Clinicians should offer the intrauterine device (IUD) as a first-line contraceptive method to all women, including adolescents, say the authors of a recent systematic review of the topic. USAID supported the research.

The authors evaluated the published evidence on adolescent use of IUDs, which consisted of six cohort studies and seven case-series reports. Few reports were recent, and none evaluated IUDs currently used in the United States.

Adolescents who used the IUD had low rates of pregnancy, ranging from two per cent after six months of use to 11 per cent after 48 months of use. Two studies compared use of the IUD to use of combined oral contraceptives; continuation rates for the IUD were similar to or better than those for pills. Concern about impairing fertility has limited IUD use in young women in the past, but research in recent decades shows that prior IUD use is not associated with a significant increase in tubal infertility.

Many adolescents could benefit from easy-to-use contraceptives, such as the IUD, since they tend to have better success using long-acting methods than they have with methods requiring daily or occasional use, such as oral contraceptives or diaphragms. To read more about this topic, see:

http://dx.doi.org/10.1016/j.contraception.2008.12.009

Source: Family Health International

More research needed on contraceptives and STIs risks

More research investigating associations between various contraceptive methods and the risk of acquiring sexually transmitted infections could help women make better reproductive health decisions, according to a systematic review of the literature conducted with support from USAID.

The reviewers focused on these highly effective contraceptive methods: oral contraceptives, the progestin-only injectable depot medroxyprogesterone acetate (DMPA), and the copper IUD. They examined published prospective studies evaluating the association between these contraceptives and the risk of acquiring HIV and other sexually transmitted pathogens.

Two themes emerged from this review:

Women in the general population who used oral contraceptives or DMPA were generally not at increased risk for acquiring HIV. The evidence was less clear for women in high-risk groups, such as sex workers.

An increased risk of chlamydial infection was associated with the use of oral contraceptives or DMPA. However, there was no clear association between the risk of gonococcal infection and the use of hormonal contraceptives.

To read more about this topic, see:

http://dx.doi.org/10.1016/j.bpobgyn.2008.11.004

Family Health International