What is the best birth control option for a 17-year-old sexually active female?

Best Birth Control Options for a 17-Year-Old Sexually Active Female

For a 17-year-old sexually active female, long-acting reversible contraceptives (LARCs) such as intrauterine devices (IUDs) or implants are the best birth control options due to their superior effectiveness, with failure rates of less than 1% per year. 1

Contraceptive Options Ranked by Effectiveness

Tier 1: Most Effective (>99%)

• Intrauterine Devices (IUDs)
  • Copper T380A: 0.6-0.8% failure rate with perfect use 2, 3
  • Hormonal IUDs (LNg 20): 0.1% failure rate 2, 3
• Contraceptive Implant
  • Levonorgestrel implants: 0.05% failure rate 2, 3

Tier 2: Highly Effective (>97%)

• Injectable Contraception
  • Depo-Provera: 0.3% failure rate with perfect use, 3% with typical use 2, 3
• Combined Hormonal Methods
  • Combined oral contraceptives (COCs): 0.1% failure rate with perfect use, 5-7% with typical use 2, 3, 1
  • Vaginal ring: Similar effectiveness to COCs 4
  • Transdermal patch: Similar effectiveness to COCs 4

Tier 3: Moderately Effective

• Barrier Methods
  • Male condoms: 3% failure rate with perfect use, 14% with typical use 2, 3
  • Female condoms: 5% failure rate with perfect use, 21% with typical use 2, 3

Key Considerations for Adolescents

Ease of Use and Adherence

• LARCs (IUDs and implants) require minimal user intervention after placement, making them ideal for adolescents who may have difficulty with daily, weekly, or monthly regimens 4, 1
• Combined hormonal methods require consistent use (daily pill, weekly patch, or monthly ring changes) 4
• Condoms require correct use with every sexual encounter 4

Safety Profile

• Progestin-only methods (implants, hormonal IUDs, injectable, progestin-only pills) have fewer serious risks compared to estrogen-containing methods 1
• Estrogen-containing methods (COCs, patch, ring) increase the risk of venous thrombosis from 2 to 7-10 events per 10,000 women-years 1
• All hormonal methods are safe for most adolescents, with few contraindications in healthy young women 4

Additional Benefits

• COCs provide non-contraceptive benefits including decreased menstrual cramping, reduced blood loss, and improvement in acne 4, 1, 5
• Extended or continuous cycle regimens may be beneficial for adolescents with conditions such as anemia, severe dysmenorrhea, or endometriosis 4
• Condoms are the only method that also protects against STIs 4, 2

Specific Recommendations for 17-Year-Olds

1. First-line recommendation: LARCs (IUDs or implant)

   • Highest effectiveness with minimal user effort 1
   • Can be used by adolescents regardless of parity 4
   • Reversible with rapid return to fertility upon removal 4

2. Second-line recommendation: Injectable contraception (Depo-Provera)

   • Requires injection every 13 weeks 4
   • May cause irregular bleeding initially, which typically improves over time 4
   • Consider bone health (calcium and vitamin D intake) due to potential BMD effects 4

3. Third-line recommendation: Combined hormonal methods

   • Good option for adolescents who can adhere to regular schedule 4
   • Provides additional non-contraceptive benefits 4, 5
   • Available in various formulations (pills, patch, ring) 4

4. Important for all sexually active adolescents:

   • Condom use should be encouraged regardless of other contraceptive methods to protect against STIs 4, 2
   • Emergency contraception should be discussed and advance provision considered 4

Common Pitfalls and Caveats

• Overestimating adherence: Adolescents may have difficulty with daily pill-taking regimens; LARCs eliminate this concern 4, 1
• Underutilization of dual protection: Emphasize that hormonal methods do not protect against STIs; condoms should be used concurrently 4, 2
• Delayed initiation: Same-day start ("quick start") of hormonal methods is recommended when pregnancy can be reasonably excluded 4
• Inadequate counseling about side effects: Thorough counseling about expected bleeding patterns and other side effects improves continuation rates 4
• Weight considerations with EC: Levonorgestrel EC may be less effective in women weighing more than 165 pounds; ulipristal acetate may be more effective in these cases 4