Best Birth Control for Teens
Long-acting reversible contraception (LARC), specifically the etonogestrel implant or levonorgestrel IUD, is the best birth control for teenagers because these methods are safe, highly effective (>99%), require no daily adherence, and result in the lowest rates of teen pregnancy including rapid repeat pregnancy. 1
Why LARC Methods Are Superior for Adolescents
The CDC explicitly recommends that education about contraceptive methods should include an explanation that long-acting reversible contraception is safe and effective for nulliparous women, including adolescents. 1 The American Academy of Pediatrics reinforces this recommendation, noting that LARC methods have failure rates of less than 1% and are ideal for adolescents who prefer methods that don't require regularly scheduled adherence. 1
The evidence is clear: LARC methods dramatically reduce teen pregnancy rates compared to shorter-acting methods. 1 This directly impacts the most important outcomes—preventing the morbidity and mortality associated with adolescent pregnancy, which carries higher risks of preeclampsia, preterm birth, and maternal death compared to adult pregnancy.
Specific LARC Options
Etonogestrel Implant (Nexplanon)
- Single-rod implant inserted in the upper arm that lasts 3 years 1
- Insertion takes approximately 1 minute; removal under 5 minutes 1
- Failure rate less than 1% with perfect and typical use 1
- Particularly effective for delaying second pregnancy in adolescent mothers 1
- Common pitfall: Irregular bleeding is the most common reason for early discontinuation, so counsel teens about this expected side effect upfront 1
Levonorgestrel IUD
- Provides local progestin effects while maintaining adequate systemic estrogen levels 2
- High continuation rates despite initial irregular bleeding patterns 2
- Can be used by adolescents of all ages with no negative effect on long-term fertility 3
- No gynecologic examination required to determine eligibility 3
When LARC Is Not Chosen: Second-Line Options
If a teen declines LARC after comprehensive counseling, the next best approach depends on their specific situation:
For Sexually Active Teens in Non-Monogamous Relationships
Dual method use is essential: Combined oral contraceptives (COCs) PLUS condoms. 4 This protects against both pregnancy and sexually transmitted infections. 1, 5
- Start with a monophasic low-dose pill containing 30-35 μg ethinyl estradiol with levonorgestrel or norgestimate 3
- COCs can be started at any time during amenorrhea or irregular cycles if pregnancy is reasonably excluded 3
- Backup contraception (condoms or abstinence) required for 7 days after starting 3
- Critical counseling point: Emphasize consistent timing is essential for effectiveness 3
For Teens in Longer Monogamous Relationships
Hormonal contraception (pills, patch, or ring) combined with condoms for dual protection remains ideal. 5, 6 Condom use should not be stopped until it is reasonably certain the partner is STI-negative. 6
Contraindications to Screen For
Before prescribing any hormonal contraception, screen for absolute contraindications: 3
- Severe uncontrolled hypertension
- Migraines with aura or focal neurologic symptoms
- History of thromboembolism or known thrombophilia
- Active or chronic liver disease
- Complicated valvular heart disease
Essential Counseling Framework
Provide comprehensive information about ALL methods, including abstinence, but ensure teens understand LARC methods are the most effective. 1 The CDC guidelines emphasize that adolescents should make informed decisions based on their unique circumstances, but providers must inform clients about the most effective methods available. 1
Key Counseling Points:
- LARC methods are safe for adolescents who have never been pregnant 1
- All methods are reversible with no negative effect on fertility 3
- Confidential services should be provided while observing state laws 1
- Emergency contraception should be discussed as backup 1
- Encourage (but don't require) family-child communication about sexual health 1
Common Pitfalls to Avoid
Do not assume teens cannot adhere to LARC methods or that they need parental consent. Confidentiality is critical—many adolescents will not use reproductive health services if confidentiality cannot be assured. 1
Do not prescribe progestin-only pills (POPs) as first-line contraception for healthy adolescents. They are markedly less effective than other progestin-only methods and require precise timing. 1
Do not delay LARC placement due to irregular menses. Irregular cycles are common and physiologic in the first 2-3 years after menarche and are not a contraindication to any contraceptive method. 3, 7
The Bottom Line
While patient choice is important, the evidence overwhelmingly supports LARC methods as the best birth control for teens when prioritizing the outcomes of reduced morbidity and mortality from adolescent pregnancy. 1 Use a "tiered" approach to counseling, starting with the most effective methods (LARC), then moving to shorter-acting hormonal methods, always emphasizing dual protection with condoms for STI prevention. 1, 4