Long-Acting Reversible Contraception for Adolescents

Abstract

IMPORTANCE Adolescents have higher rates of unintended pregnancies than any other age group. Contraceptive implants and intrauterine devices (IUDs) are long-acting reversible contraceptives (LARCs) that are known to be highly effective in preventing pregnancy. New devices have recently been approved for use in adolescents, yet pediatricians may be less familiar with how to counsel adolescents about implants and IUDs.OBSERVATIONS LARC methods should be described in basic terms to adolescents, including hormone dose, method of insertion, and method of pregnancy prevention. Clinicians should appreciate the developmental stages of adolescents, discuss the most effective methods of contraception, and ensure confidentiality from their parents. Short-acting contraception methods (eg, oral contraceptives) can be used as a temporary bridge to provide coverage until a LARC method can be placed. The most common adverse effect of LARC is nuisance bleeding, which can be managed with short courses of oral contraceptives or nonsteroidal anti-inflammatory drugs.CONCLUSIONS AND RELEVANCE LARC devices constitute first-line contraceptive methods for adolescents. All clinicians, including pediatricians, can counsel about LARC even before suggesting an oral contraceptive or another less effective contraceptive method. Effective, confidential communication with sensitive language to inform adolescents of the different types of LARC is necessary to normalize offering LARC as a contraceptive option and improve its uptake among adolescents. Special clinical populations can also be offered appropriate contraceptive options inclusive of LARC.

An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence

“…Progestin-only therapy does not raise SHBG as do OCP containing ethinylestradiol. The progestin-only intrauterine device may be an alternative first-line therapy given the low systemic impact and overall high contraceptive effectiveness [244]. Overall, there is a lack of high-quality RCTs of contraceptive treatment options for adolescents with PCOS to fully inform decision-making in this population.…”

Intrauterine mepivacaine instillation for pain relief during intrauterine device insertion in nulliparous women: a double-blind, randomized, controlled trial

“…With regard to the relative effectiveness of LARCs to other less user-friendly methods, especially among young women (14), nulliparous women are excellent candidates for IUDs. IUDs are currently recommended as first-line contraception for young women (120)(121)(122). Nulliparity is, however, one factor that increases the risk of painful insertion (68,83), and finding an effective and well-accepted method for pain relief in this patient group has previously failed.…”

Reproductive health information, behaviour and sexual education of adolescent girls in Hungary

“…It should be emphasised that most adolescents seeking for medical help experience sexuality related communication as a stressful situation, therefore it is of high importance that we should never judge them, do not express disapproval, but we should try to help and give information suitably in the given situation. We suggest the propagation of the preventive attitude, the consultation about sexuality and contraception in pediatrics (Breuner, et al, 2016;CA, 2014;Francis & Gold, 2017;SAHM, et al, 2014), and timely referral of these adolescents for specialist care. The adolescent already knows her pediatrician and therefore can open more easily in confidential questions and is willing to share such information, which is not yet know by the parents either.…”

“…Decision (selection) should be done along medical reasons and individual priorities (ACOG, 2017b;Kaunitz, 2018 Curtis, et al, 2016;Francis & Gold, 2017).…”

“…Special attention should be paid on those adolescents who underwent induced abortion or had live birth. They have to be informed about further ways of safe contraception during pregnancy and hospital stay (ACOG, 2017a;Francis & Gold, 2017;Tomlin, et al, 2017).…”