What is the first-line birth control method for a 20-year-old female?

From the Guidelines

For a 20-year-old seeking first-line birth control, combined oral contraceptive pills (COCs) containing 30 to 35 μg of ethinyl estradiol and a progestin such as levonorgestrel or norgestimate are recommended. These pills are the most popular method of hormonal contraception for adolescents and can be started on the same day as the visit (“quick start”) in healthy, nonpregnant adolescents 1. The Centers for Disease Control and Prevention (CDC) recommends prescribing up to 1 year of COCs at a time, and a routine follow-up visit 1 to 3 months after initiating COCs is useful for addressing adverse effects or adherence issues 1.

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, or complicated valvular heart disease 1.
• Patients should be counseled that a backup method (ie, condoms or abstinence) should be used for at least the first 7 days for contraceptive efficacy and that a condom should be used at all times for protection against STIs 1.
• Common transient adverse effects of COCs include irregular bleeding, headache, and nausea, and patients should be informed that these effects are usually temporary 1.

Alternative Options

• Long-acting reversible contraceptives (LARCs) are also excellent first-line options, including hormonal IUDs like Mirena or Kyleena, or the non-hormonal copper IUD (ParaGard) 1.
• The birth control implant (Nexplanon) is another highly reliable option, effective for 5 years 1.

Important Considerations

• Medical history, lifestyle preferences, desire for regular periods, and need for STI protection should be taken into account when choosing a birth control method 1.
• A healthcare provider can help determine the most suitable option based on the patient's specific needs and health factors 1.

From the FDA Drug Label

Kariva® (desogestrel/ethinyl estradiol and ethinyl estradiol tablets USP) is indicated for the prevention of pregnancy in women who elect to use this product as a method of contraception. Table II lists the typical accidental pregnancy rates for users of combination oral contraceptives and other methods of contraception The efficacy of these contraceptive methods, except sterilization, depends upon the reliability with which they are used. Correct and consistent use of these methods can result in lower failure rates Pill 5 71 Progestin Only 0.5 Combined 0.1

For a 20-year-old, combined oral contraceptives are a common first-line birth control option.

• The typical failure rate for combined oral contraceptives is 0.1% with perfect use, and 5% with typical use 2.
• Progestin-only pills are also an option, with a typical failure rate of 0.5% 2. It's essential to consider individual factors, such as medical history and personal preferences, when choosing a birth control method.

From the Research

First-Line Birth Control Options for a 20-Year-Old

• The combined oral contraceptive pill is an effective contraceptive method that can also offer other benefits, such as regulating menstrual cycles and reducing the risk of certain health conditions 3.
• Pills containing levonorgestrel or norethisterone in combination with ethinyloestradiol 35 microgram or less are considered first-line options due to their effectiveness, relatively low risk of venous thromboembolism, and availability on the Pharmaceutical Benefits Scheme 3.

Extended-Cycle Regimens

• Extended-cycle oral contraceptives are increasing in popularity, and a new extended-cycle OC containing the lowest doses of ethinyl estradiol and levonorgestrel + continuous EE throughout the cycle is now available 4.
• Studies have shown that extended-cycle regimens can reduce the number of bleeding days per year, improve bleeding patterns, and are well tolerated by women 5, 6.
• A randomized controlled trial found that an extended-cycle regimen of a combined oral contraceptive containing ethinylestradiol and levonorgestrel was effective and well tolerated, resulting in a lower number of bleeding days and a favorable bleeding pattern compared to a conventional-cycle regimen 6.

Considerations for Young Women

• Oral contraceptive pills continue to be the most commonly used form of prescription contraceptives used by adolescents and young women in the United States 7.
• Certain types of progestins have more potent antiandrogenic properties and are more effective in treating acne, hirsutism, and polycystic ovary syndrome, making them a good option for young women with these conditions 7.
• When choosing an oral contraceptive pill, it is essential to consider individual factors, such as medical history, lifestyle, and personal preferences, to select the most beneficial and appropriate option 7.