Expanding contraceptive options for adolescents with Melissa Menezes, MD

Melissa Menezes, MD, assistant professor of pediatrics at the Albert Einstein College of Medicine and attending physician in the Division of Adolescent Medicine at the Children’s Hospital at Montefiore, emphasized the importance of provider readiness in contraceptive counseling.

“I think it's about having the tools and the knowledge as a general provider in all areas of the United States, and the counseling really has more to do with the patient in your room that you're seeing in front of you,” she said.

Menezes noted that while disparities in access exist, “the best way that we as providers can really address these disparities is just having those tools, no matter where we are.”

New options for adolescents

She highlighted recently available contraceptive methods that can meet specific patient needs. The Twirla patch may be helpful for patients who experience adhesive issues with the standard contraceptive patch. For adolescents leaving home for college, the Annovera ring could provide continuity if they face challenges in accessing routine prescriptions.

Nextstellis, a combined hormonal contraceptive containing a different estrogen formulation, may offer benefits for patients who previously experienced breast tenderness or mood changes with other combined oral contraceptives. “If that's a concern of your patient, now you have this in your toolbox. This is something else you could try,” Menezes explained.

Over-the-counter options

Menezes also discussed Opill, the progestin-only pill now available over the counter. While she noted limited direct counseling on this option, she explained its role in increasing access. “If that's the case, you know, those patients could really benefit from the O pill,” she said, particularly for adolescents unable to reach a provider. “It might not be the perfect option for them, but it is better than nothing, if what they want is to be on contraception.”

Long-acting reversible contraception (LARC) considerations

In counseling patients on long-acting methods, Menezes said she advises them about both FDA-approved durations and evidence supporting extended use. She emphasized respecting patient choice. “There’s some patients who definitely want it removed at the time that FDA says that it's supposed to be removed. And then there’s definitely some patients [who] are like, I don't want to have to do another procedure. Let's just keep it in, as long as you know, I'm protected against pregnancy. That's fine,” she said.

Addressing safety concerns

Recent reports on the risk of meningioma with certain injectable contraceptives have raised patient concerns. Menezes explained that while a French study noted an increased risk, the absolute risk remains low. “The risk goes from one in 10,000 in the general population to five in 10,000,” she said. Presenting the data in absolute terms often reassures patients. Still, she emphasized that final decisions should rest with the patient: “If that risk in their estimation is too high, it's not the right choice for them.”

Disclosure: Menezes reports no disclosures.

Reference

Menezes M. What’s New in Contraceptive Care. Presentation. Presented at: American Academy of Pediatrics 2025 National Conference & Exhibition. September 26-30, 2025. Denver, Colorado.