Addressing teen contraception

August 1, 2007

Counseling teenage patients on contraceptive options can and should be part of a day's work. Here's what you need to know.

Key Points

Setting the stage

Prior to counseling efforts, several factors should be considered when choosing a contraceptive method most appropriate for her, since the optimal method will be different for each patient:

Hormonal methods

Hormonal contraceptives can be further subdivided into combined estrogen and progestin methods (hereafter referred to as estrogen-containing methods) and progestin-only methods.

Estrogen-containing method

Combination estrogen and progestin methods include most oral contraceptives, the contraceptive patch, and the contraceptive ring. The mechanism of action for these methods is two-fold: The progestin component inhibits ovulation and thickens cervical mucus, while the estrogen component provides negative feedback to the gonadotrophic hormones and allows for some growth of the endometrial lining. During the hormone-free interval, this lining is shed in a predictable fashion. Estrogen side effects such as mild nausea, headache, and breast tenderness are experienced by 10% to 15% of new pill users, but these tend to resolve by the third cycle. Serious side effects include venous thromboembolism (VTE).