Adolescence and Contraception

IntroductionThe median age of first intercourse in the United States, Western Europe, Eastern Europe (Ukraine), Eurasia (Russia), and other parts of the world is 16 years of age, with many youth having multiple sexual partners. Clinicians caring for adolescents should ask about possible coital behavior and provide effective contraception to those youth continuing to be sexually active without intent of becoming pregnant (1-23). Table 1 lists questions helpful to ask when discussing contraception with adolescents-particularly if they are sexually active.A number of effective and safe contraceptive methods (see Table 2) are available for the sexually active adolescent who wishes to avoid pregnancy. The most effective methods of contraception include abstinence, combined oral contraceptives (24), transdermal contraceptive patch (Ortho Evra®), vaginal contraceptive ring (NuvaRing®), progestin-releasing implant (Implanon®), IUDs, and intramuscular medroxy-progesterone acetate (Depo-Provera, DMPA); these methods have pregnancy rates under 1/100 woman years of use (see Table 3).active patient. The less patient-dependent a method, the closer the typical usage is to the perfect usage. Thus, methods such as the implant, DMPA, and IUDs have typical usage that is virtually equal to perfect usage, and the intravaginal ring and transdermal patch have better typical usage than OCPs.Unfortunately, the difference in contraceptive effectiveness between perfect use and typical use leads to millions of unintended pregnancies each year. Perfect use is defined as correct, consistent, and continued use of a method chosen by the sexually The barrier methods (male condoms, diaphragms, cervical caps, vaginal sponges, female condoms and vaginal spermicides) are not typically recommended as the sole contraceptive method for adolescents, unless they are mature and motivated enough to use them; even then, pregnancy rates are higher than with the methods identified above as the most effective ones.Over the past 20 years, a number of newer contraceptive methods have been approved in the United States by the Washington, DC Federal Drug Administration; these include emergency contraceptives (Preven®, Plan B®), Depo-Provera®, the cervical cap, Lunelle® (injectable contraceptive with estrogen), Mirena® (an IUD with levonorgestrel), the contraceptive patch (Ortho Evra®) and an intravaginal ring(NuvaRing®). Over the past 15 years, research has developed various ways of contraceptive steroid release (Table 4), producing a number of potential advantages (Table 5). After OCPs were developed in the 1960s, the emphasis has been on having pill formulations that have reduced estrogen and progestin dosages along with the development of phasic and extended dosing regimens as well as the above mentioned newer hormone delivery methods.This chapter reviews some of these important methods of contraception. Figure 1 lists frequency of contraceptive use by sexually active adolescents in the United States.Oral contraceptives (OCPs; COCs)One of the main contraceptives for several decades has been the combined oral contraceptive (COCs), containing synthetic estrogen (usually ethinyl estradiol [EE], occasionally mestranol) and synthetic progesterone (Table 6) (1-7).The mechanisms of action for the combined birth control pill (OCPs or COCs) to prevent pregnancy include inhibition of ovulation, cervical mucus thickening, endometrial atrophy, and tubal transport changes. When discussing OCPs with adolescents, it is helpful to note the many benefits and uses of these pills, as listed in Table 7. OCPs are usually available as 28 day packs which contain 21 days of active pills containing consistent steroid dosages (mono-phasic) and placebo pills for the last 7 days to allow the adolescent to continue with one pill a day.Variations are being developed, such as having only two days of placebo for each 28 day cycle and extended cycles. …