This week is LARC Awareness Week, which is devoted to raising the awareness about the safety and efficacy of long acting reversible contraception. LARC includes IUDs and the etonogestrel implant marketed under the name Implanon in the United States.
Why promote LARC? Well…
- LARC is underused in the United States versus other countries
- The United States has the highest rate of unplanned pregnancies in the industrialized world
- LARC is the most effective method of reversible contraception and should be 1st line contraception for any woman not wanting a permanent method
There are three big reasons that LARC is used less in the United States
- Misconceptions among providers about safety, especially a concern regarding infection and infertility
- Misconceptions among women about safety
The IUD has long been a favorite among personal injury lawyers for fear mongering. This is not really unique, lawyers are looking to sue doctors and manufacturers over NuvaRing and countless other prescription medications. Sadly, this affects practice because doctors don’t want to be sued. In fact, 63% of OB/GYNs report having changed their medical practice in some way to avoid lawsuits (honestly, I think that number is on the low side).
Unfortunately, many health care professionals still buy into the “IUDs cause pelvic inflammatory disease” when the only proven infection issue is a minor risk (in the 1% range) of post insertion infection in the first three weeks. A recent study (Berenson et al. Obstet Gynecol 2013;121:951–8) tells us that the rate of pelvic inflammatory disease is no higher even for teenagers who get an IUD, and teenagers are the group at highest risk for PID.
While the Dalkon shield, an older IUD that was poorly designed and bears no physical resemblance or really any similarities to modern IUDs, was associated with serious pelvic infections the issues with the Dalkon shield should not be projected onto modern IUDs. It would be like comparing the Hindenberg to a modern airplane. Evidence based medicine tells us that women and their providers should feel confident that outside of a very minor increase in the first 3 weeks after insertion, an IUD will not lead to an increase in pelvic infections.
And lawyers, well, why can’t they be sued for spreading misinformation?