Ask the Doctor: Anne Narayan, M.D.

Q. What factors are important to consider when choosing an intrauterine device (IUD) in each life stage?

A. Most individuals, regardless of age, have similar concerns with contraception: side effects, ease of use, bleeding patterns, duration, and effectiveness. However, as women move through their reproductive years, some of these factors become more important than others.

Teenagers and young adults tend to be drawn to methods that are easy to use, discrete, and effective. This is why long acting reversible contraceptives (LARCs) are great options. IUDs and contraceptive implants require an insertion, but do not require daily, weekly, or monthly upkeep. Initially, most teens are not thinking about how long a method will last. But when asked, since they are not looking to become pregnant for several years, they find long-lasting options appealing. Ease of use and duration make LARCS much more effective options than the standard pill, since those tend to be bigger priorities to young adults than concerns about side effects or bleeding patterns. Additionally, LARCs are discrete – some adolescents may prefer not taking medication in front of their friends or parents unless necessary. Some women (regardless of age) are nervous about IUD insertion, but when you ask those that have had them placed, they say it is painful, but it’s worth it and most are willing to get one again. But, for those who are wary of a pelvic exam or IUD insertion, a 3-year implantable contraceptive in the arm is also a great option and associated with minimal insertion discomfort. It is important to note, however, that none of these methods prevent STD’s, and barrier use with condoms is still important.

As women age into their reproductive years, priorities change. Some individuals may want to conceive in the near future, and may desire a shorter acting contraceptive method such as condoms or the pill. A good rule of thumb is if someone wants to avoid pregnancy for a year or longer, a LARC is a great option. When an IUD is removed, fertility immediately returns to baseline, so one need not worry about how long to wait to conceive after using an IUD. On the flip side, some women don’t want to conceive for many years, and the IUD is a great option for long acting contraception that is just as effective as a tubal ligation. The hormone-containing IUD lasts 3-5 years depending on type, and the non-hormonal IUD lasts 10 years. Another plus – the hormone-containing IUD is often associated with amenorrhea, and many are drawn to the idea of no or light periods. An interesting fact: IUD's are the #1 used method of contraception amongst female OBGYNs. So your providers practice what they preach.

For those in pre-menopause or menopause, bleeding patterns and medication safety become bigger priorities over pregnancy prevention (although it is still important to prevent undesired pregnancy in pre-menopause). Pre-menopause is associated with changes in periods that can be quite bothersome. An IUD can help prevent issues with bleeding and, as a side bonus, can help prevent uterine cancer. This uterine protection is also beneficial when menopausal women start to think about estrogen hormone replacement therapy. So, it isn't all about birth control.

Birth control for most women tends to require a bit of trial and error to get the right fit. But, that said, an IUD has so many benefits regardless of age, so I encourage women to consider it during their trials – they just might find the IUD to be the perfect fit.

Anne Narayan, M.D., is an OBGYN and has a practice located in Huntington Beach.