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February 20, 2013

Under new health law, alternative birth control gains renewed interest

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Although the use of LARCs has more than doubled in recent years, it is a small part of the contraceptive market. Among women who use birth control, 8.5 percent of women used one of those methods in 2009, according to the Guttmacher Institute. The use of LARCs by teenagers was significantly lower at 4.5 percent, while 8.3 percent of 20- to 24-year-olds chose this type of contraception.

In October, the American College of Obstetricians and Gynecologists reiterated its strong support for the use of LARCs in young women.

Yet many young women are unaware that long-acting methods could be good options for them, in part because their doctors may be reluctant to prescribe them, experts say. That is partly the legacy of the Dalkon Shield, an IUD that was introduced in the 1970s whose serious defects caused pain, bleeding, perforations in the uterus and sterility among some users. The problems led to litigation that resulted in nearly $3 billion in payments to more than 200,000 women.

In addition, providers may hesitate because there's a slightly higher risk that younger women will expel the device, experts say.

But expulsion is a problem more likely associated with the size of the uterus, which is not necessarily related to a patient's age, says Tina Raine-Bennett, research director at the Women's Health Research Institute at Kaiser Permanente Northern California and chairwoman of the ACOG committee that released the revised opinion on LARCs. "Expulsion is only a problem if it goes unrecognized." (Kaiser Health News is not affiliated with Kaiser Permanente.)

The new IUD Skyla became available this month. It is made by Bayer, the same company that makes Mirena, another IUD sold in the United States. Unlike Mirena, which is recommended for women who have had a child, Skyla has no such restrictions (nor does ParaGard, the third type of IUD sold here). Mirena is currently the subject of numerous lawsuits alleging some complications, such as device dislocation and expulsion.

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