The latest on teenage contraceptive options

“The most commonly used contraceptives in adolescents are condoms, withdrawal pills and oral contraceptive pills. While Fewer Teens Are Using LARC Methods, Using IUDs [intrauterine devices] and implants are on the rise,” says Cara Clure, MD, a family planning fellow at the University of Colorado at Aurora. “LARC methods are safe, highly effective options for adolescents with higher continuation and satisfaction levels compared to teens using short-acting contraceptives .”

According to the American College of Obstetricians and Gynecologists (ACOG), about 19 out of every 1,000 teenage girls became pregnant in 2017. While this is a record for the United States — down from 117 per 1,000 in 1990 — teen pregnancies in the United States are among the highest among developed countries.1 While abstinence and sex education have contributed to the decline in adolescent pregnancies , the Centers for Disease Control and Prevention (CDC) found that an increase in contraceptive use among these age groups may be the largest contributor to the decline.

Furthermore, the use of LARCs is gradually increasing. The CDC reports that in 1 survey across the country, use of LARC among teens rose from 0.4% in 2005 to 7.1% in 20133 and about 20% in 2017.4 While these trends are promising, teen dependency is increasing. in 65% of encounters to rely on the contraceptive withdrawal method show a need for more education.

ACOG recommends discussing birth control options with patients ages 13 to 15, regardless of previous sexual activity, to clear up misunderstandings; giving an overview of the most effective methods; and providing information about emergency contraception. “Since teens are at high risk for sexually transmitted infections (STIs), using two methods — using condoms in addition to a more effective method of contraception — is ideal,” says Clure.

Condom education seems to have taken hold: About 97% of teens report using condoms during sexual encounters, according to the CDC.2 However, as a dual method, says Clure, many adolescents opt for oral contraceptive pills along with the use of technology such as mobile phone alarms or apps that can send reminders and improve adherence. However, doctors cannot rely on technology alone to help adolescents figure out birth control.

“Teenagers should also be educated about what to do if they miss a pill and about emergency contraception options. Technology Reminders Can Be Helpful For People Using The Contraceptive Patch, Vaginal Ring, Or Depo-Provera [medroxyprogesterone acetate]Klaus says. LARCs, on the other hand, take a lot of guesswork out of the compliance equation. “Some adolescents may choose a LARC method because it does not require adherence.”

LARCs have become a favorite among this age group due to the effectiveness of these methods and ease of use. Adherence is easier than oral contraceptives, so teens are more likely to be satisfied and continue with these forms of birth control. The safety and convenience of LARCs make them an ideal choice to recommend to teens, ACOG reports.

The most popular types of LARCs include:

PROGESTIN IMPLANTS

These single-rod implants contain etonogestrel and are highly effective, with a failure rate of less than 1%, according to the American Academy of Pediatrics (AAP). These implants are inserted into the inner part of the upper arm and can remain in place for up to 3 years. This option can be offered to pregnant teens or teens who have just given birth for immediate postpartum protection. No effects have been seen related to breastfeeding, AAP says.5 Doctors should warn patients about the need for a backup method of birth control for at least the first week after implant, as well as the fact that implants can prevent pregnancy, but not STDs appearance.

IUDs

These devices, which are inserted into the uterus, are also very successful and can provide long-term contraception. There are 2 types of IUDs approved in the United States. These include a T-shaped device that delivers levonorgestrel and a T-shaped implant containing copper. The latter can also be used as an emergency contraceptive method for up to 5 days after unprotected intercourse. Like progestin implants, these LARCs have a failure rate of less than 1%, but concerns have been raised about infection and infertility risks with these devices.

While infertility has been largely disproved, there are other drawbacks to having an IUD inserted, according to AAP.5 These include pain during insertion and expansion, which AAP says may be more common in younger women. However, like implants, IUDs can be used as emergency contraception, can be placed in pregnant women and women immediately after delivery, and have a higher continuation rate than oral contraceptives. IUDs cannot be used in patients with purulent cervicitis, gonorrhea, chlamydia, and active pelvic inflammatory disease or certain other pelvic infections.

INJECTABLE PROGESTINE ONLY CONTRACEPTION

These LARCs are not as long lasting as other methods but also do not need to be removed to stop therapy. Long-acting progestin, also known as depot medroxyprogesterone (DMPA), is given as a single intramuscular or subcutaneous injection every 13 to 15 weeks. Although supplemental contraception should be used for at least a week and the injection cannot be used in pregnant women, this method is sometimes preferred because it can usually be started on the same day as the decision to start contraception.

A disadvantage of this method, beyond frequent injections, is more potential adverse effects (AEs) than other LARCs.

Possible side effects include:

menstrual irregularities headache mastalgia hair loss weight increase libido changes

Other options for teenage contraceptives include oral contraceptives, vaginal rings, contraceptive patches, and barrier methods such as condoms, but adherence and proper use can be difficult for some younger patients, especially those with special care needs such as developmental disabilities. Even if sexual activity is not the primary concern, contraceptives are sometimes used in these populations to address other menstrual complications.

“While there are few medical contraindications to contraceptives in healthy adolescents, a complete medical history, including an assessment of current medications, is important before initiating contraception. Adolescents with complex medical conditions may not be candidates for all birth control options, says Clare. For example, estrogen-containing contraceptives or combined hormonal methods are contraindicated in adolescents with migraines with aura or a history of venous thromboembolism, she explains.

“If teens are not good candidates for estrogen-containing contraceptives, progestin-only options, including LARC methods, are preferred,” says Clure. “Adolescents with intellectual or physical disabilities may benefit from birth control choices that reduce or suppress menstrual bleeding, such as the levonorgestrel IUD, Depo-Provera, or combined hormonal methods such as the pill and patch, because menstrual treatment can be difficult for these patients.”

Clore says all teens should be educated about potential side effects associated with different birth control methods. For example, combined hormonal methods such as pills, the patch and the vaginal ring can cause irregular bleeding, breast tenderness and nausea, especially at the beginning. Bleeding irregularities are common with the levonorgestrel IUD and the contraceptive implant. In general, the decision should rest solely with the patient after thorough education of all options.

“Patient choice should be leading when prescribing one method of contraception over another. When providing contraceptive counseling to adolescents, it is important to provide all contraceptive options that are appropriate for that patient, including LARC methods, and participate in shared decision-making with the adolescent,” says Clure. “Contraceptive counseling for teens should include anticipatory guidance about side effects, efficacy and non-contraceptive benefits, such as amelioration of dysmenorrhea and heavy menstrual bleeding, which can be a deciding factor for some patients. Adolescents should also be informed about how each method is started and stopped.” .”

AEs, and the ease of use and adherence provided by LARCs, make them the first line of teen contraception recommended by AAP.5 Pediatricians can be trained to offer LARCs to their patients, but must also be prepared to make appropriate referrals. However, Clore cautions that there is no one best method for everyone.

Contraceptive counseling for adolescents should provoke and address concerns and misconceptions about contraception. Misinformation, particularly about the safety of LARC use in teens, can create a barrier, making it important to assess the safety and benefits of LARC use in adolescents. tackle,” she adds. “No method of contraception is right for every teen, and counseling should empower the teen to make the decision that suits his/her needs and goals.”

References

1. Gerancher K; American College of Obstetricians and Gynecologists’ Committee on Adolescent Health Care. Advising young people about contraception. American College of Obstetricians and Gynecologists. August 2017. Retrieved May 15, 2021. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/counseling-adolescents-about-contraception

2. About teenage pregnancies. Center for Disease Control and Prevention. Updated March 1, 2019. Accessed April 24, 2021. https://www.cdc.gov/teenpregnancy/about/index.htm

3. Romero L, Pazol K, Warner L, et al; Center for Disease Control and Prevention. Vital signs: trends in long-acting reversible contraceptive use among teens aged 15-19 seeking contraceptive services—United States, 2005-2013. MMWR Morb Mortal Wkly Rep. 2015;64(13):363-369.

4. Abma JC, Martinez GM. Sexual activity and contraceptive use among teens aged 15-19 in the United States, 2011-2015. National Health Statistics Report. 2017;104. https://www.cdc.gov/nchs/data/nhsr/nhsr104.pdf

5. Committee on Adolescence. Contraception for adolescents. Pediatrics. 2014;134(4):e1244-e1256. doi:10.1542/peds.2014-2299

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