Best practices for discussing teenage birth control

Healthcare providers play an important role in educating youth about sex, including in discussions about contraceptive use.1.2 Adolescents may begin engaging in sexual activity while going through the numerous physical and emotional changes that occur during their transformational period.3 By the age of 20, approximately 80% of young women have had sexual intercourse; However, adolescents (aged 15 to 19) have limited understanding of the different contraceptive methods available to them and have the lowest rates of contraceptive use.1.2 Counseling individuals about the different methods of birth control and improving access to medical care can help address unwanted pregnancies and sexually transmitted diseases.3 Because most women prefer oral contraceptives to other forms such as injections, transdermal patches, and vaginal rings, it’s a good idea to familiarize yourself with the safest and most effective ways to use all of these products1.2 (Table 13). This article looks at the contraceptives available to teenagers and discusses their effectiveness and safety.

contraception

Various contraceptive methods are available for young people3 (Table 22,3,7). Healthcare providers should advise them on the effectiveness, safety and side effects of contraception,1 Educate them about the most effective options. Contraceptive methods, from most effective to least effective, are as follows: IUDs/progestin implants, progestin injections, and combined oral contraception (pills, patches, vaginal ring).2 With regard to effectiveness, it is also advisable to discuss aspects of “typical” application and “perfect” application. Perfect use is when a contraceptive is used correctly every time, while typical use allows for human error;1,2,3 These include missing pills or forgetting to change a patch, as well as using a condom.1.2 Common side effects are listed in Table 2.

Intrauterine contraception

Intrauterine devices (IUDs) are small, T-shaped, and flexible. There are currently 3 approved in the US: levonorgestrel (Mirena) 52 mg, levonorgestrel (Skyla) 13.5 mg, and a copper-containing device (Paragard). Levonorgestrel 52 mg is approved for 3 years, levonorgestrel 13.5 mg for 5 years and the copper IUD for 10 years.2.3 These devices are highly effective with a failure rate of less than 1%.2.3 Several data articles support the safety of these devices in adolescents.3,4,5 The one-time insertion of an IUD into the uterus reduces the risk of non-adherence6 and therefore the responsibility for maintaining efficacy. This can make IUDs an ideal choice for a young woman who has not yet reached adulthood. The implantation success rate is reported as 96%, however, there is a risk of pelvic infection in the initial period (~21 days) after implantation. Choosing between the 2 different types of IUDs can be difficult, but counseling patients about the risks and benefits of each option can make their decision easier. Advice points to consider include the misunderstanding of IUD infertility and safety in nulliparous women.1-3

progestin implants

A progestin implant is a thin, flexible single rod containing etonogestrel that is placed under the skin of the upper arm. Etonogestrel 68 mg (Nexplanon) is available and has an efficacy of 3 years. Implants are highly effective with a failure rate of less than 1%. These exert their effects by thickening cervical mucus, thinning the lining of the womb, and inhibiting ovulation. Implants do not appear to have a major impact on bone mineral density, as higher levels of estradiol are observed in women using implants than with progestogen injection. Implants are a great option for teens who prefer not to take regular medication on a daily basis or who prefer longer protection.1-3.7

progestin injection

Depot medroxyprogesterone acetate (DMPA; Depo-Provera) is an injection given every 3 months with a 96% effectiveness rate in preventing pregnancy. DMPA causes anovulation and thickening of cervical mucus by inhibiting pituitary gonadotropins. The benefits of this product include rare dosing, discretion, improvement in dysmenorrhea, and protection against iron deficiency anemia and endometrial cancer. Disadvantages include access to a healthcare provider for injections, menstrual cycle irregularities, delayed return of fertility, weight gain, headaches, and hair loss. Weight gain is a problem for teenagers who gain more than 5% of their body weight after 6 months of use. There is a black box warning about the drug’s potential to cause bone mineral density loss in the first 2 years of use; however, the American College of Obstetricians and Gynecologists does not specify a limit on how long DMPA can be used.1,2 During this time, adolescents should have an adequate daily intake of calcium and vitamin D (1300 mg calcium; 600 IU vitamin D), weight training and smoking cessation.1-3.7

Combined hormonal contraception

There are three different methods that contain both an estrogen and a progestin: the pill, patch, and vaginal ring. The 4 to 7 day hormone free interval can be used monthly or extended to every few months. The data has demonstrated the safety of the extended approach. Hormonal contraceptives must be taken for at least 21 consecutive days to prevent unwanted pregnancy. The timing of birth control use varies and should be considered when choosing between the pill form, injectable form, patch or vaginal ring. Teens can start using these products right away or wait until their next menstrual cycle. It is common to prefer a Sunday start or to start on the first day of the next menstrual cycle. This will ensure that the teen is not pregnant before starting birth control. However, current data do not support evidence of side effects of contraceptive hormone exposure on fetal development.1-3.6

Combined oral contraceptives

Combined oral contraceptives are the most commonly prescribed hormonal contraceptives and contain varying amounts of ethinyl estradiol. Providers should propose strategies such as B. using cell phone alarms, keeping a regular schedule, and supporting family members. Discussing missed doses is very important as taking 7 consecutive hormone pills is required to prevent pregnancy. There are many different formulations (monophasic and inphasic) and it is preferable to choose an appropriate pill covered by the adolescent’s insurance. Experts recommend starting with a monophasic formulation and moving to an in-phase regimen to mitigate side effects and/or suit the adolescent’s preferences.1-3.7

contraceptive patch

Contraceptive patches (Xulane, Zafemy) contain 150 µg norelgestromin and 35 µg ethinyl estradiol. The patch is worn weekly for 3 weeks and removed for 1 week to induce withdrawal bleeding. The abdomen, torso, upper arm and buttocks are safe places to apply the patch.1,2,3,7

Vaginal ring for contraception

The vaginal ring (NuvaRing) is a round, flexible device that is inserted into the vagina weekly for 3 weeks and contains 15 µg ethinylestradiol and 120 µg etonogestrel. During the doctor’s visit, patients should be shown a pelvic model to explain where the vaginal ring will be; You should make sure that the ring does not fall out and can stay in during intercourse.1-3.7

References:

  1. Ott MA, Sucato GS; Youth Committee. Contraception for young people. paediatrics. 2014;134(4):e1257-e1281. doi:10.1542/peds.2014-2300
  2. Youth Committee. Contraception for young people. paediatrics. 2014;134(4):e1244-e1256. doi:10.1542/peds.2014-2299
  3. Todd N, Black A. Contraception for adolescents. J Clin Res Pediatric Endocrinol. 2020;12(Supplement 1):28-40. doi:10.4274/jcrpe.galenos.2019.2019.S0003
  4. Youth Health Care Committee. Committee Opinion No. 699: Adolescent Pregnancy, Contraception and Sexual Activity. Obstetrics Gynec. 2017;129(5):e142-e149. doi:10.1097/AOG.0000000000002045
  5. Di Meglio G, Crowther C, Simms J. Contraception for Canadian adolescents. child health. 2018;23(4):271-277. doi:10.1093/pch/pxx192
  6. Kumar N, Brown JD. Barriers to accessing long-acting reversible contraceptives in adolescents. J Adolesc Health. 2016;59(3):248-253. doi:10.1016/j.jadohealth.2016.03.039
  7. Contraception explained: options for teenagers and adolescents. American Academy of Pediatrics. Updated July 20, 2020. Accessed April 27, 2022. https://www.healthychildren.org/English/ages-stages/teen/dating-sex/Pages/Birth-Control-for-Sexually-Active-Teens. aspx

Comments are closed.