From the Guidelines
For a healthy 18-year-old female, Combined Oral Contraceptive Pills (COCs) are a highly recommended contraceptive method due to their effectiveness, convenience, and minimal side effects, with a typical use failure rate of 9% 1.
Key Considerations
- COCs are the most popular method of hormonal contraception for adolescents and contain a progestin and an estrogen, with the estrogen component being ethinyl estradiol in amounts varying from 10 to 50 μg 1.
- Many adolescent medicine experts begin with a COC containing 30 to 35 μg of ethinyl estradiol and a progestin such as levonorgestrel or norgestimate 1.
- COCs can be started on the same day as the visit (“quick start”) in healthy, nonpregnant adolescents, with a backup method (e.g., condoms or abstinence) recommended for at least the first 7 days for contraceptive efficacy 1.
Benefits and Risks
- COCs have few contraindications in healthy female adolescents, but should not be prescribed for patients with severe and uncontrolled hypertension, ongoing hepatic dysfunction, or other serious medical conditions 1.
- The most serious adverse event associated with COC use is the increased risk of blood clots, which increases from 1 per 10,000 to 3 to 4 per 10,000 woman-years during COC use 1.
- Common transient adverse effects of COCs include irregular bleeding, headache, and nausea, which can be managed with recommendations published elsewhere 1.
Management and Follow-up
- Patients should be counseled on strategies to promote daily adherence, such as cell phone alarms and support from a family member or partner 1.
- A routine follow-up visit 1 to 3 months after initiating COCs is useful for addressing adverse effects or adherence issues 1.
- The CDC recommends prescribing up to 1 year of COCs at a time, and patients should be informed about the importance of using a backup method and the risks and benefits of COC use 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Contraceptive Methods for Healthy 18-Year-Old Females
- Combined oral contraceptives (COCs) are a popular choice for birth control among adolescents and young adults, including 18-year-old females 2.
- COCs typically contain a combination of estrogen (such as ethinyl estradiol) and progestin (such as levonorgestrel) 3, 4, 5, 6.
Efficacy and Safety of Extended-Cycle Regimens
- Extended-cycle regimens, which involve taking COCs for an extended period (e.g., 84 days) followed by a short hormone-free interval, have been shown to be effective and safe for healthy women, including those aged 18-35 years 4, 5.
- These regimens can reduce the frequency of menstrual bleeding and improve menstrual cycle-related symptoms, such as bloating and menstrual pain 3, 5.
Choosing the Right Contraceptive
- When choosing a contraceptive method, factors such as efficacy, safety, and personal preferences should be considered 2.
- For healthy 18-year-old females, COCs with a combination of ethinyl estradiol and levonorgestrel may be a suitable option, as they have been shown to be effective and well-tolerated in clinical trials 3, 4, 5, 6.
Benefits of Continuous-Use Regimens
- Continuous-use regimens, which involve taking COCs continuously without a hormone-free interval, can provide additional benefits, such as increased amenorrhea and reduced breakthrough bleeding 3, 6.
- These regimens may be particularly suitable for women who experience heavy or painful menstrual bleeding, or who prefer to have fewer menstrual periods 3.