Consider IUDs in Teens with Disabilities for Menstrual Management
AUGUST 29, 2020
Dr. Marta Dahiya is a Radiation Oncologist and a Director of SRF. We are grateful for her tireless work co-leading the Webinar Series, engaging with researchers and pushing SRF forward every day.
As the mom of a 17-year-old Syngapian girl, I have experienced the challenge of heavy and painful periods (dysmenorrhea) since she was 12 years old. I also was worried about starting puberty because changes in hormones can trigger seizures. As a result, I did a consultation with a pediatric gynecologist when my daughter was 14 years old. Besides over the counter medications NSAIDs (ibuprofen and naproxen), the options were:
- oral contraceptives,
- a hormone patch, or
- a Depo-Provera shot.
All of these came with a higher risk of systemic side effects and possible interactions with certain anti-epileptic drugs. I opted for not doing anything as I was afraid of the systemic side effects including changes in behaviors, mood swings, increased seizures, and depression, among others. This was three years ago.
Since then, however, IUDs have become well accepted and even recommended in teenagers. Currently, the American College of Obstetrics and Gynecology (ACOG) strongly supports IUD use among adolescent females. But how will an IUD impact a Syngapian?
I read Intrauterine Device Use in Adolescents With Disabilities by Dr. Beth Schwartz, et al was published in Pediatrics in August 2020. The article references the use of an IUD containing slow-release progestogen, called Levonorgestrel, in disabled teens.
The results show lower risk of complications. So far these IUDs have not shown statistically significant interaction with anti-epileptic drugs (AEDs) or an increase in seizures. Considering the limited literature on the topic, I think it is important to share this information with other parents of a female Syngapian who are currently, or will eventually, navigate this issue.
Speaking to MedPage Today Dr. Schwartz said “This is a really effective method for young women with disabilities or other medical conditions…I think we are slowly taking down some of the barriers around who can and should use IUDs.”
Full disclosure, I work in the medical field, but this is not medical advice. As a parent, I am sharing this information and my experience to make sure you consider an IUD, even if sedation may be necessary to place it. This is a good option when other less invasive and over the counter medications like NSAIDs have failed to provide help with good menstrual hygiene, decrease in the amount of the menstrual periods and control of the pain. Also, slow-release progesterone IUDs appear to be a better option compared to other hormonal contraceptives like Depo-Provera or patch as the systemic side effects are significantly less.
Unfortunately, the public cannot access this important article without a subscription. The abstract can be read and includes this video which is less than four minutes. Your physician should have access to the paper and I encourage you to share this blog with them if you are discussing this.
In her review of Schwartz’s article titled IUDs Are Effective for Menstrual Management in Teens with Disabilities, Dr. Jenny Radesky commented that “Self-care and menstrual health should be discussed early and in developmentally appropriate terms as children with disabilities enter adolescence. Management of pain and heavy bleeding can improve the quality of life for teens with disabilities and the parents who care for them and support the teen’s rights to sexual and reproductive health. These results suggest that IUDs should be on the list of initial management options, especially if access to experienced pediatric gynecologists is available and teens have other surgical procedures planned.”
For more information about this study, see:
- The Use of IUDs in Adolescents with Disabilities: A Menstrual Management and Contraceptive Option Well Worth Considering by Dr Lewis First Editor in Chief, Pediatrics.
- IUDs viable option for menstrual management in adolescents with disabilities in Healio.
For more information regarding this IUD use in epilepsy, see:
- Women with epilepsy initiating a progestin IUD: A prospective pilot study of safety and acceptability in Epilepsia, 2016.
- This helpful article about Contraception & Epilepsy from the UK Epilepsy Society.