What are the birth control patch options for a 14-year-old?

Birth Control Patch Options for 14-Year-Olds

For a 14-year-old adolescent requiring contraception, the transdermal contraceptive patch (Ortho Evra) is an appropriate option with typical failure rates similar to combined oral contraceptives at 9%, though low-dose combined oral contraceptives are generally recommended as first-line contraception for adolescents. 1, 2

Contraceptive Patch Details

• Mechanism: The patch contains both estrogen and progestin hormones that are absorbed through the skin
• Application: Applied to the abdomen, upper torso, upper outer arm, or buttocks
• Schedule: One patch weekly for 3 weeks, followed by 1 patch-free week
• Efficacy: 9% typical use failure rate (similar to combined oral contraceptives)
• Advantages:
  • Weekly application (vs. daily pill)
  • Visible reminder of contraceptive use
  • Does not require daily adherence
  • Can be used by most adolescents without prior pelvic examination

Important Considerations

Potential Concerns

• The FDA has identified increased estrogen exposure (1.6 times higher than with a low-dose COC) and a potential increased risk of venous thromboembolism with the patch 1
• Slightly higher risk of pregnancy for adolescents weighing more than 198 pounds (0.9% vs 0.3% in first 12 months of perfect use) 1
• Possible side effects include skin reactions at application site, hyperpigmentation, and contact dermatitis 1

Alternative Options to Consider

1. Combined Oral Contraceptives (COCs)

   • Recommended as first-line by the American Academy of Pediatrics for adolescents 2
   • Low-dose COCs (≤35 μg ethinyl estradiol) minimize estrogen-related risks 2
   • Typical use failure rate of 9% 1
   • Requires daily adherence

2. Long-Acting Reversible Contraception (LARC)

   • Highest effectiveness (>99%)
   • Includes intrauterine devices (IUDs) and implants
   • Recommended as first-line options by AAP due to efficacy, safety, and ease of use 1
   • Does not require regular adherence

3. Vaginal Ring (NuvaRing)

   • Monthly insertion (vs. weekly patch application)
   • Similar efficacy and side effect profile to other combined hormonal methods 1
   • May be preferred by some adolescents

Counseling Points

• Condoms should be used in addition to hormonal contraception to protect against STIs 1
• A backup method (condoms or abstinence) should be used for the first 7 days after starting the patch 1
• Confidentiality is important for adolescents seeking contraception, and pediatricians should be familiar with relevant minor consent laws 1
• Follow-up visits should be scheduled 1-3 months after initiation to assess for side effects and proper use 2

Clinical Algorithm for Contraceptive Selection in Adolescents

1. Assess medical eligibility

   • Screen for contraindications to estrogen (severe uncontrolled hypertension, liver disease, migraines with aura, history of thromboembolism) 2
   • If contraindications exist, consider progestin-only or non-hormonal methods

2. Consider patient preferences and adherence factors

   • Daily pill vs. weekly patch vs. monthly ring vs. long-acting methods
   • Privacy concerns (visibility of patch)
   • Ability to remember regular application

3. Evaluate effectiveness needs

   • For highest effectiveness, recommend LARC methods first
   • For moderate effectiveness with less frequent dosing than pills, consider the patch

4. Address side effect concerns

   • Discuss potential skin reactions with patch
   • Review warning signs that require immediate medical attention

While the contraceptive patch is an appropriate option for a 14-year-old, the American Academy of Pediatrics recommends discussing the most effective methods first (LARC), followed by other hormonal methods including the patch, with consideration of the individual's preferences and medical history 1.