Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point of care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

For more information, click below.


Subscribers log in here


Contraception: Overview of issues specific to adolescents

INTRODUCTION

The pregnancy and abortion rates among adolescents in the United States are higher than in other industrialized nations as a result of intermittent, improper, and lack of use of contraception [1,2].

This topic review will provide an overview of issues related to the provision of contraceptive services to adolescent females. The various types of hormonal contraception and the risks and benefits of these methods are discussed separately. (See "Emergency contraception" and "Risks and side effects associated with estrogen-progestin contraceptives" and "Overview of contraception", section on 'Issues to consider when beginning hormonal contraception'.)

NATIONAL DATA ON CONTRACEPTION IN TEENAGERS

According to the National Survey of Family Growth (2006-2008), among never-married teenagers, 79 percent of females and 87 percent of males used a method of contraception at first sex, and 96 percent reported ever using a contraceptive method [3]. With a few exceptions, teenagers' use of contraceptives has changed little since 2002. The condom remained the most commonly used method (95 percent), followed by the withdrawal method (58 percent) and the oral contraceptive pill (55 percent). The use of highly effective hormonal injectables, mainly depot medroxyprogesterone, remained stable (17 percent). One exception was an increase in the use of condoms and the use of a condom combined with a hormonal contraceptive (dual method use) reported by males. Another exception was an increase in the percent of female teenagers who had ever used periodic abstinence, or the "calendar rhythm" method. In addition, female teenagers reported using a wider array of hormonal methods than was reported in previous years (17 percent had ever used emergency contraception, 11 percent the contraceptive patch, and 7 percent the vaginal ring).

DEVELOPMENTAL FACTORS

Adolescents vary in their ability to implement various types of contraception. From a developmental perspective, sexually active girls in early adolescence have difficulty planning events and activities; they often have an idealistic point of view, think about situations in a concrete or literal way, and live in the moment. Thus, implementing a contraceptive method that requires planning and forethought to prevent the “possibility” of pregnancy is difficult at this age without monitoring and adult support. Girls in middle and late adolescence are more capable of higher-level planning, decision making, and problem solving, skills essential to effective contraceptive behavior [4,5]. (See "Adolescent sexuality", section on 'Adolescent development' and "Overview of contraception".)

MOTIVATING FACTORS

The sexually active adolescent is more likely to seek contraception if she [2,5]:

                                 

Subscribers log in here

To continue reading this article you must have access through your hospital or your group practice, log in to your personal subscription, or purchase a personal subscription. For more information, click below.
Literature review current through: May 2013. | This topic last updated: Dec 11, 2012.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2013 UpToDate, Inc.
References
Top
  1. Alan Guttmacher Institute. Facts on American Teens' Sexual and Reproductive Health. Alan Guttmacher Institute, New York 2011.
  2. Hatcher RA, Trussel J, Nelson AL, et al. Contraceptive Technology, 20th ed, Ardent Media, Inc, New York 2012.
  3. Abma JC, Martinez GM, Copen CE. Teenagers in the United States: sexual activity, contraceptive use, and childbearing, national survey of family growth 2006-2008. Vital Health Stat 23 2010; :1.
  4. Rieder J, Coupey SM. Contraceptive compliance: Personalizing an adolescent’s plan for effective birth control. The Female Patient (Suppl) 2000; :12.
  5. Nelson AI, Neinstein LS. Contraception. In: Handbook of Adolescent Health Care, Neinstein LS, Gordon CM, Katzman DK, et al. (Eds), Lippincott Williams & Wilkins, 2009. p.389.
  6. Oral contraceptives. In: Contraception Report, Grimes DA, Wallach M (Eds), Emron, Inc, New Jersey 1997. p.1.
  7. Braverman PK, Breech L, Committee on Adolescence. American Academy of Pediatrics. Clinical report--gynecologic examination for adolescents in the pediatric office setting. Pediatrics 2010; 126:583.
  8. Donovan P. Delaying pelvic exams to encourage contraceptive use. Fam Plann Perspect 1992; 24:136, 144.
  9. Emans SJ, Grace E, Woods ER, et al. Adolescents' compliance with the use of oral contraceptives. JAMA 1987; 257:3377.
  10. Reubinoff BE, Grubstein A, Meirow D, et al. Effects of low-dose estrogen oral contraceptives on weight, body composition, and fat distribution in young women. Fertil Steril 1995; 63:516.
  11. Lloyd T, Lin HM, Matthews AE, et al. Oral contraceptive use by teenage women does not affect body composition. Obstet Gynecol 2002; 100:235.
  12. Bonny AE, Britto MT, Huang B, et al. Weight gain, adiposity, and eating behaviors among adolescent females on depot medroxyprogesterone acetate (DMPA). J Pediatr Adolesc Gynecol 2004; 17:109.
  13. Bonny AE, Ziegler J, Harvey R, et al. Weight gain in obese and nonobese adolescent girls initiating depot medroxyprogesterone, oral contraceptive pills, or no hormonal contraceptive method. Arch Pediatr Adolesc Med 2006; 160:40.
  14. Busen NH, Britt RB, Rianon N. Bone mineral density in a cohort of adolescent women using depot medroxyprogesterone acetate for one to two years. J Adolesc Health 2003; 32:257.
  15. Cromer BA. Bone mineral density in adolescent and young adult women on injectable or oral contraception. Curr Opin Obstet Gynecol 2003; 15:353.
  16. Banks E, Berrington A, Casabonne D. Overview of the relationship between use of progestogen-only contraceptives and bone mineral density. BJOG 2001; 108:1214.
  17. Cromer BA, Stager M, Bonny A, et al. Depot medroxyprogesterone acetate, oral contraceptives and bone mineral density in a cohort of adolescent girls. J Adolesc Health 2004; 35:434.
  18. Rome E, Ziegler J, Secic M, et al. Bone biochemical markers in adolescent girls using either depot medroxyprogesterone acetate or an oral contraceptive. J Pediatr Adolesc Gynecol 2004; 17:373.
  19. Polatti F, Perotti F, Filippa N, et al. Bone mass and long-term monophasic oral contraceptive treatment in young women. Contraception 1995; 51:221.
  20. Scholes D, LaCroix AZ, Ichikawa LE, et al. Change in bone mineral density among adolescent women using and discontinuing depot medroxyprogesterone acetate contraception. Arch Pediatr Adolesc Med 2005; 159:139.
  21. Black box warning added concerning long-term use of Depo-provera contraceptive injection. FDA Talk Paper. November 17, 2004. Available at: www.fda.gov/bbs/topics/ANSWERS/2004/ANS01325.html (Accessed on December 05, 2007).
  22. Cromer B. In favor of continued use of depot medroxyprogesterone acetate (DMPA, Depo-Provera) in adolescents. J Pediatr Adolesc Gynecol 2005; 18:183.
  23. Rager KM. No bones about it--depot medroxyprogesterone acetate remains an excellent contraceptive option for adolescents. J Pediatr Adolesc Gynecol 2005; 18:187.
  24. Gold MA, Hertweck SP, Lara-Torre E. Use of DMPA by adolescents. J Pediatr Adolesc Gynecol 2005; 18:435.
  25. Cromer BA, Scholes D, Berenson A, et al. Depot medroxyprogesterone acetate and bone mineral density in adolescents--the Black Box Warning: a Position Paper of the Society for Adolescent Medicine. J Adolesc Health 2006; 39:296.
  26. Ness RB, Soper DE, Holley RL, et al. Hormonal and barrier contraception and risk of upper genital tract disease in the PID Evaluation and Clinical Health (PEACH) study. Am J Obstet Gynecol 2001; 185:121.
  27. World Health Organization (WHO). Improving access to quality care in family planning. In: Medical Eligibility criteria for contraceptive use, 3rd ed, Geneva, Switzerland 2003.
  28. Rinehart W. WHO updates medical eligibility criteria for contraceptices. Info Reports. Johns Hopkins University population information program. Baltimore, MD, April 2004.
  29. Bagwell MA, Thompson SJ, Addy CL, et al. Primary infertility and oral contraceptive steroid use. Fertil Steril 1995; 63:1161.
  30. Committee on Adolescent Health Care Long-Acting Reversible Contraception Working Group, The American College of Obstetricians and Gynecologists. Committee opinion no. 539: adolescents and long-acting reversible contraception: implants and intrauterine devices. Obstet Gynecol 2012; 120:983.
  31. Committee On Adolescence. Emergency contraception. Pediatrics 2012; 130:1174.
  32. Hubacher D, Goco N, Gonzalez B, Taylor D. Factors affecting continuation rates of DMPA. Contraception 1999; 60:345.
  33. Rubinstein ML, Halpern-Felsher BL, Irwin CE Jr. An evaluation of the use of the transdermal contraceptive patch in adolescents. J Adolesc Health 2004; 34:395.
  34. Zacur HA, Hedon B, Mansour D, et al. Integrated summary of Ortho Evra/Evra contraceptive patch adhesion in varied climates and conditions. Fertil Steril 2002; 77:S32.
  35. Creasy GW, Abrams LS, Fisher AC. Transdermal contraception. Semin Reprod Med 2001; 19:373.
  36. Compliance with Oral Contraceptive Pills. In: The Contraception Report, Grimes, DA (Ed), Emron, Inc, New Jersey 1994; 5:3.
  37. Polaneczky M, Slap G, Forke C, et al. The use of levonorgestrel implants (Norplant) for contraception in adolescent mothers. N Engl J Med 1994; 331:1201.
  38. Lara-Torre E. "Quick Start", an innovative approach to the combination oral contraceptive pill in adolescents. Is it time to make the switch? J Pediatr Adolesc Gynecol 2004; 17:65.
  39. Westhoff C, Heartwell S, Edwards S, et al. Initiation of oral contraceptives using a quick start compared with a conventional start: a randomized controlled trial. Obstet Gynecol 2007; 109:1270.
  40. Coffee AL, Sulak PJ, Kuehl TJ. Long-term assessment of symptomatology and satisfaction of an extended oral contraceptive regimen. Contraception 2007; 75:444.
  41. Archer DF, Jensen JT, Johnson JV, et al. Evaluation of a continuous regimen of levonorgestrel/ethinyl estradiol: phase 3 study results. Contraception 2006; 74:439.
  42. Edelman A, Gallo MF, Nichols MD, et al. Continuous versus cyclic use of combined oral contraceptives for contraception: systematic Cochrane review of randomized controlled trials. Hum Reprod 2006; 21:573.
  43. Rickert VI, Tiezzi L, Lipshutz J, et al. Depo Now: preventing unintended pregnancies among adolescents and young adults. J Adolesc Health 2007; 40:22.
  44. Tang JH, Lopez LM, Mody S, Grimes DA. Hormonal and intrauterine methods for contraception for women aged 25 years and younger. Cochrane Database Syst Rev 2012; 11:CD009805.
  45. Rosenstock JR, Peipert JF, Madden T, et al. Continuation of reversible contraception in teenagers and young women. Obstet Gynecol 2012; 120:1298.
  46. Elkins TE, Gafford LS, Wilks CS, et al. A model clinic approach to the reproductive health concerns of the mentally handicapped. Obstet Gynecol 1986; 68:185.
  47. Neinstein LS, Nelson AL. Contraception. In: Adolescent Health Care: A Practical Guide, 4th ed, Neinstein LA (Ed), Lippincott Williams & Wilkin, Philadelphia 2000. p.834.
  48. Gold MA, Sucato GS, Conard LA, et al. Provision of emergency contraception to adolescents. J Adolesc Health 2004; 35:67.