Teen birth control recommendations: long-term options

Though most parents would prefer that their teen remain abstinent indefinitely, teens often have other ideas. Recognizing that many teens choose to be sexually active, the American Academy of Pediatrics (AAP) recently expanded its guidelines on contraception for adolescents to include newer long-term options for preventing pregnancy.

These options include intrauterine devices (IUDs) and progestin implants.

"As parents, we want teens to wait as long as possible, but the reality is that adolescents are often sexually active," said Dr. Jill Rabin, a professor of obstetrics and gynecology at Hofstra North Shore-LIJ School of Medicine in Hempstead.

The good news, she said, is that "studies have been very clear: Providing reliable contraceptives doesn't encourage promiscuity."

Rabin noted that the new forms of contraception added to the AAP guidelines are "safe, effective and reversible." She also said that the American College of Obstetricians and Gynecologists "supports the use of long-acting reversible contraceptives for all women, including teens, because of their lower unintended pregnancy rate."

Dr. Jane Swedler, an adolescent medicine specialist at Winthrop-University Hospital in Mineola, described the new guidelines as a "wonderful way to empower primary care physicians to offer teens long-term reversible contraception as an option" and a "progressive step forward for improving access, information and services to help teenagers."

"Right now, the U.S. is just below the Ukraine in teen pregnancy rates," Swedler said. "We can do better."

In issuing the guidelines, the pediatrics group noted that more than 750,000 unintended teen pregnancies still occur in the United States each year. Because more than 80 percent of these pregnancies are unplanned, AAP said it was evident there was an unmet need for contraception in this age group.

IUDs and progestin implants have proved to be far more effective than other forms of birth control used by teens, such as condoms or oral birth control pills. One big reason for this is compliance. Teens don't have to remember to take a pill every day or to go to the store to get condoms when they're using long-term forms of contraception.

IUDs

IUDs are inserted into the uterus. Types currently available include a copper IUD that can be left in place for up to 10 years and two kinds of hormone-releasing IUDs -- one that can be left in place for three years (Skyla) and another that can be left in place for five years (Mirena), according to AAP. These IUDs release the hormone levonorgestrel.

"IUDs are long-term, really effective contraception that work independent of a teen's ability to be compliant," Swedler said. "And, in addition to being extremely effective, IUDs are also easily reversible. It's not a big deal for your doctor to put it in or take it out." She added that the hormone-releasing IUDs often also have an added benefit of controlling menstrual cycles. Teens who have heavy menstrual cycles and cramps may see these symptoms improve with an IUD.

IUDs do carry the burden of the past -- a stigma in the minds of some teens' mothers or grandmothers. An early version in the 1970s, the Dalkon shield, was withdrawn from the market after 17 women died and some 200,000 sustained infections, injuries or miscarriages from the device. But in the four decades since, IUDs have changed and are regaining popularity, with most doctors today endorsing their safety as well as their effectiveness.

Rabin and Swedler acknowledged that there have been concerns about IUD use by teens, specifically that teens tend to have a higher risk for infection and, according to AAP, an IUD is more likely to be expelled by the uterus than it is in women who've already had a child.

The newer IUDs are smaller, especially the Skyla, Rabin said. And if there are concerns that it might not fit in someone who hasn't yet had a child, "the uterus can be measured with ultrasound to see if the IUD will fit," she said. Swedler added that today's IUDs are made of different materials from those used in the past. "They're made of an inert plastic material now that doesn't transmit infection," she said.

Progestin implants

The other long-term contraceptive option included in the AAP guidelines is the progestin implant, Implanon and Nexplanon being the two currently approved hormone-releasing implants.

The implant, placed under the skin on the inside of the upper arm, "lasts for three years and has the best result for reducing the unintended pregnancy rate," Rabin said. "But, in about 10 percent of women, there can be unpredictable bleeding."

The bottom line

With any long-term method of contraception, teens still need to be counseled about the importance of condom use to prevent the spread of sexually transmitted infections, both experts advised. "Infection prevention absolutely has to be part of the conversation," said Swedler. And she advised that parents have continuing conversations with their teens about sexuality and contraception.

"Teens' hormones are starting to rage and sexuality is a very natural part of adolescence," Swedler said. "Parents need to have open conversations with kids. Tell them if they can delay having sex, that's great. It will reduce many risks. Teens of parents who openly discuss sexuality tend to delay the onset of sexual activity, and when they do begin, they are often using safe-sex methods."

"Giving your teen information is not the same as condoning the activity," she said.