Contraception Explained: Birth Control Options for Teens & Adolescents

Hormonal contraceptives

In addition to the implant and levonorgestrel IUD, hormonal contraceptives come in a variety of forms—pill, patch, injection and vaginal ring. All are more than 90% effective in preventing pregnancy. They should be used with a condom or other type of barrier protection to prevent sexually transmitted infections.

Progestin injection (DepoProvera)

• What it is:
  A shot containing a progestin hormone that prevents the ovaries from releasing an egg.

• Advantages:
  • 96% effective at preventing pregnancy with typical use.
  • Long-lasting protection; only requires visits to the doctor every three months.
  • The shot also protects against endometrial cancer and iron deficiency anemia.
  • May have less cramping and lighter periods. Many teens stop having periods after several doses.
• Disadvantages:
  • May cause weight gain.
  • May include irregular bleeding or light spotting.
  • Could affect bone density with prolonged (more than two years) use. Bone strength usually gets better after stopping.

Contraceptive vaginal ring

• What it is:
  The contraceptive vaginal ring has combined progestin and estrogen hormones (etonogestrel/ethinyl estradiol) that prevent the ovaries from releasing an egg. You place the ring in your vagina once a month. It stays in place for 3 weeks and is then removed for a week. During that week, the user has a period.
• Advantages:
  • 93% effective at preventing pregnancy with typical use.
  • Lighter periods.
  • Less cramps.
  • Acne may improve.
• Disadvantages:
  • Some users forget to replace the ring each month.
  • May cause headaches, nausea, vaginal discharge or breast tenderness.
  • May increase the risk of blood clots.

Contraceptive patch

• What it is:
  There are two combined estrogen and progestin contraceptive patches (ethinyl estradiol and either norelgestromin or levonorgestrel). The hormones are absorbed through the skin (transdermal), and prevent the ovaries from releasing an egg. You remove the patch and put on a new one each week for three weeks. Then, you do not wear a patch for one week. During that week, you have a period.
• Advantages:
  • 93% effective at preventing pregnancy with typical use.
  • Lighter periods.
  • Less cramps.
  • Acne may improve.
• Disadvantages:
  • The patch is less effective in overweight or obese individuals; these individuals should talk to their health care providers about the patch.
  • Some users forget to change the patch each week.
  • May increase the risk of blood clots.
  • Other people might see the patch if it is not covered by clothes. This may bother some teens.
  • May cause headaches, nausea, skin irritation or breast tenderness.

Combined oral contraceptive pills

• What they are:
  Combined oral contraceptive pills contain both estrogen and a progestin, and are taken daily. They come in a variety of formulations, with different progestins, different doses of estrogen and different lengths of time between periods.
• Advantages:
  • 93% effective at preventing pregnancy with typical use.
  • Lighter periods.
  • Less cramps.
  • Improves acne.
  • Reduces the risk of ovarian and endometrial cancers and iron-deficiency anemia.
• Disadvantages:
  • Serious but rare side effects may include blood clots and stroke.
  • May cause headaches, nausea or breast tenderness.
  • Must be taken every day. This can be hard for some teens to remember. The health care provider will explain what to do if a dose is missed.

Progestin-only oral contraceptive pills

• What they are:
  There are three types of progestin-only (minipill) oral contraceptives currently available in the United States. Two require a prescription and is available one over-the-counter (see more information below).The two prescription pills include:
  • Norethindrone (0.35 mg) prevents pregnancy by thickening cervical mucus. The pill should be taken at the same time every day. There are no breaks between packs and no hormone-free tablets.
  • Drospirenone containing progestin-only pills. The drospirenone pill as a built in 4-day hormone-free interval intended to create more predictable monthly bleeding, and may be better for people who want a progestin only pill but have breakthrough bleeding on norethindrone.

Advantages:

• Lighter periods.
• Less cramps.
• Lower chance of hormonal side effects, such as nausea and headaches.

Disadvantages:

• May be less effective at preventing pregnancy than combination oral contraceptive pills.
• May cause irregular bleeding or spotting, especially during the first few months of taking them.
• Fewer non-contraceptive benefits like improved acne.

Barrier methods of contraception

Barrier methods are hormone-free methods to prevent pregnancy and include condoms, contraceptive gels and spermacides, along with diaphragms and cervical caps. Condoms also prevent sexually transmitted infections and pregnancy.

Because sexually transmitted infections are common among teens, it is recommended that teens use condoms together with more effective hormonal contraceptive methods.

External condom (male condom)

• What it is:
  A latex, synthetic, or natural material designed to fit over the penis. Natural fiber condoms will not prove protection against sexually transmitted infections.
• Advantages:
  • 87% effective at preventing pregnancy with typical use.
  • Available without a prescription.
  • Easy to use.
  • Inexpensive.
  • Protects against sexually transmitted infections.
  • Can be used with other methods for added pregnancy prevention.
• Disadvantages:
  • A new one should be used for each act of intercourse.
  • Condom use takes some practice and instruction.
  • Can break or slip off during sex.
  • People allergic to latex may have to use polyurethane or polyisoprene condoms.

Internal condom

• What it is:
  A loose-fitting polyurethane sheath with two flexible rings. One ring fits inside the vagina, anus or mouth. The other fits on the outside.
• Advantages:
  • 79% effective at preventing pregnancy with typical use.
  • Can be used in combination with other methods to provide added pregnancy prevention.
• Disadvantages:
  • Requires a prescription.
  • Can be difficult to insert.
  • May slip during use.
  • More expensive than external condoms.

Dental dam

• What it is:
  A latex or synthetic (nitrile or polyurethane) sheet that is a barrier users place over the penis, vulva, vagina, mouth, anus or any part of the body.
• Advantages:
  • Available without a prescription.
  • Provides protection from infection during oral sex.
• Disadvantages:
  • Information about how well it works is not available.

Contraceptive gel & spermicides

• What they are:
  A spermicide is a gel, cream or foam that is applied inside the vagina before having sex. Spermicides contain nonoxynol-9, a chemical that is toxic to sperm that can be used with other methods to help prevent pregnancy. Phexxi is a new prescription contraceptive gel that raises the acidity in the vagina, which makes it harder for sperm to swim.
• Advantages:
  • Available without a prescription.
  • No hormonal side effects.
• Disadvantages:
  • Not as effective at preventing pregnancy as other forms of contraception when used alone. (Nonoxynol-9 is 79% effective; Phexxi’s manufacturer reports a typical use effectiveness of 86%.)
  • No protection against sexually transmitted infections. In fact, among populations at high risk for HIV, nonoxynol-9 may increase HIV risk.
  • Phexxi must be applyed immediately before, or up to an hour before, sexual intercourse and then reapplied every afterward.

Emergency contraception

Emergency contraception can work after sexual intercourse, but timing is important. All forms of emergency contraception are more likely to prevent pregnancy if used as soon as possible after sex (ideally within six hours of intercourse). Emergency contraception will not interfere with an established pregnancy.

Types of emergency contraception currently available:

• Levonorgestrel (Plan B Onestep, NextChoice) is an oral form of emergency contraception medicine that contains the same type of progestin hormone as combined oral contraceptives. Levonorgestrel is available over-the-counter as an emergency contraception without a prescription or age restrictions, so adolescents can access it.
• Ulipristal Acetate (Ella) is another emergency contraception medicine, but it is only available with a prescription.
• Having an IUD implanted within five days of sexual intercourse is another emergency contraception option. This needs to be done by a doctor, but it stays in place and continues to help prevent pregnancy.

Withdrawal, abstinence & periodic abstinence

Withdrawal

In withdrawal, the penis is taken out of the vagina before ejaculation. It is a difficult skill for young people to learn. Also, it does not protect against STIs, as the penis releases fluids into the vagina before ejaculation. It is only 78% effective at preventing pregnancy in adults (adolescent data is not available).

Fertility awareness natural birth control method

With fertility awareness (also called periodic abstinence or “rhythm method”) approaches, people keep track of their periods, take their temperature each morning and inspects the color and/or texture of cervical mucus every morning. During the week that they have signs of ovulating, they do not have sex. Fertility I hope you find this article helpful as well as interestingawareness places a high responsibility on users. Also, it may be less effective for adolescents, since their periods are often irregular and ovulation may not be predictable. Fertility awareness mobile apps are available, but have not been tested in adolescents.

Abstinence

As a contraceptive method, abstinence is 100% effective when used perfectly. However, in national surveys, many adolescents who plan to be abstinent become sexually active, making the actual real-world effectiveness much lower. Becaues of this, we should not rely on abstinence counseling alone. Instead, we should provide teens with complete sexual health information including birth control.

Remember

It may feel awkward to talk with your adolescent about contraception, but it is an important part of protecting their health and well-being. Your pediatrician is available for support and guidance.

I hope you find this article helpful as well as interesting