Your IUD & Implant Last Longer Than You Think

by Lulu Chang
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Just call it the birth control gift that keeps on giving. According to new research, the intrauterine device (IUD) and the implant remain effective for a full year after they are said to lose their protective powers. While doctors and health officials have only approved the use of the implant for three years and the IUD for five years, a new study published in the journal Obstetrics & Gynecology shows that these already long-lasting forms of birth control can actually prevent pregnancy for much longer than advertised. In fact, the study is ongoing to determine whether the IUD and implant remains effective for up to three years beyond their approved use.

The study, conducted by the Washington University School of Medicine in St. Louis followed a total of 500 women, all of whom were using an IUD or an implant within six months of their prescribed expiration dates. In preliminary results, scientists found that even 12 months after the devices' supposed expiration dates, none of the 237 women using an implant became pregnant, and only one woman out of the 263 using an IUD became pregnant. That failure rate — under 1 percent — is nearly identical to the failure rate of IUDs when used within their approved five-year time frame, suggesting that continued usage of the contraceptive devices beyond their recommended window carries no additional risk of pregnancy.

This, study author Colleen McNicholas, an assistant professor of obstetrics and gynecology at Washington University, carries with it new potential for a much cheaper birth control alternative. In a news release, McNicholas noted, "This research is important because extended use of these devices will reduce cost to both the individual and insurer and improve convenience for women, who can delay removal and re-insertion." While IUDs and implants are currently less popular forms than the pill, their popularity has been on the rise in the last few years. Whereas only 2.4 percent of women reported using these devices in 2002, this proportion grew nearly 10 points to 12 percent between 2011 and 2013, according to a Guttmacher Institute analysis of data from the federal National Survey of Family Growth.

The slow uptake of these long-term forms of contraception may be linked to the relative unawareness of how precisely the devices work. An IUD, as described by popular brand Mirena, is "a small, T-shaped device that is placed into the uterus by a trained healthcare provider during a routine office visit." Mirena then "releases small amounts of a progestin hormone called levonorgestrel locally into the uterus," preventing fertilization and pregnancy. Mirena's website claims that the IUD "lasts for as long as you want, for up to 5 years," but if McNicholas' hypothesis proves correct, this may be extended to up to eight years.

There are also non-hormonal IUD options, like the Paragard, a copper device that's effective forten whole years.

An implant, on the other hand, is inserted "just under the skin of the inner side of your upper arm" but works similarly to an IUD in that it releases a pregnancy-preventing hormone directly into the body. The study involved two popular implants, Implanon and Nexplanon, both of which prevent the release of the egg and its subsequent fertilization. Both are approved for three years and have a less than 1 percent fail rate. However, in the Washington University study, not a single woman using either implant became pregnant while having unprotected sex a year after their implants' effectiveness was meant to wear thin, suggesting new horizons for the potential of the devices.

To further test their results, researchers intend on enrolling 300 additional women in the trial, bringing the total number of participants to 800 women, all of whom are between the ages of 18 and 45. As per the study's procedure, each of these women will be monitored with follow-up appointments every six months for 36 months, or until their IUDs or implants are removed.

This comes as phenomenal news for users of these devices, who already enjoy the benefits of one of the safest and most effective forms of birth control available. According to the Centers for Disease Control and Prevention, IUDs and implants, rank among the most dependable forms of contraception. The only method more dependable? Sterilization.

Still, most American women do not depend on IUDs and implants to prevent pregnancy, which gynecologists say may contribute to the relatively high rate of unwanted pregnancies that still occur year over year in the United States. The American College of Obstetricians and Gynecologists Committee on Gynecologic Practice's opinion, for one, has stated:

In part, high-unintended pregnancy rates in the US may be the result of relatively low use of long-acting reversible contraceptive methods, specifically the contraceptive implant and intrauterine devices.
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But pregnancy rates at home pale in comparison to the international landscape, with medical reports from earlier in the week suggesting that slow adoption of devices like hormonal IUDs has had devastating effects on reproductive health and responsibility. According to scientists with the World Health Organization who examined data from 35 low-income to middle-income countries, such devices could have prevented 9 out of 10 unwanted pregnancies.

With this new study, however, contraception as we know it could change altogether. After all, as Dr. Jeffrey Peipert, a Washington University professor of obstetrics and gynecology, noted in a news release surrounding the study, "The longer a contraceptive method is effective, the bigger the impact it can have." He also added, "In the long term, this work has the potential to change how we provide contraceptive methods around the world and can enable women to control their reproductive health and family size."

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Doctors are hopeful that the novel data will convince more women to turn to IUDs and implants as opposed to more common, traditional forms of birth control, like the condom or the pill. Dr. Jill Maura Rabin, the co-chief of ambulatory care in Women's Health Programs-PCAP Services in the North Shore-LIJ Health System, asserted, "The ability to keep these devices in place for longer periods will not only reduce patients' contraceptive costs, but will add convenience and flexibility to their lives."

So ladies, stop worrying about your one-a-day pill, and start considering an IUD.