Best Oral Contraceptive for a Sexually Active 15-Year-Old
For a sexually active 15-year-old, a combined oral contraceptive (COC) containing 30-35 μg of ethinyl estradiol with levonorgestrel or norgestimate is the best choice for oral contraception. 1
Rationale for Recommendation
Safety and Effectiveness
- Low-dose COCs (containing ≤35 μg ethinyl estradiol) are first-line options for adolescents 1
- COCs have a typical-use failure rate of 9% but can be as low as 0.1% with perfect use 1
- The risk of serious adverse events like blood clots is very low in adolescents (increases from 1 per 10,000 to 3-4 per 10,000 woman-years) 1
- Smoking is not a contraindication to COC use in teenagers under 35 years old 1
Benefits Beyond Contraception
COCs offer several non-contraceptive benefits particularly valuable for adolescents:
- Decreased menstrual cramping and blood loss
- Improvement in acne
- Protection against endometrial and ovarian cancers with use >3 years
- Reduced risk of pelvic infections
- Completely reversible with no negative effect on long-term fertility 1
Specific Formulation Recommendations
Many adolescent medicine experts recommend starting with:
- 30-35 μg of ethinyl estradiol combined with:
- Levonorgestrel or norgestimate as the progestin component 1
These formulations provide:
- Excellent contraceptive efficacy
- Manageable side effect profile
- Good cycle control for adolescents
Administration Guidelines
Starting the Method
- Can be started on the same day as the visit ("quick start") in healthy, non-pregnant adolescents
- A backup method (condoms or abstinence) should be used for the first 7 days
- Condoms should always be used for STI protection 1
Missed Pill Instructions
If one pill is missed (<24 hours late):
- Take the missed pill as soon as possible
- Continue taking remaining pills at the usual time
- No additional contraceptive protection needed
If two or more consecutive pills are missed (≥48 hours):
- Take the most recent missed pill immediately
- Continue taking remaining pills at the usual time
- Use backup contraception for 7 consecutive days
- Consider emergency contraception if pills were missed during the first week 1
Follow-Up Care
- A routine follow-up visit 1-3 months after initiating COCs is recommended to address adverse effects or adherence issues 1
- The CDC recommends prescribing up to 1 year of COCs at a time 1
Common Side Effects and Management
Common transient side effects include:
- Irregular bleeding
- Headache
- Nausea
These typically resolve within 2-3 months of use. If side effects persist, changing to a different formulation may help.
Special Considerations for Adolescents
- Adherence may be more challenging in adolescents, resulting in higher typical-use failure rates
- Strategies to promote daily adherence include cell phone alarms and support from family members
- Extended or continuous cycle regimens (skipping the placebo week) may be beneficial for some adolescents with conditions like severe dysmenorrhea or heavy bleeding 1
Contraindications
COCs should not be prescribed for patients with:
- Severe uncontrolled hypertension
- Ongoing hepatic dysfunction
- Complicated valvular heart disease
- Migraines with aura
- Thromboembolism or thrombophilia
- Complications of diabetes 1
Remember that an internal pelvic examination is not needed before initiating COCs, though STI screening is recommended for all sexually active patients.