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Young women and women who have not yet had children can generally use
intrauterine devices (IUDs), but providers should be cautious. Because these groups face
increased risk of IUD expulsion and pelvic inflammatory disease (PID), the IUD generally
is not recommended as the first method of choice.1
For adolescents who need family planning, the IUD does have distinct advantages: It is
nonhormonal and requires minimal compliance after insertion. The risks of infertility,
however, should be considered before recommending this method to younger women.
"Age by itself is not a contraindication for IUD use," says Dr. Roberto Rivera,
FHI's corporate director of international medical affairs. "There is no biological
reason to say a young woman is at higher risk than an older woman. An older woman and a
younger woman with the same sexual behavior have the same risks."
While there is no medical rationale against IUD use by adolescents, demographic studies
show that women under age 25 have a higher incidence of sexually transmitted diseases
(STDs) than older women, who are more likely to be married or living in union. Younger
women are not biologically more susceptible to STDs; however, lifestyles and sexual
behavior, such as multiple sexual partners, may put them at greater risk.
For the majority of IUD users, fertility typically returns immediately or soon after the
device is removed, and duration of use does not appear to affect a woman's ability to
conceive. One study in New Zealand found that within 48 months of IUD removal, 91.5
percent of women, who had never before been pregnant, had conceived, while 95.7 percent of
those who had been pregnant before IUD use had conceived.2
Family planning providers should help clients understand how contraceptive use may affect
their risks of PID and their future fertility. In spite of risks of infertility to young
women and nulliparous women, the decision about which method to use ultimately should be
made by the woman.
-- Barbara Barnett
Footnotes
Curtis KM, Bright PL, eds. Recommendations
for Updating Selected Practices in Contraceptive Use: Results of a Technical Meeting,
Volume I. Chapel Hill: Technical Guidance Working Group, U.S. Agency for International
Development, 1994. Improving Access to Quality Care in Family Planning: Medical
Criteria for Initiating and Continuing Use of Contraceptive Methods. Geneva: World
Health Organization, 1995.
Wilson JC. A prospective New Zealand
study of fertility after removal of copper intrauterine devices for contraception and
because of complications: A four-year study. Am J Obstet Gynecol
1989;160(2):391-96.
For more information, visit Family Health International's Website at www.fhi.org
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