Hormonal and copper IUDs.
Changes in the behavior of doctors could make a big difference in how many women opt for using long-acting reversible contraceptives (LARCs). This Jane Brody column reports on a committee’s strong argument urging obstetricians and gynecologists to increase their prescribing of long-acting alternatives. The committee states that only about half of all doctors offer these devices in their practice, even though research shows these alternatives are more effective and relatively safe.
The story does a great job of examining the way that up-front higher cost may be confusing some patients about the true long-term savings these devices can provide. It would have been nice to hear from someone — a clinician perhaps — who does not routinely prescribe LARCs and why that’s the case. What are their concerns and what are the obstacles to making this more widely available?
Preventing unwanted pregnancies could work much better if the doctors who see women recommended better options known as long-acting reversible contraceptives or LARCs more often. Some of the resistance to LARCs is likely among older docs who remember the scary history of pelvic inflammatory disease (and infertility) from IUDs. And the rest may be from those with concerns about high upfront costs. In addition, insertion of IUDs and Implanon are specialized skills that not all practitioners have (gynecologists and family practitioners are usually the ones to offer these methods, not internists), whereas as most practitioners are comfortable prescribing the pill.
We applaud the way this story examines what may be the “under use” of devices and clearly explains some of the nuance about up-front costs versus the long-term cost of contraception. Bravo for pointing out that the Affordable Care Act now covers these devices, which at one time may have seemed “too expensive” for some patients.
We think it would have been even better if the story had a few actual figures in it – to demonstrate this. For example, one website from Planned Parenthood explains the cost for the copper IUD this way:
“The cost for the medical exam, the IUD, the insertion of the IUD and follow-up visits to your health care provider can range from $500 to $900. That cost pays for protection that can last more than a decade.”
As the story points out – that cost will not fall to an individual patient who is covered under the ACA. But the old prejudices about cost may be part of the reason for the gap in popularity.
The story gives figures on the effectiveness of a variety of contraception methods.
Here is an excerpt:
In a 2012 study of 7,486 women aged 14 to 45, long-acting reversible contraceptives, or LARCs, were shown to be 20 times as effective in preventing pregnancy than the pill, contraceptive patch or vaginal ring. The risk of an unwanted pregnancy with these other methods was especially high among women under 21, whose rate of unintended pregnancy was nearly double that among older women.
Absolute risks are also cited in the report on one-year pregnancy rate with real-world use, which is another strength of the story.
The story lists some of the potential side effects of long-acting implants or IUDs. These include “irregular bleeding and cramping” as short-term impacts. We’ll give the benefit of the doubt, but we would have liked an additional comment by someone not connected to the committee report on whether there are any long-term studies underway about downstream potential impacts for women 5 or 10 years after using these. In addition, rare but potentially serious complications of copper IUDs, such as perforation (when the IUD pushes through the wall of the uterus), could have been mentioned.
The Committee report from the American College of Obstetrics and Gynecology relied on reviews of many high-quality peer-reviewed studies related to long-term contraception alternatives. However, the story doesn’t establish what kinds of evidence the committee based its recommendations on. Had the story taken greater pains to discuss this aspect of the report, readers could be more confident that the recommendations are solid and worth following.
The story quotes one expert, Megan Kavanaugh, who is one of the authors of one of the studies referenced in the article. Kavanaugh works for the Guttmacher Institute, and has declared no conflicts in other publications on contraception. It would have been nice to hear from someone who is totally independent of the studies and report covered in the column, but we think Dr. Kavanaugh qualifies as sufficient for a Satisfactory rating here.
This story did a great job of outlining many different alternative methods of contraception and their effectiveness.
You could say this story was about availability itself, and especially about why things that are widely available are not prescribed by doctors more often. All of these long-term contraceptives are available.
LARCs are not novel and the story establishes this.
The story does not appear to rely on a news release.
Systematic, Criteria-Driven
NO! NO! NO! @TheHeartOrg - This study was on rabbits, and is at least 2 yrs away from human trials. THAT should be the headline, not "breakthrough". Journalists, pls check this @HealthNewsRevu toolkit when writing about animal studies. https://t.co/QFznfsn4ag https://t.co/L1WIStfV8G
2
Comments (2)
Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.
Linda Prine MD
November 2, 2015 at 7:14 amThe health insurance companies are a big part of the problem. They require prior authorizations or don’t cover them at all. Medicaid payments typically are a negotiated rate with each clinic so there is no mechanism for billing a big added expense like this, so many Medicaid clinics do not provide them. And then you have Title X family planning clinics that are under attack by Congress, struggling financially, and going out of business.
Laurence Alter
November 2, 2015 at 7:45 amTo Gary & Staff,
I can’t see a link to this story, so I can only go on your summarized points (years and years of computer/on-line use have not helped me use/find links), I assume the news article did not quote an authority from the field of endocrinology – an obvious source (ex.: Endocrine Society). This is doubly important as this is go-to sub-specialty when the primary physician (internist) is inconclusive in his/her diagnosis.
Respectfully,
Laurence
Our Comments Policy
But before leaving a comment, please review these notes about our policy.
You are responsible for any comments you leave on this site.
This site is primarily a forum for discussion about the quality (or lack thereof) in journalism or other media messages (advertising, marketing, public relations, medical journals, etc.) It is not intended to be a forum for definitive discussions about medicine or science.
We will delete comments that include personal attacks, unfounded allegations, unverified claims, product pitches, profanity or any from anyone who does not list a full name and a functioning email address. We will also end any thread of repetitive comments. We don”t give medical advice so we won”t respond to questions asking for it.
We don”t have sufficient staffing to contact each commenter who left such a message. If you have a question about why your comment was edited or removed, you can email us at feedback@healthnewsreview.org.
There has been a recent burst of attention to troubles with many comments left on science and science news/communication websites. Read “Online science comments: trolls, trash and treasure.”
The authors of the Retraction Watch comments policy urge commenters:
We”re also concerned about anonymous comments. We ask that all commenters leave their full name and provide an actual email address in case we feel we need to contact them. We may delete any comment left by someone who does not leave their name and a legitimate email address.
And, as noted, product pitches of any sort – pushing treatments, tests, products, procedures, physicians, medical centers, books, websites – are likely to be deleted. We don”t accept advertising on this site and are not going to give it away free.
The ability to leave comments expires after a certain period of time. So you may find that you’re unable to leave a comment on an article that is more than a few months old.
You might also like