What is the most suitable oral contraceptive (OC) for adolescent females?

From the Guidelines

The most suitable oral contraceptive for adolescent females is a combined oral contraceptive pill containing 30 to 35 μg of ethinyl estradiol and a progestin such as levonorgestrel or norgestimate. This recommendation is based on the American Academy of Pediatrics guidelines, as outlined in the study published in Pediatrics in 2014 1. The study suggests that any "low-dose" pill, containing 35 μg or less of ethinyl estradiol, can be used for adolescents.

Key Considerations

• The choice of oral contraceptive should be based on the individual's health status, with contraindications including severe and uncontrolled hypertension, ongoing hepatic dysfunction, and complicated valvular heart disease 1.
• Patients should be counseled on the potential risks and benefits of combined oral contraceptives, including the increased risk of blood clots, which is still lower than the risk associated with pregnancy and postpartum 1.
• Common adverse effects of combined oral contraceptives include irregular bleeding, headache, and nausea, which can often be managed with recommendations outlined in the study 1.
• Drug interactions should be avoided, and patients should be informed about the potential effects of medications such as anticonvulsants and antiretroviral drugs on the effectiveness of combined oral contraceptives 1.

Practical Guidance

• Adolescent females should be started on a combined oral contraceptive pill on the same day as the visit, with a backup method used for at least the first 7 days for contraceptive efficacy 1.
• Patients should be instructed on what to do if pills are missed, with a missed pill taken as soon as it is remembered, and a backup method used if more than one pill is missed in the first week of the cycle 1.
• Extended or continuous cycles may be useful for treating medical conditions such as anemia, acne, and dysmenorrhea, and for adolescents who prefer amenorrhea, with the most common adverse effect being unscheduled bleeding 1.

From the FDA Drug Label

New acceptors of oral contraceptive agents should be started on preparations containing 0.035 mg or less of estrogen. Minimizing exposure to estrogen and progestogen is in keeping with good principles of therapeutics. For any particular estrogen/progestogen combination, the dosage regimen prescribed should be one which contains the least amount of estrogen and progestogen that is compatible with a low failure rate and the needs of the individual patient.

The most suitable oral contraceptive (OC) for adolescent females is one that contains 0.035 mg or less of estrogen. This is because minimizing exposure to estrogen and progestogen is in line with good therapeutic principles, and the goal is to use the lowest possible dose that is effective and compatible with a low failure rate. 2

From the Research

Oral Contraceptives for Adolescent Females

• The choice of oral contraceptive (OC) for adolescent females depends on various factors, including efficacy, safety, and tolerability 3.
• Low-dose monophasic combination oral contraceptives, such as those containing 100 microg levonorgestrel and 20 microg ethinyl estradiol, have been shown to be effective and well-tolerated in adolescent females 4, 5.
• Extended-cycle oral contraceptives, which provide 84 days of active pills followed by 7 days of low-dose ethinyl estradiol, may also be a suitable option for adolescent females, offering a similar efficacy and adverse effect profile to other extended-regimen OCs 6.
• Progestin-only pills (POPs) and combined oral contraceptive pills (COCs) are also available, with certain types of progestins having more potent antiandrogenic properties and being more effective in treating acne, hirsutism, and polycystic ovary syndrome 3.
• When choosing an OC for adolescent females, it is essential to consider the individual's medical history, lifestyle, and personal preferences, as well as the potential risks and benefits of each option 3.

Efficacy and Safety of Low-Dose Monophasic Combination OCs

• Studies have demonstrated that low-dose monophasic combination OCs, such as those containing 100 microg levonorgestrel and 20 microg ethinyl estradiol, have a Pearl index of 0.84-0.88, indicating high efficacy 4, 5.
• These OCs have also been shown to have a good tolerability profile, with common adverse events including headache and metrorrhagia 4, 5.
• Breakthrough bleeding and spotting are common side effects of OCs, but the incidence of these events decreases with continued use 4, 5.

Considerations for Adolescent Females

• Adolescent females may be more susceptible to the effects of hormonal contraceptives, and therefore, it is crucial to choose an OC that is safe and effective for this population 3.
• The choice of OC should be individualized, taking into account the adolescent female's medical history, lifestyle, and personal preferences 3.
• Healthcare providers should provide adequate counseling and guidance to adolescent females to ensure that they understand the benefits and risks of each OC option and can make an informed decision 3.