IUDs (intrauterine devices) and implants are not only safe for nearly all women of reproductive age, but also the best forms of reversible contraception currently available, the American College of Obstetricians and Gynecologists announced today in a Practice Bulletin published in Obstetrics & Gynecology.

The new recommendations offer guidance to specialist doctors (Ob-Gyns) in selecting suitable candidates for long-acting reversible contraceptives (LARCs), as well as managing medical issues related to their use.

Eve Espey, MD, MPH, co-author of the Practice Bulletin, said:

"LARC methods are the best tool we have to fight against unintended pregnancies, which currently account for 49% of US pregnancies each year. The major advantage is that after insertion, LARCs work without having to do anything else. There's no maintenance required."

Experts say that over 50% of women who have a pregnancy they had not planned for had been using some form of contraception. Among those women, the main reason they became pregnant was because they either did not use the contraception properly, or were inconsistent with it.

The authors wrote:

"LARCs have the highest continuation rates of all reversible contraceptives, a key factor in contraceptive success."

Contraceptive implants and IUDs are inserted by a specialist at their practice office. There are two available types of IUDs:
  • The copper IUD - this device is effective for ten years. It releases small quantities of copper into the uterus, effectively preventing fertilization. Copper also undermines the sperm's ability to travel through the uterus into the fallopian tubes. If inserted within five days of unprotected sex, it can also be used effectively for emergency contraception.

    Females continue ovulating with this device, with possibly more initial menstrual bleeding and cramping. Studies indicate that these symptoms diminish after time. The main reason women discontinue long-term copper IUD use is heavy menstrual bleeding and dysmenorrhea (period pains). It is important that doctors inform their patients about this beforehand.
  • The Hormonal IUD - progestin, a hormone, is released into the uterus, resulting in thickening of cervical mucus and thinning of the uterine lining. Sperm may also lose some of their activity. This device has been approved by the FDA (Food and Drug Administration) for the treatment of heavy bleeding, because it may make menstrual cycles lighter. It is an effective contraceptive for five years.
The contraceptive implant - a small rod, the size of a matchstick, is inserted under the skin of the upper arm. It releases controlled amounts of an ovulation-suppressing hormone. It has a pregnancy rate of 0.05% - the most effective method of reversible contraception available today. It is effective for up to three years.

The authors explain that less than 6% of women in America of reproductive age use IUDs (2006-2008). The American College of Obstetricians and Gynecologists believes that IUDs are not very popular because of concerns regarding cost, as well as lack of knowledge.

Dr. Espey said:

"Women need to know that today's IUDs are much improved from earlier versions, and complications are extremely rare. IUDs are not abortifacients-they work before pregnancy is established-and are safe for the majority of women, including adolescents and women who have never had children. And while upfront costs may be higher, LARCs are much more cost-effective than other contraceptive methods in the long run. The benefits of IUDs and the contraceptive implant in preventing unplanned pregnancy could be profound with widespread adoption of these methods, and ob-gyns are in a great position to effect change."

"Practice Bulletin No. 121: Long-Acting Reversible Contraception: Implants and Intrauterine Devices"
Obstetrics & Gynecology. 118(1):184-196, July 2011. doi: 10.1097/AOG.0b013e318227f05e

Written by Christian Nordqvist