Hormonal contraception for the adolescent.

1. Nupur Gupta, MD, MPH* 2. Stephanie Corrado, MD* 3. Mark Goldstein, MD* 1. *Division of Adolescent Medicine, Massachusetts General Hospital for Children, Boston, Mass After completing this article, readers should be able to: 1. Discuss the oral contraceptive pill, its contraceptive and noncontraceptive benefits, and its absolute contraindications. 2. Identify the different routes of administration that have been developed, newer formulations of conventional methods, and novel contraceptive agents that are being developed. 3. Describe each of the contraceptive methods, including adverse effects, efficacy, and compliance. 4. Recognize external and internal barriers to use, commonly held misperceptions by adolescents, and the relation of such misperceptions to developmental stages. 5. Explain how to provide effective and acceptable contraceptive services for adolescents. The United States has the highest rate of teen pregnancy and births in the western industrialized world, with more than 750,000 women ages 15 to 19 years old becoming pregnant each year. About 80% of these pregnancies are unintended and occur in unmarried teens. Of these, about 30% end in abortions, 57% in live births, and 14% in miscarriage. In the United States, oral contraceptive pills (OCPs) remain the most common form of hormonal contraception for adolescents and reproductive-age women. (Technically, these drugs are dispensed as tablets, but the term “pill” is so closely linked with oral contraception that it will be used in this article.) Although the failure rate of the OCP is 0.3 per 100 women-years with ideal use, typical use failure rates, particularly for adolescents, are much higher (3 to 8/100 women-years). Contraception efficacy for the most common methods used by adolescents (Table 1) indicates the continued need for more effective and nonuser-dependent contraception. | Method | Percent of Women Experiencing an Unintended Pregnancy Within The First Year of Use | Percent of Women Continuing Use at 1 Year3 | |:----------------------------------------:| ---------------------------------------------------------------------------------- | ------------------------------------------ | --- | | Typical Use1 | Perfect Use2 | | (1) | (2) | (3) | (4) | | No method4 | 85 | 85 | | | Spermicides5 | 29 | 18 | 42 | | Withdrawal | 27 | 4 | 43 | | Condom6 | | | | | Female | 21 | 5 | 49 | | Male | 15 | 2 | 53 | | Combined pill and minipill | 8 | 0.3 | 68 | | Combined hormonal patch | 8 | 0.3 | 68 | | Combined hormonal ring | 8 | 0.3 | 68 | | Depot medroxyprogesterone acetate (DMPA) | 3 | 0.3 | 56 | | Combined injectable7 | 3 | 0.05 | 56 | | Intrauterine device | | | | | Copper T | 0.8 | 0.6 | 78 | | Levonorgestrel intrauterine system | 0.2 | 0.2 | 80 | | Levonorgestrel implants | 0.05 | 0.05 | 84 | | Female sterilization | 0.5 | 0.5 | 100 | | Male sterilization | 0.15 | 0.10 | 100 | * Emergency contraceptive pills: Treatment initiated within 72 hours after unprotected intercourse reduces the risk of pregnancy by at least 75%. * ↵1 Among typical United States couples who initiate use of a method (not necessarily for the first time), the percentage who experience an accidental pregnancy during the first year if they do …