October 7, 2014

Contraception: What's best for teens?

Teen pregnancy is a public health concern, and it's totally preventable. True, not having sex is the best way to prevent pregnancy. However according to the most recent CDC Youth Risk Behavior Survey (YRBS), over 64% of teens have had sex by the time they graduate high school, so we need to suck it up and talk about the next best way to prevent pregnancy: contraception.

Last week, the American Academy of Pediatrics released an updated statement asserting that the best contraception for teens is Nexplanon (implant in the arm that lasts 3 years) and the intrauterine device (device placed in the uterus during a pelvic exam and lasts 3 years-10 years, depending on the type). Together, these contraceptives are called Long Acting Reversible Contraceptives (LARCs).  These are the most effective pregnancy prevention for a number of reasons.

For one, LARCs take the responsibility of adherence off the teen's shoulders. All forms of contraception work best when taken appropriately. For example, birth control pills should be taken at the same time every day (I'm going to repeat that. At the same time every day. NOT "in the mornings during school days and at nights during the weekend, and oops, I forgot to take Friday's pill so I'm going to take 2 on Saturday.")  There are similar scenarios for the patch, ring, and injection; trust me, I hear them at least once a day from my patients. This is why most sources list 2 effectiveness statistics for each method: one is for PERFECT use (as in, taking the medications exactly how they are prescribed down to the T) and another for typical use (how most well-meaning people take meds).  For the implant and IUD, once they're in, they're in.  There is no difference between perfect use and typical use. Even when looking at perfect use for those other contraceptives, LARCs still have a higher effectiveness rate.

The duration of LARCs (3 years for the implant, 3-10 years for the IUD) is perfect for females going through transitions like starting college or graduating from college and starting a job.  Sometimes there are issues that can make obtaining the other contraceptives more difficult (access to pharmacy to pick up the prescription, access to clinic to get the shot, finding a provider in the area that takes her insurance, transportation, etc.) Although having a LARC does not mean that the female should stop getting annual check-ups, at least she can rest easy that she is at low risk of getting pregnant during these transition periods.

Also, LARCS are also great for period control. There are many reasons that periods need medical treatment, including being too heavy or long, too painful, or not often enough.  Hormone fluctuations during the menstrual cycle can be responsible for seizures, severe mood changes, skin changes, etc. There are many medical conditions in which hormonal medication is a mainstay of treatment, including Polycystic Ovarian Syndrome and Endometriosis. In my clinic, I do the procedures for implants and IUDs as much for menstrual management as I do for contraception.

Don't get me wrong — I am a big fan of whatever the teen chooses to prevent pregnancy, be it the birth control pill, patch, ring, shot or LARC. (Besides the "withdrawal method." I'm not a fan of that. I have lots of patients with babies due to that method of "birth control.") I just want each teen to know ALL her options and make sure she is choosing the right one for herself (and LARCs are a great option for everyone.) I also want each teen to know that nothing is 100% effective at preventing pregnancy besides abstinence; and no hormonal contraceptive method prevents sexually transmitted infections so condoms are always encouraged for dual protection.