Every year in the United States, approximately 750,000 teenagers become pregnant, and most of these pregnancies are not planned. In order for birth control to be effective, teenagers need options that they can easily use. Teenagers are more likely to continue using longer-acting contraceptive methods, such as IUD birth control or Implanon. Those teens who are sexually active and use birth control typically report inconsistent use. This has led the American College of Obstetricians and Gynecologists (ACOG) to consider whether it is advantageous to prescribe IUD birth control or Implanon for teenagers.Sadly, surveys of teenagers in the United States show that teens know very little information about IUDs. One survey of 72 girls between the ages of 14 to 18 showed that although 74% were using birth control, only 19% had ever heard of IUDs. After being educated on IUD birth control, many teenagers stated that they liked the fact that IUD use did not harm later fertility or require daily usage, was not needed with each sex act, and was discreet. Teenagers need to be educated on the high effectiveness of long-acting reversible contraceptive methods like IUD birth control, as well as Implanon.
What Doctors Are Suggesting:
ACOG has just revised its Practice Bulletin to address the need for long-acting reversible contraceptive methods for teenagers. According to ACOG, Implanon and IUD birth control use can be beneficial for teenagers. Though these practice guidelines are new, the actual practice of inserting IUDs and Implanon in teenagers is not. Many teenagers have already been provided with these birth control options, so the practice guidelines have finally caught up to what the medical community has been doing for years.
IUD birth control use in teenagers -- for both ParaGard and Mirena -- is classified under Category 2 of the U.S. Medical Eligibility Criteria for Contraceptive Use. This means that the benefits of using this contraceptive method generally outweigh the risks. IUD use has received a 2 classification because of some concern over the risk for expulsion (when the IUD partially or completely slides out of the uterus), which can be caused by nulliparity, as well as STI risk from the riskier sexual behavior typical in younger age groups. The use of Implanon in teenagers has received a classification of Category 1 –- this means that there is no restriction for the use of the birth control method.
What the Research Says
Unfortunately, there is very little literature on Implanon or IUD birth control use in the teenage population, so more research is needed for better, more detailed results. That being said, some studies do exist, and their results are promising.
An in-depth review looking into IUD use in teenagers found that expulsion rates ranged widely --from 5% to 22%. These rates can be a little misleading because they seem to be affected by your age and whether or not you have ever been pregnant. Plus, the available research shows inconsistent results. For example, some studies reveal that women who have never given birth have more instances of IUD expulsion, while other studies suggest that those who have given birth report higher rates of expulsion. None of these studies considered how the combination of age and pregnancy history may have influenced the results.
Teenagers are also more likely to continue with IUD birth control use than with other methods. The number of teenagers who are still using the IUD at 1 year is high (ranging from 48%-88%), and their IUD use slightly decreased over time. Teenagers continue their IUD use at the same rate or even longer than teenagers who use birth control pills.
Pregnancies were also uncommon among teenage IUD birth control users. One study comparing teenage pregnancy rates found that (after 24 months of continuous use), teens using the copper IUD (ParaGard) had reported no pregnancies, while 3% of teenage birth control pill users became pregnant. Another study found that teen pregnancy rates rose from 2% after 6 months of IUD use to 11% at 48 months of being on the IUD.
One last concern that research has revealed about IUD birth control use in teenagers is pain. Studies have shown that painful or difficult IUD insertion is a major concern for teenagers. This may be because the teenager has never given birth before. There are actions that doctors can take to help ease some of this pain, but these methods have not been proven to consistently provide pain relief during an IUD insertion. Research has also shown that pain and bleeding are frequent reasons for teenagers to have their ParaGard IUD removed. One study highlighted how more teenage IUD users complained of bleeding issues than did teenage pill users.
Research on teenage Implanon use is even more sparse.
In 2010, a study was conducted on 137 teenagers (ages 12–18 years old) who had just given birth. It compared tolerance, continuation, and repeat pregnancy rates in teens who used Implanon, combination birth control pills, Depo Provera, barrier methods (like condoms and spermicide), or nothing.
By 24 months, 35% of the teenagers had become pregnant again. Teenage Implanon users became pregnant later on than the other birth control groups (with first repeat pregnancy at 23.8 months, as compared to 18.1 months for the pill/depo group and 17.6 months for barrier/none group). Implanon users were also more likely to continue using Implanon at 24 months than the teen pill/depo users.
Of those teens who had Implanon removed before 24 months of use, 40% said that abnormal bleeding was their reason for stopping. That being said, the researchers concluded that teenagers who decide to use Implanon are significantly less likely to become pregnant and were found to stick with this birth control method longer than those who chose the other contraceptive methods.
Even though the literature on Implanon and IUD birth control for teenagers is greatly lacking, available studies suggest that IUDs such as Mirena and ParaGard, as well as Implanon, are practical options for today’s teens. Encouraging teen use of long-acting reversible birth control methods could help decrease the number of unplanned teenage pregnancies. The high number of teens who stick to their Implanon and IUD use is promising, and teenagers are more likely to be compliant with these birth control methods.
The practice guidelines created by ACOG suggest that IUDs and Implanon should be suggested to teenagers as potential birth control options. The benefits and advantages of ParaGard and/or Mirena in teens typically offset the potential risks, and there are no restrictions on the use of Implanon in teenagers. Because of this, it appears that these are effective and reliable birth control options that should be offered to teenagers who are seeking contraception at family planning clinics or local doctor’s offices.
American College of Obstetricians and Gynecologists. "Practice Bulletin #121 - Long-Acting Reversible Contraception: Implants and Intrauterine Devices." Obstetrics & Gynecology. July 2011. 118(1):184-196. Accessed via private subscription.
Deans, E.I., & Grimes, D.A. “Intrauterine devices for adolescents: A systematic review.” Contraception. 2009. 79: 418-423. Accessed via private subscription.
Lewis, L.N., Doherty, D.A., Hickey, M., & Skinner, S.R. “Implanon as a contraceptive choice for teenage mothers: A comparison of contraceptive choices, acceptability and repeat pregnancy.” Contraception. 2010. 81(5): 421-426. Accessed via private subscription.
World Health Organization. "Medical eligibility criteria for contraceptive use." 4th ed. Geneva: WHO; 2009. Accessed July 12, 2011.