What is the recommended birth control for an adolescent female?

Recommended Birth Control for a 14-Year-Old Female

Low-dose combined oral contraceptives (COCs) containing 30-35 μg of ethinyl estradiol with a progestin such as levonorgestrel or norgestimate are the recommended first-line birth control option for adolescent females. 1

First-Line Options

• COCs are the most popular method of hormonal contraception among adolescents, offering reliable effectiveness with a perfect-use failure rate of 0.3% (though typical use failure rate is 9%) 1, 2
• Low-dose COCs (containing 35 μg ethinyl estradiol or less) are appropriate first-line options for adolescents, balancing effectiveness with minimal side effects 1
• No pelvic examination is required before initiating COCs, removing a potential barrier to contraception access for adolescents 1
• COCs can be started on the same day as the visit ("quick start"), making them immediately accessible 1

Benefits and Considerations of COCs

• COCs provide additional non-contraceptive benefits including decreased menstrual cramping and blood loss, which can be particularly helpful for adolescents with heavy menstrual cycles 3
• Common transient side effects include irregular bleeding, headache, and nausea, which typically resolve after the first few months of use 1
• COCs have few contraindications in healthy adolescents but should not be prescribed for patients with severe hypertension, liver dysfunction, migraines with aura, or history of thromboembolism 1
• The most serious adverse event is increased risk of blood clots (3-4 per 10,000 woman-years compared to 1 per 10,000 in non-users), though this risk is still lower than during pregnancy 1

Alternative Options

• The levonorgestrel intrauterine device (IUD) is highly effective and provides excellent menstrual suppression, making it suitable for adolescents with heavy menstrual bleeding 3
• Depot medroxyprogesterone acetate (DMPA) injections offer convenience with dosing every 13 weeks but may cause bone mineral density reductions and weight gain in some users 1
• Progestin-only pills are valuable for adolescents who cannot use estrogen-containing methods, though they require very stringent adherence 1, 4

Practical Implementation

• When prescribing COCs, start with a monophasic pill containing 30-35 μg of ethinyl estradiol and levonorgestrel or norgestimate 1, 5
• Schedule a follow-up visit 1-3 months after initiating COCs to address any adverse effects or adherence issues 1
• Counsel patients that backup contraception (condoms or abstinence) should be used for the first 7 days after starting COCs 1
• Emphasize the importance of consistent condom use for STI protection regardless of hormonal contraceptive method 1

Important Counseling Points

• Discuss strategies to promote adherence, such as cell phone alarms or support from a trusted adult 1
• Provide clear instructions on what to do if pills are missed 1
• Recommend daily intake of 1300 mg of calcium and 600 IU of vitamin D for skeletal health, particularly important if considering DMPA 1, 3
• Consider prescribing emergency contraception in advance as part of routine adolescent care 1

Pitfalls to Avoid

• Don't require a pelvic examination before prescribing hormonal contraception, as this creates an unnecessary barrier to access 1
• Don't withhold contraception due to concerns about smoking in adolescents under 35 years old, as smoking is not a contraindication to COC use in this age group 1
• Don't assume that all antibiotics reduce COC effectiveness; only rifampin has been shown to significantly impact contraceptive efficacy 1, 6
• Don't switch between brand-name and generic low-dose COCs without consideration, as differences in bioavailability may affect contraceptive efficacy and increase breakthrough bleeding 7