What birth control methods are suitable for teens with menorrhagia (heavy menstrual bleeding)?

Birth Control Options for Teens with Heavy Menstrual Cycles

The levonorgestrel IUD is the most effective birth control option for teens with heavy menstrual bleeding, as it provides excellent menstrual suppression while offering long-term contraception without estrogen-related risks. 1

First-Line Options

Levonorgestrel Intrauterine Device (IUD)

• Provides significant improvement in dysmenorrhea and heavy menstrual bleeding in adolescents 1
• High satisfaction and continuation rates (≥75% at 1 year) among adolescents 1
• Allows effective menstrual suppression without exogenous estrogen exposure 1
• Can be safely used in teens with contraindications to estrogen 1
• No negative effect on long-term fertility 1

Combined Oral Contraceptives (COCs)

• Provide decreased menstrual cramping and blood loss 1
• Low-dose pills (containing 30-35 μg ethinyl estradiol) with levonorgestrel or norgestimate are commonly recommended for adolescents 1
• Extended or continuous cycle regimens are particularly beneficial for teens with heavy bleeding 1
• Completely reversible with no negative effect on long-term fertility 1
• Typical-use failure rate is 9% (perfect use: 0.3%), indicating adherence is a key issue 1

Alternative Options

Depot Medroxyprogesterone Acetate (DMPA)

• Long-acting progestin injection given every 13 weeks 1
• Provides improvement in dysmenorrhea and protection against iron-deficiency anemia 1
• Convenient for adolescents who have difficulty with daily, weekly, or monthly adherence 1
• Major disadvantages include menstrual irregularities (initially present in nearly all patients) and potential weight gain 1
• May cause reductions in bone mineral density (BMD), though substantial recovery occurs after discontinuation 1

Contraceptive Vaginal Ring

• Releases 15 μg ethinyl estradiol and 120 μg etonogestrel daily 2
• Simplest regimen with comparable efficacy to other combined hormonal methods (Pearl index ~1 per 100 woman-years) 2
• Studies show lower incidence of irregular bleeding compared to some oral contraceptives 3
• Excellent cycle control with withdrawal bleeding occurring in virtually all cycles 3
• Can be used in extended cycle regimens for teens who prefer fewer periods 1

Norethindrone (Progestin-Only Pill)

• Effective alternative for adolescents with contraindications to estrogen 4
• Studies show 78.9% of adolescents with heavy bleeding experienced complete cessation within 7 days when used as a taper 4
• Discontinuation rate of 48.5%, most commonly for irregular bleeding (54.5%) 4

Clinical Considerations

For Teens with Heavy Menstrual Bleeding

• Consider starting with a monophasic COC containing 30-35 μg of ethinyl estradiol and a progestin like levonorgestrel or norgestimate 1
• Extended or continuous cycle regimens may be particularly appropriate for teens with heavy bleeding or anemia 1
• For teens with contraindications to estrogen, the levonorgestrel IUD provides excellent menstrual suppression 1
• Norethindrone can be used as an effective taper for acute heavy menstrual bleeding 4

Common Pitfalls to Avoid

• Assuming IUDs are not appropriate for adolescents - current data show they are generally well tolerated with high satisfaction rates 1
• Requiring pelvic examination before starting hormonal contraception - no gynecologic examination is needed to determine eligibility for COC use 1
• Overlooking the importance of counseling about menstrual irregularities with DMPA, which can improve continuation rates 1
• Failing to recommend calcium (1300 mg) and vitamin D (600 IU) daily for teens using DMPA 1
• Not discussing the need for consistent condom use for STI protection regardless of contraceptive method chosen 1

Special Considerations

• For teens with neurologic or cardiovascular conditions, progestin-only methods may be preferable 4
• Weight gain status at 6 months with DMPA is a strong predictor of future excessive weight gain with ongoing use 1
• The levonorgestrel IUD is useful for adolescents with medical conditions requiring long-term menstrual suppression where estrogen is contraindicated 1