A recent Associated Press article reported on a significant uptake in long-acting reversible contraceptives (LARCs) by teens in the wake of the Supreme Court’s reversal of Roe v. Wade. According to the article, interest has, at least anecdotally, increased dramatically even amongst teens who are not sexually active, suggesting that the fear-mongering, gloom-and-doom tone now rampant in mainstream media articles has been largely effective on this age group.
But do teens know what risks they’re incurring when they roll up their sleeves for an implant or undergo intrauterine device (IUD) insertion?
Increased interest in LARCs predates the Roe decision
The AP interviewed a Rutgers University professor and former long-time Guttmacher Institute employee whose research suggests that use of LARCs was already on the rise long before Roe was overturned.
Dr. Laura Lindberg found that 15% of 15-19 year olds utilized LARCs between 2015 and 2019, while just 3% of that population was using them between 2006 and 2010. Undoubtedly, though, the downfall of Roe accelerated that trend. On June 24th, Planned Parenthood reported that online birth control appointments were up 150% over an average day, and up 375% among IUD-seekers specifically, and whose infamous teen chatbot, Roo, reportedly received more than double the usual number of birth control-related queries.
Months later, online birth control appointments allegedly remain elevated by 20% over the previous average.
What do young women know about IUD and implant safety?
The AP story referenced a 16-year-old Florida teen who opted for the Nexplanon implant, which it referred to simply as “a reversible matchstick-sized contraceptive.” The girl’s mother, who commented in Spanish, said she liked that the implant didn’t require her daughter to remember to take a pill every day.
The story doesn’t mention any side effects or complications of long-acting reversible contraceptives, and one wonders: what were this mother-daughter duo taught about the implant’s risks and side effects? And what do young women across the U.S. know about the potential complications of IUD use? Precious little, in all likelihood, especially when organizations like the American Academy of Pediatrics promote LARCs to the general public as “the most effective methods to prevent pregnancy” without any mention of their risks.
According to a 2017 report from The National Campaign to Prevent Teen and Unplanned Pregnancies celebrating an ad campaign’s success in increasing LARC use by South Carolina teens, when 18-45 year olds were surveyed about their knowledge of IUDs and implants, “most say they know ‘little or nothing’ about Implants (77%) and IUDs (68%).”
How many know that Bayer, manufacturer of the popular Mirena IUD, paid out $1.6 billion just two years ago to settle nearly 40,000 lawsuits related to damages inflicted on users of its now-defunct permanent birth control device Essure? How many know that the arm implant Nexplanon’s precursor Implanon was the subject of many class action lawsuits alleging failure to provide informed consent about its many risks?
What young women don’t know could hurt them: Side effects and complications of IUDs
Uterine perforation
Four of the five IUDs currently on the market (Mirena, Klyeena, Skyla, Liletta) are hormonal IUDs, containing a synthetic form of the naturally occurring hormone progesterone. The fifth (Paragard) is copper-based. Plastic, T-shaped IUDs are intended to sit in the uterus, but in rare cases, perforation of the uterus, large intestine, small intestine, rectum, appendix, urinary tract, bladder, or ureter by the IUD can occur.
A 2022 FDA-funded study published in the Lancet found that while uterine perforation rates by IUDs were relatively rare, their incidence ranged from six to 42 times higher than previously thought, depending on the population studied. The Lancet study prompted a label change for Mirena IUDs to encourage any user with new onset pain or change in bleeding patterns to contact their healthcare provider to rule out uterine perforation.
Unintended pregnancy
Additionally, a 2022 research study from the University of California at San Francisco found that typical use rates of unintended pregnancy in the first year after IUD insertion were not the “less than 1 percent” routinely touted by everyone from the FDA to the American College of Obstetricians and Gynecologists. The UCSF researchers found that unintended pregnancy rates were actually 2.4% for progestin IUD users and 2.99% for copper IUD users.
Risk of pregnancy is naturally highest in women who experience IUD expulsion (the IUD falls out). A 2021 study found a 9% accidental expulsion rate amongst adolescent women. Young women who were overweight and/or had a history of anemia or bleeding problems were at highest risk for accidental expulsion.
Pain
The UCSF study further found that a year after insertion, progestin IUD and copper IUD users respectively reported: pain somewhere other than the abdomen in 15% and 13% of users, abdominal pain with gastrointestinal symptoms in 10% and 9% of users, pelvic pain in 6% of both IUD and copper users, and menstrual issues for 5% and 6% of users.
Other side effects
According to the Cleveland Clinic, progestin IUD users may experience “irregular periods, missed periods, increased risk of developing non-cancerous ovarian cysts, breast tenderness, headaches, mood changes, nausea.” Copper IUD users may experience “heavy period bleeding, painful menstrual cramps (dysmenorrhea), increased risk of developing non-cancerous ovarian cysts,” which can be very painful.
Natural Womanhood further notes that in copper IUD users, copper toxicity, while rare, may be possible. And research presented at the 2014 meeting of the American College of Rheumatology found that inflammation caused throughout the body by the copper IUD (which works to prevent pregnancy in part by stimulating inflammation in the uterine lining) could potentially predispose some women to developing rheumatoid arthritis.
IUDs contraindicated for active STI infection
Cleveland Clinic advises that “you shouldn’t get an IUD or implant if you have a sexually transmitted infection (STI),” which disqualifies a large percentage of teen girls. The CDC reported that in 2018, fully half of the 26 million new STI diagnoses were among 15-24 year olds, though the site does not say how many were among 15-24 year old girls. And this 2019 study reported that 1 in 4 sexually active females was estimated to have at least one STI.
Side effects and complications of implants
The most well-known complication of Nexplanon arm implant use is migration (like this young woman experienced), unintended movement of the implant from the arm to someplace else in the body. Back in 2016, the FDA deemed the migration risk high enough to add a warning to the Nexplanon label.
As a hormonal contraceptive, Nexplanon additionally carries the regular risks of hormonal birth control, including increased risk of potentially life-threatening or even fatal blood clots, and the risk is higher in women who smoke and/or are overweight. The label cautions that 10% of women in research studies had their implant removed because of menstrual problems. “Other frequent side effects” include “mood swings, weight gain, headache, acne,” and “depressed mood,” a particularly concerning possibility (we reported on one college student’s experience here) in an adolescent population already at increased risk of mental health problems. More common side effects include vaginitis, viral infections, back pain, stomach pain, and nausea.
LARCs pose real risks to young women
The media and medical organizations do young women no favors by glossing over or omitting altogether the significant risks that come with IUD or implant use. They deserve to know all the possible side effects or complications so that they can provide truly informed consent. That fact hasn’t changed since the overturning of Roe v. Wade.
