Safest Birth Control Options for Teenagers

Discussing topics that are sexually bold is not a common practice in many cultures. In fact even in United States, parents often feel uncomfortable giving their teens “the sex talk” and therefore most guardians seek the help of pediatricians to counsel kids on reliable birth control methods.

But healthcare providers strongly advise parents to educate the teens regarding safe sexual attitudes, promising birth control methods and strategies to prevent STDs. Likewise, pediatricians can also help a great deal by prescribing contraception methods that are most suitable for the lifestyle and personal preferences of the teens.

The prevalence of unwanted teen pregnancies is fairly high in the US population. According to latest statistics (1), the rate of teen pregnancy in 2014 was 26.5 live birth per every 1,000 teens. This corresponds to 273,105 babies born to teen mommies.

Safest Birth Control Options for Sexually Active Teens

According to several studies, it has been observed that most teen know nothing about the safest and most reliable methods of contraception. For example study reported in the Journal of Adolescent Health (2), investigators concluded that more than 71% adolescents were unsure about the safety and efficacy of IUD contraceptives and more than 80% agreed to not using a permanent method of contraception in the past 6 months.

• Contraceptive Implant:

It is a small, flexible and thin plastic device that contains active hormonal analogues (mostly progestins). Like all other hormonal implants, it is recommended to introduce this hormonal formulation in the skin of forearm for long term relief from unwanted pregnancy. It is important to mention that you would still need a condom (or other methods of physical barrier) to minimize the risk of contracting sexually transmitted diseases. Contraceptive implants are recommended for teens because the error rate is only 0.05%. In addition, other benefits for considering contraceptive implants are:

• Pros:

• Long-term birth control and relief from other contraceptive agents (for a period of at least 3 years)
• Highly safe with virtually no risk of infection or other adverse effects
• The progestin hormone prevents the egg release from ovary.

• Cons:

• Irregular bleeding is a common side effect.
• Less common side effects include weight gain, acne and headaches

• IUD (Intrauterine Device):

In uterus, a flexible, small, T shaped device can be inserted. Copper T IUD doesn't have hormones and there is no need to replace it for up to 10 years. Levonorgestral IUD have hormones and can work for 3-5 years without replacement. The error rate is only 0.2%-0.8%

• Pros:

• Safe, long term safety.
• Hormonal and non-hormonal IUD options are available for women who are reluctant to use hormones.
• Lighter periods and minimal risk of cramping

• Cons:

• Short term pain after insertion
• Irregular bleeding and spotting

• Progestin Injections:

They prevent egg release from ovaries and the effect of one intramuscular injection lasts for up to 3 months. Error rate is up to 6%

• Pros:

• Lasts long
• Protection from endometrial cancer
• Less intense cramping and periods

• Cons:

• Significant risk of weight gain
• Spotting
• Bleeding
• Ovarian cycles may take some time to get normal discontinuation.
• A higher risk of blood clotting event

• NuvaRing:

A ring is placed into vagina every month to prevent the release of egg from the ovaries. The ring stays there for 3 weeks. Error rate is 9%.

• Pros:

• Lighter periods and minimal risk of cramps
• Improvement in acne

• Cons:

• It takes effort to remember to replace the ring every month
• Frequent attacks of headaches in addition to tender breasts and nausea
• Blood clotting risk increases several folds

• Contraceptive Patch:

Skin absorbs the hormone from the dermal patch and prevents the egg release. Replacement is required every week for 3 weeks then it is removed. Error rate is 9%.

• Pros:

• Lighter periods and less intense abdominal cramping
• Improvement in acne

• Cons:

• Poor patient compliance as most patients forget when to replace the patch
• Occurrence of blood clot formation in the blood increases
• Privacy concerns as it is visible (which a lot of teens don’t like)
• Substantial risk of skin irritation, nausea, headache and tender breasts.

• Medicines:

Progesterone and estrogen is present in combination pill but the progestin-only medicines have progesterone for teenagers. Error rate of 9%

• Pros:

• Lighter cramps and periods
• Acne improvement
• Lesser risk of endometrial cancer and iron deficiency

• Cons:

• Blood clotting, stroke, headache, hypertension
• Tender breast and nausea
• High risk of forgetting the daily dose

• Male Condom:

A condom offer contraception by acting as a physical barrier by covering the penis to prevent the contact of sperms with female vaginal lining. This is the only contraceptive method that also prevent STDs by restricting the entry of male secretions into the vagina (or by limiting the direct contact of male and female genitalia). However, high error rate of 18% limits the efficacy.

• Pros:

• No prescription required
• Cheap
• Easy to use
• Protection from STDs
• Can be used with other methods

• Cons:

• Learning how to use it effectively is challenging (especially on teens)
• Breakable and can slip during use
• Not for latex allergic individuals

• Female Condoms:

A pouch that fits into vagina and is left outside. The error rate is 21%

• Pros:

• No prescription required
• Protects against STDs
• Can be used with other methods

• Cons:

• Difficult to use
• Can slip
• Expensive

In Emergency

It has been observed that most teens do not use a permanent or reliable method of contraception, which is why it is very important to guide teens regarding emergency contraception.  Additionally, despite using contraception, a failure may occur (such as condom puncture or other such accidents). Emergency contraception employ the ingestion of one-time pills containing progestin hormones.

Some other Methods:

Some other methods that are less reliable are:

• Withdrawal: Taking out the penis from vagina just before the ejaculation. The failure rate is very high and teens should avoid this as a sole method of birth prevention.
• Fertility awareness procedures: The process require these restrictions:

• Tracking periods religiously to ascertain the safe fertility window.
• Measurement of basal body temperature every morning
• Inspection of cervical mucus
• Avoiding sexual intercourse during the fertility period.

The error rate is 24%

• Supermicide: A foam or cream (with spermicidal chemicals) can be inserted in the vagina before the intercourse. Error rate is 28%

For best results, it is highly recommended to see a healthcare practitioner to learn which methods/ strategies are most appropriate for you.

References:

1. Teal, S. B., & Romer, S. E. (2013). Awareness of long-acting removable contraception among teens and young adults. Journal of Adolescent Health, 52(4), S35-S39.

2. Frost, J. J., Lindberg, L. D., & Finer, L. B. (2012). Young adults' contraceptive knowledge, norms and attitudes: associations with risk of unintended pregnancy. Perspectives on Sexual and Reproductive Health, 44(2), 107-116.