Safest Birth Control Pill for a 19-Year-Old with Bipolar Disorder
The safest birth control pill for a 19-year-old with bipolar disorder is a combined oral contraceptive (COC) containing 30-35 μg of ethinyl estradiol with drospirenone as the progestin component. 1
Rationale for Selection
- Low-dose combined oral contraceptives (containing 35 μg ethinyl estradiol or less) are recommended as first-line contraceptive options for adolescents, including those with underlying medical conditions 2
- Drospirenone-containing pills have antimineralcorticoid and antiandrogenic properties similar to natural progesterone, which can help prevent water retention, weight gain, and mood fluctuations that may exacerbate bipolar symptoms 1
- Limited evidence suggests that oral contraceptives do not significantly worsen the clinical course of bipolar disorder compared to non-hormonal methods 3
- Contraception is particularly important in bipolar disorder as studies show suboptimal contraceptive use in this population (58.8%) despite increased risk of unintended pregnancy 4
Important Considerations for Bipolar Patients
- Mood stability is a critical consideration when selecting contraception for patients with bipolar disorder 5
- The temporal relationship between hormonal contraception initiation and mood changes should be closely monitored 5
- Studies have found that oral contraceptive use in women with bipolar disorder did not significantly change mood across the menstrual cycle compared to non-users 3
- Women with bipolar disorder are typically on mood stabilizers (lithium, valproate, lamotrigine) or atypical antipsychotics that may have teratogenic effects, making effective contraception essential 2
Medication Interactions to Consider
- Lamotrigine (commonly used for bipolar depression) has its effectiveness decreased by some oral contraceptives, requiring dosage adjustments 2
- Valproate (used for mania) requires special consideration in young women due to potential for polycystic ovary disease and teratogenicity 2
- Avoid starting antidepressants without mood stabilizers as they may trigger manic episodes 6
Administration Guidelines
- COCs can be started on the same day as the visit ("quick start") in healthy, non-pregnant adolescents 2
- A backup method (condoms or abstinence) should be used for at least the first 7 days for contraceptive efficacy 2
- A follow-up visit 1-3 months after initiating COCs is recommended to address any adverse effects or adherence issues 2
Managing Missed Pills
- If one pill is missed (<24 hours late): Take the missed pill as soon as remembered and continue the regular schedule 2
- If two or more consecutive pills are missed (>48 hours late): Take the most recent missed pill immediately, continue the pack, and use backup contraception for 7 days 2
- Strategies to promote adherence include cell phone alarms and support from family members 2
Monitoring Recommendations
- Regular follow-up to assess mood stability and any contraceptive side effects 2
- Monitor for common transient side effects including irregular bleeding, headache, and nausea 2
- No evidence supports that COCs cause weight gain or significant mood changes in the general population 2
By selecting a COC with drospirenone and appropriate ethinyl estradiol dosing, you can provide effective contraception while minimizing potential impacts on bipolar disorder symptoms. Close monitoring and coordination with the patient's mental health provider are essential components of care.