Can a 13 year old female with oligomenorrhea (infrequent menstrual periods) be started on birth control pills, such as Loestrin (ethinyl estradiol and norethindrone) or Junel (ethinyl estradiol and norethindrone)?

Birth Control for a 13-Year-Old with Oligomenorrhea

Yes, birth control pills can be safely started in a 13-year-old female with oligomenorrhea (only 2 periods per year) and are often beneficial for managing this condition.

Rationale for Using Birth Control Pills in Adolescents with Oligomenorrhea

• Combined hormonal contraceptives (CHCs) provide significant non-contraceptive benefits for adolescents with oligomenorrhea, including regulation of menstrual cycles and improvement in hormone-related symptoms 1
• CHCs can help prevent progressive transformation into more severe forms of ovarian dysfunction that may become less reversible in adulthood 2
• Treatment with ethinyl estradiol and progestin has been shown to decrease androgen levels and improve ovarian function in adolescents with oligomenorrhea 2

Recommended Approach

Initial Assessment

• Ensure there is no contraindication to combined hormonal contraceptives before starting treatment 1
• Laboratory screening prior to initiating contraception is generally not necessary in asymptomatic adolescents due to the low prevalence of contraindications in this age group 3

Medication Selection

• Start with a monophasic pill containing 30-35 μg of ethinyl estradiol and a progestin such as levonorgestrel or norgestimate 1
• Many adolescent medicine providers begin with this formulation before considering other regimens based on patient response and adverse effects 1
• While low-dose pills (20 μg ethinyl estradiol) are available, they may provide poorer cycle control, especially in patients with oligomenorrhea 4

Administration Guidelines

• Combined hormonal contraceptives can be started at any time if it is reasonably certain that the patient is not pregnant 1
• If started within the first 5 days since menstrual bleeding began, no additional contraceptive protection is needed 1
• If started >5 days since menstrual bleeding began, the patient should use additional contraceptive protection for the next 7 days 1
• For patients with amenorrhea (no periods), CHCs can be started at any time with additional contraceptive protection for the first 7 days 1

Expected Benefits and Outcomes

• Regulation of menstrual cycles with predictable bleeding patterns 1
• Potential improvement in acne and other androgen-related symptoms 1, 2
• Decreased risk of endometrial and ovarian cancers with prolonged use 1
• Completely reversible with no negative effect on long-term fertility 1

Important Considerations

• Typical use failure rates for combined oral contraceptives are 9% in the first year, though this is primarily related to inconsistent use 1, 5
• Counsel the patient on proper pill-taking, including what to do if pills are missed 1
• Consider extended or continuous cycle regimens (skipping the placebo pills) for patients who experience severe menstrual symptoms or prefer fewer periods 1
• The most common adverse effect of extended-cycle regimens is unscheduled bleeding 1

Follow-up Recommendations

• Schedule follow-up to assess response to treatment, adherence, and any side effects 1
• Monitor for improvement in menstrual regularity and any hormone-related symptoms 2
• Be prepared to adjust the formulation if needed based on response and tolerability 1

Birth control pills are a safe and effective option for managing oligomenorrhea in adolescents, with benefits that extend beyond contraception to include improved menstrual regularity and hormone balance.