Written by Eliza Buyers, MD, FACOG
Family physicians play a pivotal role in counseling adolescent patients about reproductive life planning. An overwhelming 82% of all teen pregnancies are unintended and the majority could be prevented with highly effective contraception. This is one of the many reasons that long-acting, reversible contraception (LARC) is now recommended as the first-line option for teens and young women who want birth control.
The sub-dermal implant is a highly effective form of reversible contraception and is easy to insert and remove. Providers should inform potential users that there will be a change in their menstrual bleeding. About one-third of patients will have amenorrhea, whereas most will have a more unpredictable bleeding pattern. Reassure teens who have persistent bleeding with the implant that this is an expected side effect and offer medical treatment (for example, NSAIDs or OCPs). Preinsertion counseling about the possibility of unpredictable bleeding and reassurance after implant insertion increases continuation and satisfaction with this method.
There are several intrauterine devices (IUDs) available, all of which are safe for women of any age, including teens and women who have never been pregnant. Dispelling common myths and misperceptions about IUDs is a necessary aspect of contraceptive counseling and results in higher rates of use.
Common misperceptions about IUDs
- Infection: IUDs do not increase the risk of acquiring a sexually transmitted infection (STI) or pelvic inflammatory disease (PID). If STI or PID does occur with an IUD in place, the infection can be treated with the IUD left in situ. Screening for STDs can be done at the same time as insertion.
- Outdated restrictions: Women with the following conditions can safely use an IUD: previous ectopic pregnancy, multiple partners, previous STDs, women of any age and women who have never been pregnant.
- Outdated protocols: An IUD can be inserted at any time during the menstrual cycle as long as pregnancy can be reasonably excluded (i.e., negative pregnancy test and no unprotected sex in previous two weeks, or woman is currently using another effective form of contraception).
- Fertility: Previous IUD use has no effect on future fertility. Once removed, fertility immediately returns.
- Cost: All insurers, including Medicaid, must cover the cost for contraceptive visits, devices and surveillance. Uninsured teens or those who need strict confidentiality can be referred to Title X family planning clinics that provide free or reduced cost services.
- Postpartum insertion: An IUD can be inserted immediately after the delivery of the placenta. An implant can be placed before discharge home. Both methods are safe for breastfeeding.
Many teens use the implant and the levonorgestrel IUD for their non-contraceptive benefits including reduced bleeding and pain. LARC methods do not contain estrogen and are therefore a safe option for teens that have migraine with aura, or other contraindications to estrogen-containing methods.
A landmark study of more than 9,000 women showed that when women are counseled on all options for contraception and barriers such as access and cost are removed, 75% will choose a LARC method. Furthermore, implants and IUDs have the highest user satisfaction rates of any method and continuation rates over double that of pills or Depo-Provera.
Teen-friendly, medically accurate information on sexual health
Finally, many teens and young adults will want to do their own research and have additional questions about contraceptive methods. The resources below provide medically accurate, teen-friendly information on contraception, STDs, sex and relationships.
- Bedsider.org is an online birth control support network operated by The National Campaign to Prevent Teen Pregnancy that provides information and comparison of all contraceptive methods and a health clinic finder. They also provide the ability to set up daily, weekly or monthly text message reminders for taking birth control. They do not receive any funding from pharmaceutical companies.
- MTV's public health campaign supports and encourages young people to make responsible decisions about their sexual health by providing STI information and prevention. They also provide links to other trusted sexual health resources including a live chat feature. The campaign is also supported by the Kaiser Family Foundation.
For questions about who to consult about adolescent contraception, call the Adolescent Medicine team at 720-777-6131 or toll free via OneCall at 800-525-4871.