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Making LARC Options Available for Adolescents

Obstet Gynecol; ePub 2018 May; Savage, et al

Long-acting reversible contraceptives (LARC) have higher efficacy, higher continuation rates, and higher satisfaction rates compared with short-acting contraceptives among adolescents who choose to use them, and obstetrician-gynecologists should counsel all sexually active adolescents who do not seek pregnancy on the range of reversible contraceptive methods, including LARC. This according to a recent committee opinion from the American College of Obstetricians and Gynecologists (ACOG), which also offers the following recommendations and conclusions:

  • Complications of intrauterine devices (IUDs) and contraceptive implants are rare and differ little between adolescents and women, which makes these methods safe for adolescents.
  • Patient choice should be the principal factor driving the use of one method of contraception over another, and respect for the adolescent’s right to choose or decline any method of reversible contraception is critical. A reproductive justice framework for contraceptive counseling is essential to providing equitable health care, promoting access and coverage for all contraceptive methods, and avoiding potential coercion. Obstetrician–gynecologists should use this framework and offer LARC alongside all other reversible methods to adolescents who wish to prevent pregnancy.
  • New-onset abnormal uterine bleeding unrelated to initial placement of a LARC should be evaluated similarly to abnormal bleeding in non-LARC users.
  • Because adolescents are at higher risk of sexually transmitted infections (STIs), obstetrician–gynecologists should continue to follow standard guidelines for STI screening. They should advise adolescents who choose LARC methods to use male or female condoms consistently (dual method use) to decrease the risk of STIs, including human immunodeficiency virus (HIV).

Citation:

Adolescents and long-acting reversible contraception: Implants and intrauterine devices. ACOG Committee Opinion No. 735. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2018;131:e130–9.