Contraceptive devices are effective and safe for use in adolescents, yet pediatricians are less familiar with these contraceptive methods. Consequently, contraceptive device use in adolescents is very low compared to other age groups. Counseling adolescents on these effective contraceptive methods can normalize the use of contraceptive devices as a birth control method.
The American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Society for Adolescent Health and Medicine recommend the implant and IUDs as first-line agents for contraception in adolescents. Despite a substantial decline between 2008 and 2011, teen pregnancy and adolescent birth rates in industrialized countries are highest in the United States. By using simple terminology during counseling and ensuring patient confidentiality, clinicians can normalize offering implants and IUDs to adolescents.
Dr. Jenny K. R. Francis from the Department of Pediatrics at the Columbia University Medical Centre in New York published a review on the use of contraceptive devices in adolescents in the Journal of the American Medical Association on May 30, 2017. This review serves to educate clinicians on the different characteristics of contraceptive devices available to adolescents. In addition, managing adverse effects, prescribing contraceptive devices to special adolescent populations, and bridging to contraceptive devices with other birth control methods are discussed.
Two methods of contraceptive devices exist in the United States: the implant and the IUDs. The hormonal implant is placed under the skin of the upper, inner arm, and is the method with the greatest effectiveness. The IUD placement is a more discomforting procedure since it requires insertion into the uterus during a gynecological examination. Both hormonal and nonhormonal IUDs are available to adolescents. The choice between hormonal IUDs depends on several factors such as menstrual cycle characteristics, drug cost, dose of progesterone, and size of the frame and placement tube of the device. Proper counseling between the physician and patient will allow for the best device to be prescribed.
Patients taking multiple medications for complex conditions such as seizure, autoimmune, and cardiovascular disorders, are good candidates for contraceptive devices since they minimize the risk of drug interactions. Contraindications for contraceptive device placement include pregnancy, suspected pregnancy, or uterine bleeding of unknown cause. Anatomical concerns, such as a distorted uterine cavity, and active sexually transmitted infections are specific contraindications for the insertion of an IUD.
The patient must understand that the device may not be effective immediately. If the device is placed between day 1 and day 5 of the menstrual cycle, immediately following a switch from another contraceptive method, or immediately after childbirth or after an abortion, bridging with another hormonal or nonhormonal contraceptive is unnecessary. Otherwise, a second method of contraception is required for the first 7 days after insertion. The copper IUD is the only device that is effective immediately, regardless of when the device is inserted. Once the device is inserted, a common side effect to expect from any contraceptive device is irregular bleeding for the first 3 to 6 months. Although this adverse effect can be managed with oral combined contraceptives or nonsteroidal anti-inflammatories, it is the most common reason for discontinuing device use.
Effective communication, simple explanations, and a confidential setting allow physicians to counsel adolescents on the use of contraceptive devices. Choosing the appropriate device and alleviating patient concerns can normalize offering devices as contraception to adolescents. Offering more effective methods of contraception can help control the high rate of teenage pregnancy in the United States.
Written By: Jessica Caporuscio, PharmD