Contraceptive care for Canadian youth

Abstract

Sexual and reproductive health is an important component of comprehensive health care for youth. This statement provides guidance for selecting and prescribing contraceptives for youth, including commonly prescribed hormonal contraceptives-the pill, patch, ring and injectable progestin-and long-acting reversible contraceptives (LARCs). LARCs, including subdermal implants (which are not available in Canada) and intrauterine contraceptives (IUCs), are substantially more effective during typical use than hormonal contraceptives. This statement endorses LARCs as the first-line option for contraception for Canadian youth, while emphasizing that providers must collaborate with youth to select a contraceptive method that is acceptable, safe, effective and practical for them. Strategies that eliminate obstacles to initiating and continuing contraception are provided.

Contraception for Adolescents

“…The risk of cervical cancer may be increased in COC users compared with non-users. Data on breast cancer risk with COC use is conflicting but many studies have failed to demonstrate an increased risk of breast cancer or breast cancer mortality in COC users (21,22,23) IUCs can only be inserted during menses An IUC can be inserted at any time during the menstrual cycle provided that pregnancy or the possibility of pregnancy can be ruled out (24) COC: combined oral contraceptive, IUC: intrauterine contraceptive, LNG-IUS: levonorgestrel-releasing intrauterine system, IUCs: intrauterine contraceptives Many international organizations have recommended moving to a tiered approach to contraceptive counselling, whereby HCPs present contraceptive options in order of contraceptive effectiveness and start the contraceptive discussion with Tier 1 LARC methods (8,33,38). Contraceptive effectiveness is one of a woman's most important considerations when choosing a contraceptive method (39) and using top tier methods would achieve the highest effective contraception.…”

“…Adolescents may fear weight gain, bleeding, acne, and mood side effects, while their parents may fear effects on future fertility and the risk of cancer. Regardless of the method of contraception chosen, adolescents should be counselled on the importance of the use of latex condoms to reduce the risk of STI acquisition (dual method) (25,38).…”

“…STI screening may be performed on the day of IUC insertion but insertion should not be delayed while waiting for the results, provided that there are no overt signs of infection. HCPs should provide at least a year-long prescription and should consider having samples on site to provide to adolescents (38). All adolescents should be counselled on how long to use back up contraception after starting a new contraceptive method.…”

“…Neither age nor nulliparity are contraindications to their use although rates of IUC expulsion are significantly higher in adolescents compared to older women regardless of parity or IUC type (4,53). Many international societies have stated that IUCs are a safe first line choice for adolescents (8,31,32,38,54,55) and encourage HCPs to counsel all adolescents on their use for the prevention of pregnancy due to their low typical use-failure rates and high one-year continuation rates. IUC rates have a 99% efficacy, with over 80% continuing with the method at one year (54).…”

“…Adolescence is a time of bone mass accrual which continues up to approximately age 25 years (38). Although data on CHC effects on BMD is conflicting, there is currently no evidence supporting increased risks of osteoporosis or fracture in CHC users (72,85).…”