My teenager has her first serious boyfriend.   I don’t think she’s sexually active yet, but I want her to know her options and be prepared.  What’s available for birth control in teens?

Young women may choose to start hormonal contraception for a variety of reasons, including painful, irregular, or heavy periods, or for birth control.  In addition to preventing pregnancy, these methods may help to make cramps less painful, bleeding lighter and shorter, and some may make cycles more predictable. 

My conversations with teens who are considering sexual activity also always include a discussion of the option of abstinence.  Honestly, I hope each teen will talk with her parents about the values and expectations in the family, and consider delaying starting sex as long as possible.  However – since statistically 42% of teens will start having sex before the end of high school, I feel strongly that they are informed on ways to protect themselves.  There are two main types of hormonal birth control: progesterone-only and combined (=estrogen + progesterone).  

Progesterone-only forms of birth control include the Depo-Provera shot, which is given every 12 weeks in the office, Nexplanon (the birth control implant), and the intrauterine device (IUD).  The Depo shot has been around a long time and is a very good form of birth control IF the patient gets her shots on time.  It’s a good option for patients who can’t reliably take a pill every day, or who can’t take estrogen for a medical reason.  Depo’s most common side effect is irregular bleeding, and may cause weight gain more other birth control methods. 

Even more convenient and effective are the long-acting reversible contraception (LARC) methods Nexplanon and the IUD.  The American Academy of Pediatrics and the American College of Obstetrics and Gynecology actually recommend LARC as the first line choice of birth control for teens and young women who choose not to abstain from sex.  The biggest advantage is that once they are placed, they are nearly 100% effective in preventing pregnancy.  We will start offering Nexplanon at TCC beginning April 6th.  This is a flexible rod, about the size of a toothpick, which is inserted just under the skin in the upper arm and stays in place for up to 3 years.  It’s reliable, discreet, and effective.  The most common side effect is irregular menstrual bleeding.  IUDs are placed by ob/gyn doctors in their offices and depending on the device may last up to 3-5 years.  The progesterone in the Nexplanon and IUDs help to decrease bleeding and cramping,  Some women may even stop bleeding altogether, which is perfectly safe while the device is in place.

Forms of combined contraception are the pill, patch, and ring. The oral contraceptive pill (“The Pill”) is the most common form of contraception in the US.  This requires a patient who is conscientious about taking her pill every day.  Ideally, users of the pill will have periods that are less painful, shorter and lighter.  While most patients don’t have any side effects, some may experience headaches, breast tenderness, or nausea.  The pill does not typically make a patient gain weight.   In terms of preventing pregnancy, perfect use the pill is effective over 99% of the time, but typical (= real life!) use, it’s closer to 90%. 

No discussion of sexual activity is complete without mention of the importance of condoms.  Although all of the options above are effective in preventing pregnancy, they don’t do a bit to prevent sexually transmitted infections!  I always recommend condom use EVERY TIME in addition to birth control. 

Whew!  Big stuff.  Here are some other websites with great information, and as always, please talk to your doctor if you have questions about these options.

www.youngwomenshealth.org

http://www.healthychildren.org/english/ages-stages/teen/dating-sex/Pages/default.aspx

Dr. Sarah Tycast