Doctor says push for teen IUD use brings health risks

Washington D.C., Sep 26, 2012 / 16:05 pm

A major OB/GYN group's promotion of intrauterine devices (IUDs) and hormonal implants in teenage girls has drawn criticism over the risks posed to patients' health and well-being.

Dr. Bill Toffler, professor of family medicine at Oregon Health and Science University, said the recommendation was "sadly misguided."

"There are a lot of problems with IUDs," he told CNA, questioning the wisdom of promoting "risk-laden devices" that 50 percent of women want to remove within a year.

While those promoting the change were likely "well-intentioned," their ideas "miss many important factors," he said.

On Sept. 20, the American College of Obstetricians and Gynecologists updated its guidelines for teenagers to say that IUDs and hormonal implants should be "first-line contraceptive options" that are discussed at each doctor's visit.

The doctors group noted that the vast majority of teenage pregnancies are unintended, despite the widespread use of contraceptives, such as condoms and the birth control pill.  

It recommended that doctors suggest the longer term alternatives which are inserted inside a woman's body and can be left in place for several years.

Toffler noted that IUDs are typically expensive, costing hundreds of dollars, although under the Affordable Care Act, minors will have access to IUDs and other contraceptives at no cost, and in some states will be able to receive them without parental consent.

The devices also release powerful hormones within the body and can lead to a significant risk of infection, especially during the early stages, he said.

"Essentially, you're putting a foreign body into a normally sterile cavity," he explained.

In addition, one in every 1000 women who use an IUD will have their uterus perforated, potentially putting their future fertility at risk, he said.

Toffler warned that the promoters of the new guidelines "have thrown these concerns under the bus" in their zeal to reduce teenage pregnancy rates.

However, their attempts to do so may actually contribute to teenagers having "less inhibition" about sex and engaging in increasing levels of risky behavior, he said.

"People may be falsely reassured," he explained, noting that with the average teenage relationship lasting only three months, many young people are already involved in numerous "fleeting" sexual relationships.

In addition, Toffler said, the promotions of IUDs are misleading, and women are not properly informed about how they function.

He explained that it is an undisputed fact that "one of the ways they work is to interfere with implantation," thus ending the life of an already-created human embryo.

Some women who think they are simply using a preventive form of contraception may not realize that the device is also an abortion-inducing agent, he observed.

Toffler also said that he has had personal experience with women who became pregnant while using IUDs, posing a risk in removing the device. Such situations are also associated with higher proportions of ectopic pregnancies, which occur outside the womb and can be life-threatening for the mother.

Women need better information that respects them and their best interests, Toffler stressed. He noted that IUDs do not prevent sexually transmitted diseases and other "risks of people having multiple sexual partners."

At the same time, he said, "there are many successful abstinence-based programs."

Unfortunately, he said, these programs receive little attention, and the "paradigm" of contraception is promoted as if there were no medical, physical, emotional and psychological consequences of multiple sexual partners during the teenage years.