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Ease of Use Key Requirement For Adolescent Contraception


 

ATLANTA — When it comes to choosing an effective method of contraception for adolescents, ease of use should probably top the list of requirements. Dr. Geri Hewitt said at the annual meeting of the American Academy of Pediatrics.

Adolescents, particularly younger teens, are less likely to use consistent contraception, and when they do, they are less likely to use effective methods. In fact, adolescents are reluctant to seek medical contraceptive advice, even though they may already be sexually active, said Dr. Hewitt of Ohio State University, Columbus.

Teens face numerous barriers to good contraception, said Dr. Hewitt. Teens are still covered by their parents' health insurance and so may be shy, or feel awkward, approaching their physician for contraception advice. They have inadequate knowledge about good contraception, they tend to be in denial about engaging in sexual activity, they have concerns about the side effects of “the pill,” and they also fear, mistakenly as it turns out, that they will have to have a pelvic examination in order to obtain a prescription for an oral contraceptive.

“Planning is not what they do…. They have to acknowledge that they are going to be sexually active, and many teenagers are not mature enough to do this,” Dr. Hewitt said.

One way she gets her teenage patients to open up about their sexual activity is by asking them if they have a boyfriend. “This approach often works better than directly asking them if they are sexually active, or even if they are thinking of having sex,” she said.

Dr. Hewitt highlighted these new options for adolescent contraception:

The transdermal contraceptive patch (Ortho Evra). This patch is highly effective, with an easy, once-a-week dosing schedule. The active ingredients, norelgestromin 150 mcg/day and ethinyl estradiol 20 mcg/day, are released from the medicated layer of the patch and delivered into the systemic circulation, in a steady state, with no peaks and troughs. The patch is at its most effective in teens who are within 35% of their ideal body weight. But it may fall off with excessive heat, humidity, exercise, and swimming. “Mothers like it. They say 'if I have to go to war with my daughter about taking her contraception, at least I only have to do it once a week,'” Dr. Hewitt said.

The combined contraceptive vaginal ring (NuvaRing). This flexible, transparent ring contains ethinyl estradiol and etonogestrel. The ring is inserted into the vagina for 3 weeks, and then removed for 1 week for a withdrawal bleed. “If it's in the vagina, it's in the right spot. It needs to be in contact with the vaginal mucosa for transvaginal absorption. If she can use a tampon, she can use the Nuvaring.” The Nuvaring uses the “absolute lowest” dose of estrogen, which is a “good selling point” for teens, she said.

The subdermal contraceptive rod (Implanon). This single-rod, nonbiodegradable implantable contraceptive rod is 4 cm in length and 2 mm in diameter, and it contains progestin etonogestrel, an active metabolite of desogestrel. The rod provides contraception for up to 3 years. “The Implanon is much easier to insert and remove than the Norplant, and is very highly effective. But, you do need someone to insert and remove the rod, and you must allow the teen to [have it removed] if she wants,” Dr. Hewitt said.

One way to get teenagers to open up about their sexual activity is by asking them if they have a boyfriend. DR. HEWITT

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