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IUDs, implants advocated for birth control

In about 1 in 1,000 cases, ACOG says, the IUD can push through the wall of the uterus. It then needs to be removed, which sometimes requires surgery.

Traditionally, IUDs were considered an option mainly for women who'd already had children.

That, according to Espey, was based on concerns that IUDs raised the risk of pelvic inflammatory disease (PID), which can cause infertility. So doctors were reluctant to place IUDs in younger women who had not yet had a baby.

"But the available evidence suggests that IUDs do not cause PID," Espey said.

As for why IUDs and implants are not more popular in the U.S., Espey said that awareness is one factor.

"One of the main barriers is that doctors and patients just don't consider these first-line options," she said.

The other big barrier, Espey said, is probably cost.

The upfront cost of the Mirena device itself has gone up over the years and is now nearly $800. The ParaGard price tag is about $500. Then there are the doctor's charges.

Implanon costs between $400 and $800, including implantation.

Since the devices last for years, those costs could become worthwhile over time, Espey said. Birth control pills, for instance, cost anywhere from about $10 to $50 a month, depending on whether a woman uses generic or brand-name pills.

Another downside of the high device costs for IUDs: some doctors may stock few of them, or none at all.

So, Espey said, even if a woman is interested in an IUD, she might not be able to get one from her doctor.

SOURCE: http://bit.ly/jQFey3 Obstetrics & Gynecology, July 2011.

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