Abstract
In affluent societies, median age at menarche has dropped to below 13 years. Younger age at menarche is associated with earlier sexual activity. To avoid unintended teenage pregnancies, barriers to contraception provision must be kept low, i.e. availability without prescription or through a low-threshold prescription system, low-cost options and long-term prescriptions or easy refills. Since many adolescents are (over)concerned about side effects, these should be addressed. A gynaecological examination prior to prescription is no longer recommended. All effective reversible contraceptive methods are available to adolescents: user-based hormonal contraceptives, trimonthly depot medroxyprogesterone acetate (DMPA), and long-acting reversible contraception (LARC). User-based hormonal contraceptives carry a small absolute risk of venous thromboembolism (~4 per 10,000 patient-years), but the risk is more than tenfold higher among young women with an inherited clotting defect. DMPA reduces bone mineral accumulation, but this is a reversible effect; the metabolic risks, including weight gain and insulin resistance, appear to be greater. LARC, including intrauterine contraceptive devices and the progestogen-containing implant, is gaining popularity among teenagers; abnormal bleeding is the main side effect. Any effective contraceptive should preferably be combined with consistent condom use to prevent sexually transmitted infections (“the double Dutch”).
Similar content being viewed by others
Abbreviations
- COC:
-
Combined oral contraceptive
- DMPA:
-
Depot medroxyprogesterone acetate
- EE:
-
Ethinylestradiol
- IUCD:
-
Intrauterine contraceptive device
- LARC:
-
Long-acting reversible contraception
- STI:
-
Sexually transmitted infection
- VTE:
-
Venous thromboembolism
References
Behringer T, Reeves MF, Rossiter B, Chen BA, Schwarz EB (2011) Duration of use of a levonorgestrel IUS amongst nulliparous and adolescent women. Contraception 84:e5–e10
Belsky J, Steinberg L, Houts RM, Halpern-Felsher BL (2010) The development of reproductive strategy in females: early maternal harshness → earlier menarche → increased sexual risk taking. Dev Psychol 46:120–128
Beral V, Bull D, Reeves G, Peto R (1996) Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53 297 women with breast cancer and 100 239 women without breast cancer from 54 epidemiological studies. Lancet 347:1713–1727
Bloemenkamp KWM, Rosendaal FR, Helmerhorst FM, Vandenbroucke JP (2000) Higher risk of venous thrombosis during early use of oral contraceptives in women with inherited clotting defects. Arch Intern Med 160:49–52
Chasan-Taber L, Willett WC, Manson JAE, Spiegelman D, Hunter DJ, Curhan G, Colditz GA, Stampfer MJ (1996) Prospective study of oral contraceptives and hypertension in the United States. Circulation 94:483–489
Clark LR, Barnes-Harper KT, Ginsburg KR, Holmes WC, Schwarz DF (2006) Menstrual irregularity from hormonal contraception: a cause of reproductive health concerns in minority adolescent young women. Contraception 74:214–219
Coles MS, Makino KK, Stanwood NL (2011) Contraceptive experiences among adolescents who experience unintended birth. Contraception 84:578–584
Deokar AM, Jackson W, Omar HA (2011) Menstrual bleeding patterns in adolescents using etonogestrel (ENG) implant. Int J Adolesc Med Health 23:75–77
Gaffield ME, Curtis KM, Mohllajee AP, Peterson HB (2006) Medical eligibility criteria for new contraceptive methods: combined hormonal patch, combined hormonal vaginal ring and the etonogestrel implant. Contraception 73:134–144
Gallo MF, Grimes DA, Schulz KF, Helmerhorst FM (2004) Combination estrogen-progestin contraceptives and body weight: systematic review of randomized controlled trials. Obstet Gynecol 103:359–373
Harel Z, Johnson CC, Gold MA, Cromer B, Peterson E, Burkman R, Stager M, Brown R, Bruner A, Coupey S, Hertweck P, Bone H, Wolter K, Nelson A, Marshall S, Bachrach LK (2010) Recovery of bone mineral density in adolescents following the use of depot medroxyprogesterone acetate contraceptive injections. Contraception 81:281–291
He C, Zhang C, Hunter DJ, Hankinson SE, Louis GMB, Hediger ML, Hu FB (2009) Age at menarche and risk of type 2 diabetes: results from 2 large prospective cohort studies. Am J Epidemiol 171:334–344
Hendriks AEJ, Laven JSE, Valkenburg O, Lie Fong S, Fauser BCJM, de Ridder MAJ, de Jong FH, Visser JA, van Ginneken AM, Boot AM, Drop SLS (2011) Fertility and ovarian function in high-dose estrogen-treated tall women. J Clin Endocrinol Metab 96:1098–1105
Jernström H, Loman N, Johannsson OT, Borg Å, Olsson H (2005) Impact of teenage oral contraceptive use in a population-based series of early-onset breast cancer cases who have undergone BRCA mutation testing. Eur J Cancer 41:2312–2320
Jick SS, Hagberg KW, Hernandez RK, Kaye JA (2010) Postmarketing study of ORTHO EVRA® and levonorgestrel oral contraceptives containing hormonal contraceptives with 30 mcg of ethinyl estradiol in relation to nonfatal venous thromboembolism. Contraception 81:16–21
Krettek JE, Arkin SI, Chaisilwattana P, Monif GRG (1993) Chlamydia trachomatis in patients who used oral contraceptives and had intermenstrual spotting. Obstet Gynecol 81:728–731
Lidegaard Ø, Nielsen LH, Skovlund CW, Skjeldestad FE, Løkkegaard E (2011) Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses. BMJ 343:d6423
Mestad R, Secura G, Allsworth JE, Madden T, Zhao Q, Peipert JF (2011) Acceptance of long-acting reversible contraceptive methods by adolescent participants in the Contraceptive CHOICE Project. Contraception 84:493–498
Moreau C, Bouyer J, Bajos N, Rodriguez G, Trussell J (2009) Frequency of discontinuation of contraceptive use: results from a French population-based cohort. Hum Reprod 24:1387–1392
Morris DH, Jones ME, Schoemaker MJ, Ashworth A, Swerdlow AJ (2011) Secular trends in age at menarche in women in the UK born 1908-83: results from the Breakthrough Generations Study. Paediatr Perinat Epidemiol 25:394–400
Petitti DB (2003) Combination estrogen-progestin contraceptives. N Engl J Med 349:1443–1450
Poulter NR, Chang CL, Farley TMM, Meirik O, Marmot MG (1995) Venous thromboembolic disease and combined oral contraceptives: results of international multicentre case-control study. Lancet 346:1575–1582
Santelli JS, Melnikas AJ (2010) Teen fertility in transition: recent and historic trends in the United States. Annu Rev Public Health 31:371–383
Tarr ME, Gilliam ML (2008) Sexually transmitted infections in adolescent women. Clin Obstet Gynecol 51:306–318
Trussell J (2011) Contraceptive failure in the United States. Contraception 83:397–404
Van den Heuvel MW, van Bragt AJM, Alnabawy AKM, Kaptein MCJ (2005) Comparison of ethinylestradiol pharmacokinetics in three hormonal contraceptive formulations: the vaginal ring, the transdermal patch and an oral contraceptive. Contraception 72:168–174
Verhaeghe J (2010) Hormonal contraception in women with the metabolic syndrome: a narrative review. Eur J Contraception Reprod Health Care 15:305–313
Westhoff CL, Jones HE, Guiahi M (2011) Do new guidelines and technology make the routine pelvic examination obsolete? J Womens Health (Larchmt) 20:5–10
Wise LA, Mikkelsen EM, Rothman KJ, Riis AH, Sørensen HT, Huybrechts KF, Hatch EE (2011) A prospective study of menstrual characteristics and time to pregnancy. Am J Epidemiol 174:701–709
Yang XR, Chang-Claude J, Goode EL, Couch FJ, Nevanlinna H, Milne RL et al (2011) Associations of breast cancer risk factors with tumor subtypes: a pooled analysis from the Breast Cancer Association Consortium Studies. J Natl Cancer Inst 103:250–263
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Verhaeghe, J. Clinical practice. Eur J Pediatr 171, 895–899 (2012). https://doi.org/10.1007/s00431-012-1676-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-012-1676-x