women were allowed to choose which birth control they wanted, free of charge.

"A major surprise was that many people chose long-acting reversible contraceptive (IUD) when barriers were lifted," Peipert said. "Around 75 percent of women chose a long-acting reversible contraceptive; the hormonal IUD was the most popular."

Women's health experts also said myths surrounding IUDs may keep many woman from using this option.

"Many patients have heard bad things about IUDs, such as they cause infertility or infections," said Dr. Kevin Ault, associate professor of gynecology and obstetrics at Emory University School of Medicine in Atlanta. "Careful medical research over the past decade shows these fears are not true."

Dr. Lauren F. Streicher, assistant professor of obstetrics and gynecology at Northwestern Memorial Hospital in Chicago, said some women may have also heard that if they have not yet had children they should not opt for an IUD. While this is untrue, she does recommend having a doctor who is experienced place IUDs in these women as placement can be technically difficult.

And then there is the fact that many women may not know what an IUD is, or that such an option exists. IUDs are not nearly as highly advertised as birth control pills, doctors said -- at least not yet.

"The reason most women choose pills is a combination of marketing, patient familiarity and comfort level, physician comfort with counseling and insertion, and misconceptions about IUD safety," Streicher said.

But as more studies like this most recent one emerge, Streicher said, more women may shift to IUDs in the years to come.

"Very clearly, contraception that is not user-dependent is going to have the lowest failure rates," Streicher said. "Half of unintended pregnancies every year are not 'no contraception,' they are 'failed contraception' such as missed pills, etc."

Vonder Haar, a participant in the study, has now had an IUD for three years, and she said she is grateful to the study for giving her the opportunity to use this method of birth control.

"I have recommended this to everyone," she said. "It has made such a difference; I think every girl should be able to have access to this."

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