What questions should be asked of a 14-year-old female seeking birth control to determine the appropriate contraceptive method?

Essential Questions for Contraceptive Selection in a 14-Year-Old

Use an adolescent-centered, equity-informed approach that prioritizes the patient's goals, preferences, and life circumstances over method efficacy alone, while assessing medical contraindications, developmental needs, and contextual barriers. 1

Core Assessment Framework

1. Patient Goals and Priorities

Start by asking what matters most to her:

• Primary goal: "What is most important to you in choosing birth control?" (pregnancy prevention, menstrual regulation, acne improvement, or other benefits)
• Pregnancy prevention priority: "How important is it to you to avoid pregnancy right now?" and "What are your life goals before considering parenting?" 2
• Method preferences: Does she want to avoid hormones, devices, or daily pills? 1

Rationale: The 2025 AAP guidelines explicitly shift away from efficacy-first counseling to center the adolescent's stated priorities. A less-effective method used consistently may provide better protection than a highly effective method that's discontinued. 1

2. Medical History and Contraindications

Ask specifically about:

• Menstrual patterns: Heavy bleeding, severe cramping, irregular cycles, or conditions like endometriosis
• Headaches: Migraine with or without aura (critical for combined hormonal contraceptive safety)
• Blood clot history: Personal or family history of venous thromboembolism
• Bleeding disorders: Von Willebrand disease or other coagulopathies
• Current medications: Especially those that interact with hormonal contraceptives 3
• Mental health: History of depression or mood disorders (relevant for progestin-only methods) 4

3. Side Effect Concerns and Health Worries

Directly address her specific concerns:

• "What have you heard about birth control that worries you?" 5
• Ask about fears regarding: fertility, cancer risk, weight gain, mood changes, menstrual changes 5
• Side-effect priorities: What side effects would be most unacceptable to her? (bleeding changes, weight gain, acne, mood effects) 2

Common pitfall: Adolescents often discontinue methods due to menstrual-related side effects that make them feel their reproductive health is threatened. Proactively addressing these concerns improves adherence. 5

4. Sexual Activity and STI Protection

• Current sexual activity: Frequency and whether it's planned or sporadic
• Number of partners: Current and anticipated
• Condom use: Current practices and willingness to use dual protection
• STI risk assessment: History of STIs, partner STI history 6

Critical point: Emphasize that condoms are essential regardless of contraceptive method chosen, given high STI rates in adolescents. 6

5. Practical and Contextual Factors

Assess barriers to access and continuation:

• Daily adherence capacity: "How confident are you about remembering a daily pill?" 2
• Privacy needs: Can she store pills/devices at home without parental discovery if needed?
• Transportation and access: Ability to return for injections, appointments, or refills 1, 2
• Insurance and cost concerns: What methods are covered? 3
• Provider access: Availability for follow-up and method management 2

6. Parental and Social Support

• Parental involvement: Does she want parents involved in the decision? (Offer confidentiality when legally permitted) 1
• Peer influences: What methods do friends use or recommend? 2
• Trusted adult support: Is there another adult she trusts for support? 1

7. Gender Identity and Inclusive Language

For gender-diverse adolescents:

• Preferred language: How does she refer to her body and reproductive organs? 1
• Menstrual suppression goals: Is eliminating periods a priority? 1
• Gender-affirming treatments: If applicable, clarify that testosterone is not effective contraception 1

Method-Specific Counseling Based on Responses

After gathering this information, present options aligned with her priorities:

If pregnancy prevention is paramount:

• Recommend LARC (implant or IUD) as most effective (0.1-0.8% failure rate) 1
• Implants may be most acceptable for adolescents regarding insertion procedure 4

If she wants no hormones/devices:

• Barrier methods with intensive education and counseling 1
• Copper IUD if she's open to devices but not hormones

If menstrual benefits are important:

• Combined oral contraceptives (COCs) for dysmenorrhea, heavy bleeding, acne 3
• Extended/continuous cycles for severe symptoms or bleeding disorders 3
• Start with monophasic 30-35 μg ethinyl estradiol pill with levonorgestrel or norgestimate 3

If daily adherence is challenging:

• Vaginal ring (monthly), patch (weekly), or injection (every 3 months) 3
• LARC methods eliminate adherence concerns 6

Critical Counseling Points

Address misconceptions directly:

• COCs do not cause infertility and are completely reversible 3
• COCs do not increase breast cancer risk and protect against endometrial/ovarian cancer after 3+ years 3
• Explain menstrual changes with each method and what they mean for her health 5

Provide emergency contraception education:

• Prescribe or discuss advance provision 6
• Explain when it's needed (especially with missed pills in first week) 3

Ensure understanding:

• Use non-technical language to explain how methods work 5
• Confirm she can correctly use her chosen method 7
• Establish that she can always return with concerns 5