From the Guidelines
Birth control can be used to regulate menstrual cycles in teenagers with primary amenorrhea, but only after a thorough medical evaluation to determine the underlying cause, and the most recent evidence from 2014 supports the use of combined oral contraceptives (COCs) for this purpose 1. When considering the use of birth control for regulating menstrual cycles in teenagers with delayed menarche, it is essential to prioritize their overall health and well-being. The primary concern is to rule out any underlying medical conditions that may be causing the delayed menarche, such as pregnancy, anatomical abnormalities, chromosomal disorders, or hormonal imbalances.
Key Considerations
- A thorough medical workup is necessary before starting treatment, including a review of the patient's medical history, physical examination, and laboratory tests as needed.
- Combined hormonal contraceptives containing estrogen and progestin, such as Ortho Tri-Cyclen, Yasmin, or Lo Loestrin Fe, can be prescribed to induce regular withdrawal bleeding and provide other benefits like preventing endometrial hyperplasia and supporting bone health.
- The American Academy of Pediatrics recommends that COCs can be started on the same day as the visit (“quick start”) in healthy, non-pregnant adolescents, and that a backup method (e.g., condoms or abstinence) should be used for at least the first 7 days for contraceptive efficacy 1.
- Regular follow-up appointments are essential to monitor response to treatment and adjust medication if needed, and patients should be counseled on common transient adverse effects, such as irregular bleeding, headache, and nausea, and on strategies to promote daily adherence, such as cell phone alarms and support from a family member or partner 1.
Benefits and Risks
- The benefits of using COCs for regulating menstrual cycles in teenagers with primary amenorrhea include establishing regular cycles, preventing endometrial hyperplasia, and supporting bone health.
- The risks associated with COC use include an increased risk of blood clots, which increases from 1 per 10,000 to 3 to 4 per 10,000 woman-years during COC use, and other adverse effects, such as irregular bleeding, headache, and nausea 1.