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When the pill isn't right

Long-acting contraception options for adolescents

Significant economic and educational issues surround teenage pregnancy, the goal being to avoid as many unplanned pregnancies as possible. Safe and effective long-acting contraceptives are approved for use in adolescents and may be more appealing for their infrequent administration. Educating your patients on their options allows them to select the contraceptive best suited for them.

Although there has been a general decrease in adolescent pregnancy rates during the 1990s and 2000s, the United States continues to have the highest pregnancy rate among teenagers in the developed world.1-3 Most pregnancies occurring during adolescence in the United States are unplanned (82%), and significant disparities in pregnancy rates exist: Hispanic and black adolescents have 3-fold higher pregnancy rates than non-Hispanic whites, and pregnancy rates are much higher in some southern and southwestern states than in other areas.4,5

Adolescent mothers are much less likely than their peers to complete high school, and only 2% go on to graduate from college.6,7 Unfortunately, pregnancy during adolescence often leads to multigenerational socioeconomic repercussions and remains a significant public health issue despite a general decrease in adolescent birth rates.

Although many adolescents abstain from sex, almost half of adolescent boys and girls have had sexual intercourse at least once, making it essential that providers understand contraception in the effort to decrease teenage pregnancy.8,9

Condoms are the most commonly used contraceptive among adolescents, and the oral contraceptive pill is the most commonly used prescribed contraceptive.9 However, the pill has a failure rate of close to 30% in adolescents in the first year of use.10 It's discouraging that despite the availability of multiple forms of contraception, more than half of sexually active adolescent girls have relied on withdrawal as their method of birth control.9

Table: Contraception choices for adolescents
Long-acting contraceptives are approved and recommended for contraception during adolescence and have been shown to have lower failure rates in adolescents than condoms and the birth control pill (Table).11-14 Although the importance of condom use during every sexual event to prevent sexually transmitted infections (STIs) needs to be reinforced, long-acting contraceptives may be appealing to adolescents for their infrequent administration.

Very-long-acting contraceptives also offer increased privacy because they do not require pharmacy refills or a place to be stored. Many do not contain estrogen and so carry less thromboembolic risk and have fewer medical contraindications than estrogen-containing contraceptives such as the pill.13

These contraceptives often induce amenorrhea, which may be desirable to adolescents with menorrhagia, anemia, dysmenorrhea, or developmental delay. Finally, for adolescents with problems remembering to take a daily pill, use condoms inconsistently, or have irregular daily schedules because of a job or sports, long-acting contraceptives are more likely to be used correctly and prevent pregnancy.

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