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Tara Kumaraswami, MD |
Nearly 50 percent of all pregnancies in the United States are unintended, and that rate is much higher among adolescents who become pregnant. The solution to this pressing public health problem, according to the American College of Obstetrics and Gynecologists (ACOG), is for obstetrician-gynecologists to increase their patients’ access to contraceptive implants and IUDs, also known as long-acting reversible contraceptives (LARCs).
“It’s wonderful that ACOG put out this recommendation summarizing the research about long-acting reversible contraception as a viable option,” said Tara Kumaraswami, MD, assistant professor of obstetrics & gynecology at UMass Medical School. “Research demonstrates that many women who are eligible for IUDs and implants might not be aware of this.”
Released last week, the opinion from the ACOG Committee on Gynecologic Practice’s Long-Acting Reversible Contraception Working Group details strategies for ob/gyns to reduce barriers and increase access to long-acting reversible contraception methods, which concludes that they are the safest and most effective forms of birth control available.
“We as physicians need to be able to educate our patients and give them accurate information,” said Dr. Kumaraswami. “Those who may have been feeling apprehensive about prescribing these methods now have the support of ACOG.”
The five long-acting reversible contraceptives approved for use in the United States include one copper intrauterine device and three hormone releasing IUDs, and a single-rod hormone-releasing device that is implanted in a woman’s arm. Each provides protection from pregnancy ranging from 3 to 10 years.
The committee opinion notes that studies confirm the superiority of LARC methods over short-acting contraceptive methods, finding that implants and IUDs are 20 times more effective than oral contraceptive pills, patches or rings. Evidence from several studies further indicates that increasing use of LARC methods can reduce rapid repeat pregnancy among adolescents and repeat abortions among women who have already had one.
“IUDs and implants are wonderful options for all women, including adolescents and women who haven’t had children. They are effective and have few contraindications,” said Kumaraswami. “Once the IUD or implant is in place you know that it’s working and don’t have to do anything on a daily, weekly or monthly basis.
“Many ob/gyns have been placing IUDs and implants in adolescents and women without children, so we’ve seen that they are effective methods, and that patients are satisfied with them.”
ACOG’s evidence-based recommendations further dispel long-held misconceptions about the safety of IUDs based on decades-old designs that have since been greatly improved.
“Today’s devices do not increase infection rates over women without IUDs and do not increase rates of infertility,” said Kumaraswami. “They are excellent choices for women who desire pregnancy in the future but not at this time. Once placed they are effective, but as soon as they come out a woman can try for pregnancy right away.”
While LARC methods are the most effective forms of contraception, they do not protect against STDs. “We always have to counsel our patients about continuing to use condoms and speaking with their partners openly and honestly about their sexually transmitted infection history and protecting themselves as well,” Kumaraswami noted. Such discussions underscore the importance of counseling individual patients based on their needs, reproductive histories and preferences.
“I start with LARCs because they are the most effective options, but I counsel patients about all available options,” said Kumaraswami. “It’s an individual decision, which is why it’s up to us as their doctors to provide patients with accurate information.”
Related links on UMassMedNow:
Ob/Gyn: Studies show emergency contraception safe for any age
UMMS expert calls for better access to birth control
