From the Guidelines
I strongly recommend initiating a combined oral contraceptive (COC) containing 30-35 μg of ethinyl estradiol with a progestin such as levonorgestrel or norgestimate for adolescents, as it is the most popular and effective method of hormonal contraception for this age group. This formulation provides a good balance of effectiveness and minimal side effects, with few contraindications in healthy female adolescents 1. The COC can be started on the same day as the visit, with a backup method such as condoms or abstinence used for at least the first 7 days for contraceptive efficacy, and a condom used at all times for protection against STIs.
Key Considerations
- COCs have few contraindications in healthy female adolescents, but should not be prescribed for patients with severe and uncontrolled hypertension, ongoing hepatic dysfunction, complicated valvular heart disease, migraines with aura or focal neurologic symptoms, thromboembolism or thrombophilia, complications of diabetes, and complicated solid organ transplantation 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.
- Patients should be informed that common transient adverse effects of COCs include irregular bleeding, headache, and nausea, and that drug interactions should be avoided, particularly with medications that decrease COC effectiveness such as anticonvulsants and antiretroviral drugs 1.
Management and Follow-up
- A routine follow-up visit 1 to 3 months after initiating COCs is useful for addressing adverse effects or adherence issues 1.
- Patients should be counseled on strategies to promote daily adherence, such as cell phone alarms and support from a family member or partner, and instructed on what to do if pills are missed 1.
- Extended or continuous cycles may be useful for treating medical conditions such as anemia, acne, severe dysmenorrhea, endometriosis, and dysfunctional or heavy menstrual bleeding, and for adolescents who prefer amenorrhea 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Recommended Course of Treatment (COC)
The recommended course of treatment for combined oral contraceptives (COCs) varies depending on the specific formulation and individual patient needs.
- Low-dose COCs containing 20 μg of ethinyl estradiol (EE) are available and have been shown to be effective in preventing pregnancy 2, 3, 4, 5, 6.
- These low-dose COCs may have a similar efficacy and adverse effect profile compared to other extended-regimen OCs 2.
- However, some studies have found that low-dose estrogen COCs may result in higher rates of bleeding pattern disruptions, such as irregular bleeding or spotting 3, 4.
- The choice of COC should be based on individual patient factors, such as medical history, lifestyle, and personal preferences.
Efficacy and Safety
- Studies have shown that low-dose COCs containing 20 μg of EE are effective in preventing pregnancy, with a Pearl Index of 0.23 or lower 5, 6.
- These COCs have also been shown to be well-tolerated, with a low incidence of adverse events and a high level of patient satisfaction 5, 6.
- However, the safety and efficacy of COCs can vary depending on the specific formulation and individual patient factors, and patients should be closely monitored and advised on the potential risks and benefits of COC use 3, 4.
Bleeding Patterns
- Low-dose COCs may be associated with changes in bleeding patterns, such as irregular bleeding or spotting 3, 4.
- However, some studies have found that the incidence of bleeding disturbances is similar to or lower than that of higher-dose COCs 2, 5.
- The bleeding pattern of low-dose COCs can vary depending on the specific formulation and individual patient factors, and patients should be advised on what to expect and how to manage any bleeding disturbances that may occur 5, 6.