Prevention of Adolescent Pregnancies

Hormonal

Nonhormonal

COCs

The condom

Emergency contraception

The double dutch method (COCs and condom)

LARCs

Others^a

Injectable contraception

Sponge and diaphragm

IUDs

Abstinence

Implants

Withdrawal

Patches

Periodic sexual intercourse

Vaginal rings

COCs combined oral contraceptives, LARCs long-acting reversible contraceptive methods, IUDs intrauterine devices

^aNot recommended

5.2 Oral Contraceptives

Among the new generation COCs, those with estradiol or estradiol valerate together with the new progestagenic compounds are recommended [6].

If COCs are used properly, their failure rate is less than 1 %, while the typical failure rate is approximately 3 % in adults and 5–15 % in adolescents [6, 7]. On the other hand the noncontraceptive benefits of the new generation COCs should be emphasized to improve compliance during adolescence (Table 5.2) [8, 12].

Table 5.2

Noncontraceptive beneficial effects of 17 β-estradiol COCS

Ovarian cysts, premenstrual tension, ectopic pregnancies

Endometrial, epithelial ovarian cancer and colorectal cancer

Menstrual disorders: dysfunctional uterine bleeding, dysmenorrheal oligomenorrhea

Endometriosis

Pelvic inflammatory disease, dyspareunia, chronic pelvic pain

Bone mass

Polycystic ovarian syndrome: acne and hirsutism

Lipid and carbohydrate profile, thyroid, hemostatic and inflammation makers, liver function

Ovarian stimulation (pretreatment)

The COCs side effects are the most commonly reported reasons why adolescents discontinue this method. COCs users discontinued their use because of sexually transmitted infections, the fear for breast and cervical cancer, as well as the venous thromboembolism.

Teens should be advised that COCs are only effective if taken regularly. Another contraceptive method should be followed if more than two consecutive pills are missed in any menstrual cycle. In any case, sexually active adolescents always should be advised to use condoms, even while taking COCs.

5.3 The Condom

The condom should be consistently used during adolescence preferably in combination with COCs (the double dutch method) as a method of providing complete protection against unwanted pregnancies and STDs. The condom is easily available and inexpensive, presents no side effects, and has an effectiveness of up to 88% [13].

5.4 Emergency Contraception

The emergency contraceptive methods are listed below [13–14]:

The combined “estrogen and progestin” emergency contraception (EC) kit. The kit contains four tablets of ethinyl estradiol and levonorgestrel.
The progestin-only product. Two tablets of levonorgestrel, to be taken 12 h apart.
A single dose of RU-486 – mifepristone. A progesterone blocker, which acts as an abortifacient given within 72 h of coitus with nearly of 100 % success rate.
A 19-nor-progestagenic derivative given within 5 days after coitus, acting as endometrial progestagenic modulator.

The situations that call for the use of EC are: