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Gold-standard birth control: The IUD and the implant

More research shows long-acting reversible methods to be...freakin' awesome, basically.

In terms of effectiveness, not all birth control methods are created equal. And if there was any doubt as to which methods stand out in that arena, an article by the folks behind the Contraceptive CHOICE Project (just published in the New England Journal of Medicine) should put it to rest.

The Contraceptive CHOICE Project, a groundbreaking initiative by researchers at Washington University in St. Louis, offered women in the St. Louis region access to any kind of birth control they wanted for free (swoon, right?), then looked at what method(s) the participants chose and how well their choices worked for them. The researchers found that when cost and lack of information aren't an issue, women are way more likely to choose a super-effective method of birth control like the IUD or the implant—in fact 75% of the project's participants chose one of those methods. This is great news since the researchers also found that those methods are way less likely to fail than other methods. Intrigued yet? Let us tell you more:

  • Participants using the pill, the patch, or the ring were 20 times more likely to have an unintended pregnancy than participants using the IUD, the implant, or the shot. About one in 11 pill, patch, and ring users got accidentally pregnant during the study; fewer than 1 in 100 IUD and implant users got pregnant during that time.*

  • Younger women (those under 21) were much more likely to have trouble using the pill, the patch, or the ring effectively. They were almost twice as likely to have an unintended pregnancy while using those methods compared to their 21-and-over counterparts.

  • Study participants were a selected group (not a randomized trial). That said, they were a large group (to the tune of 7,486), and diverse.

  • The study results found the same level of effectiveness for the IUD and implant as we list on Bedsider, which come from the National Survey of Family Growth.

  • The shot was found to work just as well as the implant and the IUD, but the researchers only counted people who used it consistently, so their rates represent perfect use rather than typical.

The bottom line? Methods like the implant and the IUD are special because they're so, so low-maintenance. Women who use them are much more likely to stick with them than with higher-maintenance methods like the pill, the patch, and the ring. They require a little more effort up front—a visit to the health care provider and possibly a higher initial cost—but, for most women, the long-term benefit is well worth it.

We think senior study author Jeffrey Peipert, MD, said it best: "If there were a drug for cancer, heart disease or diabetes that was 20 times more effective, we would recommend it first." Hopefully health care providers will take the cue, but in the meantime, you can take the initiative by learning more about the implant (there's a new model coming to town) and the IUD and talking to your provider about your options.

*Editor's Note: A previous version of this article incorrectly reported the failure rates for the birth control methods tracked in the study. We fixed the error and apologize for any confusion.

I'm getting my IUD put in this month. I pray that all goes well, because I want to be able to preach the good word!

2012-06-07 00:28:22 UTC

A T

I wanted the IUD but the doctors ( and my mom ) wouldn't let me because I'm only 16, yet us 16 year olds seem to be more irresponsible with being consistent enough with other forms like the pill?  That doesn't seem fair, and after reading this article I'm really worried about getting pregnant now because I'm on the pill. 

2012-06-07 19:33:06 UTC

Dreamsequance

Some doctors won't recommend an IUD for younger girls because it can be more difficult or painful to insert an IUD when your cervix has never dilated before.  Others don't recommend it for younger girls because the IUD carries a greater risk of complication if an STI is contracted and younger girls tend to have riskier sex. I had my copper IUD (Paraguard) inserted when I was 18.  I love that it doesn't have any hormones and that I don't have to think about it.  There was a good bit of discomfort the day I got it, but since then it's been fine and dandy.   With that said, as long as you take your pill on time, every time (as directed), you won't mess it up.  If you're still worried about it, you can talk to your doctor about scenarios that would make the pill less effective (like taking antibiotics, etc) so you can know how to prevent slip ups.  Also, you might want to look into the implant which uses a hormone similar to the pill, but it implanted into your arm and lasts for up to three years.  It's less invasive to your girly parts, so your doctor and mom might be more willing to let you use it.  

2012-06-16 20:07:05 UTC

Shelly

I have been on the Implanon for about 4 and a half months now. Everything has been fine and normal (considering I'm getting packed full of hormones that is) but recently I have started taking a pill for my acne. My dad told me that is an antibiotic and that it could mess up my Implanon's effectiveness. Is this a possibility? Should I be worried?

2012-09-08 23:50:04 UTC

MandiSaurusRex

Our apologies for taking so long to reply to your post. It’s fantastic that your dad is looking out for you, but chances are good that you have nothing to worry about. The most commonly used antibiotics—including doxycycline, tetracycline, the penicillin families, and ciprofloxacin—have no interaction with the implant (etonogestrel). But since we don’t know exactly what you’re taking, we suggest talking with your provider or pharmacist to be sure.

2013-01-29 21:17:24 UTC

Bedsider Medical Advisor

Our apologies for taking so long to reply to your post. It’s fantastic that your dad is looking out for you, but chances are good that you have nothing to worry about. The most commonly used antibiotics—including doxycycline, tetracycline, the penicillin families, and ciprofloxacin—have no interaction with the implant (etonogestrel). But since we don’t know exactly what you’re taking, we suggest talking with your provider or pharmacist to be sure.

2013-01-29 21:17:24 UTC

Bedsider Medical Advisor

Our apologies for taking so long to reply to your post. It’s fantastic that your dad is looking out for you, but chances are good that you have nothing to worry about. The most commonly used antibiotics—including doxycycline, tetracycline, the penicillin families, and ciprofloxacin—have no interaction with the implant (etonogestrel). But since we don’t know exactly what you’re taking, we suggest talking with your provider or pharmacist to be sure.

2013-01-29 21:17:24 UTC

Bedsider Medical Advisor

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