Bone mineral density in adolescent females using depot medroxyprogesterone acetate

244

133

A working knowledge of contraception will assist the pediatrician in both sexual health promotion as well as treatment of common adolescent gynecologic problems. Best practices in adolescent anticipatory guidance and screening include a sexual health history, screening for pregnancy and sexually transmitted infections, counseling, and if indicated, providing access to contraceptives. Pediatricians’ long-term relationships with adolescents and families allow them to help promote healthy sexual decision-making, including abstinence and contraceptive use. Additionally, medical indications for contraception, such as acne, dysmenorrhea, and heavy menstrual bleeding, are frequently uncovered during adolescent visits. This technical report provides an evidence base for the accompanying policy statement and addresses key aspects of adolescent contraceptive use, including the following: (1) sexual history taking, confidentiality, and counseling; (2) adolescent data on the use and side effects of newer contraceptive methods; (3) new data on older contraceptive methods; and (4) evidence supporting the use of contraceptives in adolescent patients with complex medical conditions.

Section: Progestin Injectionsmentioning

confidence: 99%

Contraception for Adolescents

Ott

Sucato²

2014

244

133

“…Studies in both adolescents 77 and adults 78 suggest that weight gain status at 6 months is a strong predictor of future excessive weight gain with ongoing DMPA use, but that weight gain does not occur in all patients. 79,80 DMPA causes reductions in bone mineral density (BMD), [81][82][83] 91 no gynecologic examination is needed to determine eligibility for COC use. Like other combined methods including the contraceptive vaginal ring and transdermal patch, COCs can be started on the same day as the visit ("quick start") in healthy, nonpregnant adolescents.…”

Section: Progestin-only Injectable Contraceptionmentioning

confidence: 99%

Contraception for Adolescents

Braverman¹,

Adelman²,

Alderman³

et al. 2014

307

107

Contraception is a pillar in reducing adolescent pregnancy rates. The American Academy of Pediatrics recommends that pediatricians develop a working knowledge of contraception to help adolescents reduce risks of and negative health consequences related to unintended pregnancy. Over the past 10 years, a number of new contraceptive methods have become available to adolescents, newer guidance has been issued on existing contraceptive methods, and the evidence base for contraception for special populations (adolescents who have disabilities, are obese, are recipients of solid organ transplants, or are HIV infected) has expanded. The Academy has addressed contraception since 1980, and this policy statement updates the 2007 statement on contraception and adolescents. It provides the pediatrician with a description and rationale for best practices in counseling and prescribing contraception for adolescents. It is supported by an accompanying technical report.

“…16 Although depot medroxyprogesterone acetate, an injectable contraceptive, can effectively minimize or eliminate menstrual flow, prolonged use has been linked recently to bone density loss in healthy adolescent females, which may not reverse completely after discontinuation of the medication. 17 Adolescents who are already at risk of osteopenia from chronic medical conditions may be at even greater risk of bone mineral density loss from depot medroxyprogesterone acetate use. Historically, sterilization of minors with developmental disabilities was performed without appropriate regard for their decision-making capacities, abilities to care for children, feelings, or interests.…”

Section: Introductionmentioning

confidence: 99%

Sexuality of Children and Adolescents With Developmental Disabilities

Murphy¹,

Elias²

2006

243

Children and adolescents with developmental disabilities, like all children, are sexual persons. However, attention to their complex medical and functional issues often consumes time that might otherwise be invested in addressing the anatomic, physiologic, emotional, and social aspects of their developing sexuality. This report discusses issues of puberty, contraception, psychosexual development, sexual abuse, and sexuality education specific to children and adolescents with disabilities and their families. Pediatricians, in the context of the medical home, are encouraged to discuss issues of sexuality on a regular basis, ensure the privacy of each child and adolescent, promote self-care and social independence among persons with disabilities, advocate for appropriate sexuality education, and provide ongoing education for children and adolescents with developmental disabilities and their families.