What is the recommended oral contraceptive for a teenage female with no significant medical history, such as hypertension (high blood pressure) or diabetes, and no history of blood clots?

Recommended Oral Contraceptive for a Healthy Teenage Female

For a healthy teenage female without medical contraindications, start with a monophasic combined oral contraceptive containing 30-35 μg ethinyl estradiol plus levonorgestrel or norgestimate. 1, 2

Specific First-Line Formulation

• Monophasic pills with 30-35 μg ethinyl estradiol combined with levonorgestrel or norgestimate are the recommended first-line choice for adolescents, as these second-generation progestins have well-established safety profiles and the estrogen dose provides adequate cycle control while minimizing systemic side effects like water retention. 1

• This formulation is effective for contraception (0.3% perfect-use failure rate, 9% typical-use failure rate) and provides additional benefits including decreased menstrual cramping, reduced blood loss, and improvement in acne. 3

Initiation Protocol

• Use the "quick start" method: Begin the pill on the same day as the clinic visit without requiring a pelvic examination in healthy, non-pregnant adolescents. 1, 2

• Counsel the patient to use backup contraception (condoms) for the first 7 days after starting the pill to ensure contraceptive efficacy. 1, 2

• Schedule routine follow-up at 1-3 months after initiation to address any persistent adverse effects or adherence issues. 1

Safety Considerations for This Population

• Combined oral contraceptives are safe in healthy adolescents without severe uncontrolled hypertension (≥160/100 mmHg), hepatic dysfunction, complicated valvular heart disease, migraines with aura, or thromboembolism/thrombophilia. 3

• The baseline venous thromboembolism risk in adolescents increases from 1 per 10,000 woman-years to 3-4 per 10,000 woman-years with COC use, which remains substantially lower than the 10-20 per 10,000 woman-years risk associated with pregnancy. 3, 1

• COCs have no negative effect on long-term fertility and are completely reversible. 3

Adherence Strategies

• Counsel on strategies to promote adherence, such as setting cell phone alarms and enlisting support from a family member or partner, as typical-use failure rates are significantly higher than perfect-use rates due to missed pills. 3

• If more than one pill is missed: Take only the most recently missed pill as soon as possible, continue the remaining pills at the usual time, and remember that 7 consecutive hormone pills are required to prevent ovulation. 3

Dual Protection Recommendation

• Prescribe condoms in addition to oral contraceptives for all sexually active teenagers, as COCs provide no protection against sexually transmitted infections. 2

• Male latex condoms have an 18% typical-use failure rate but provide essential STI protection that hormonal methods cannot offer. 2

Alternative Considerations

While COCs are appropriate for this patient, long-acting reversible contraception (LARC) methods like the levonorgestrel IUD or etonogestrel implant have superior effectiveness (<1% failure rate) and higher continuation rates (≥75% at 1 year) and should be discussed as first-line options for pregnancy prevention. 2 However, if the patient prefers oral contraceptives, the monophasic formulation described above is the optimal choice.