Recommended Contraception Methods for Adolescents
Long-Acting Reversible Contraception (LARC) methods, including IUDs and implants, should be considered first-line contraceptive choices for adolescents due to their superior efficacy, safety, and ease of use. 1, 2
Contraceptive Options for Adolescents (In Order of Effectiveness)
1. Long-Acting Reversible Contraception (LARC)
- Effectiveness: >99% (highest among all methods)
- Options:
- Hormonal IUDs (e.g., LNg 20)
- Copper IUDs (e.g., Copper T 380A)
- Subdermal implants (e.g., Nexplanon)
- Advantages:
- No need for daily adherence
- Highest effectiveness rates
- Can be used for 3-10 years depending on the method
- Rapid return to fertility after removal
- Key considerations:
- No pelvic examination required before placement
- Can be placed in nulliparous adolescents
- Appropriate for those with certain chronic medical conditions
2. Injectable Contraception
- Effectiveness: 97% with typical use
- Option: Depot medroxyprogesterone acetate (DMPA)
- Advantages:
- No daily adherence required
- Private method
- Caution: May cause weight gain, particularly in adolescents with obesity 1
3. Combined Hormonal Contraception
- Effectiveness: 91% with typical use 3
- Options:
- Combined oral contraceptives (COCs)
- Transdermal patch
- Vaginal ring
- Recommendations for COCs:
- Start with low-dose COCs (≤35 μg ethinyl estradiol) 2
- Use "quick start" method when possible
- No pelvic examination required before starting
- Prescribe up to 1 year supply at initial visit
- Schedule follow-up 1-3 months after initiation
4. Progestin-Only Pills
- Effectiveness: Lower than COCs with typical use
- Considerations:
- Requires very strict adherence (must be taken at same time daily)
- Good option for those with contraindications to estrogen
5. Barrier Methods
- Effectiveness: 79-86% with typical use 3
- Options:
- Male condoms
- Female condoms
- Diaphragm with spermicide
- Important note: Condoms should be used in addition to hormonal methods for STI protection 2
Counseling Approach for Adolescents
Discuss all methods in order of effectiveness
- Present LARC methods first due to superior efficacy
- Explain benefits and potential side effects of each method
Address common concerns
- Confidentiality protections and limits
- Side effects and their management
- What to do if method fails or is used incorrectly
Provide emergency contraception information
- Explain levonorgestrel EC (Plan B) can be taken up to 72 hours after unprotected sex
- Most effective when taken immediately after unprotected intercourse 2
Special Considerations
Medical Conditions
- Obesity:
- All contraceptive methods are appropriate except DMPA, which may cause additional weight gain in adolescents with obesity 1
- COCs, vaginal rings, IUDs, and implants do not cause additional weight gain in adolescents with obesity compared to normal-weight peers
Contraindications to Combined Hormonal Methods
- Severe uncontrolled hypertension (≥160/100 mmHg)
- Ongoing hepatic dysfunction
- Complicated valvular heart disease
- Migraines with aura or focal neurologic symptoms
- Thromboembolism or thrombophilia
- Complications of diabetes 2
Medication Interactions
- Be aware of medications that may decrease hormonal contraceptive effectiveness:
- Rifampin
- Certain anticonvulsants (e.g., carbamazepine, phenytoin)
- Some antiretroviral drugs 2
- Most broad-spectrum antibiotics do not affect COC effectiveness
Follow-up Recommendations
- Schedule follow-up 1-3 months after initiating contraception
- Monitor blood pressure annually for those using combined hormonal methods
- Address any side effects or adherence issues
- Reinforce consistent and correct use
Remember that adolescents have the right to confidential contraceptive care within the limits of state and federal laws. Providing comprehensive contraceptive counseling and access is essential to preventing unintended pregnancy in this population.