Extended use of oral hormonal contraception: contraceptive and non-contraceptive benefits
Contraceptive and Adolescence Your Role As Pediatrician
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Transcript of Contraceptive and Adolescence Your Role As Pediatrician
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Tahshann S. Richards, DO, MPHAttending PhysicianDepartment of Family MedicineUnion Community Health CenterOctober 18, 2012
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National Youth Risk Behavior Study 47.4% of students had ever had sexual
intercourse 33.7% of students had sexual intercourse
with at least one person during the 3 mo before the survey (currently sexually active)
6.2% of he students had sexual intercourse for the first time before 13 years old
15.3% had sexual intercourse with ≥4 persons during their life
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National Youth Risk Behavior Study Among 33.7% sexually active students
reported that during their last sexual encounter they or their partner had used the following:
Condom (60%) Birth control pills (18%) Injectable birth control, birth control ring, or
intrauterine device (IUD) (5.3%) Condom plus any of the above (9.5%)
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82% of adolescent pregnancies are unplanned
Accounts for 1/5 of all unintended pregnancies in the US
106 Bronx teens / 1,000 get pregnant 30% more than the national rate about 2x frequency in Staten Island Teen births -4 per 1,000 in the Bronx
2x rates in Queens and Manhattan
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Start the talk early!! Preadolescence
Puberty Provide health info to preteens and family
Adolescence Attitudes/knowledge about sex Sexual activity Use of contraception
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Talking about contraceptive DOES NOT: Increase rate of sexual activity Reduce the age of coitarche Increase number of sexual
partners Increase sexual experimentation
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Promote healthy and responsible sexual decision making (including abstinence)
Be supportive and non-judgmental Good history taking Careful listening KISS (Keep it Simple Silly) method
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Know Teens Rights When is confidentiality waived? Guidelines for reimbursement for services Medical record access Appointment scheduling Office policy regarding information
disclosure
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For sexually active teens using contraceptives Support compliance Manage side effects Change method of contraception
accordingly Provide referral and frequent follow up Counsel and screen periodically for STIs
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Abstinence Most effective Delay initiation of sexual activity until
adulthood Efficacy of abstinence based education
controversial
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Condoms Mechanical barrier method Reduce transmission of STDs; therefore
NOT optional Pros
Easily accessible No Rx required Inexpensive Legally purchased by minors Young men share responsibility for
contraception
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Female condoms Barrier method Effective in prevention of STDs Cons
Costly Limited accessibility Difficult to insert Squeaks
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Spermicides Contains nonoxynol 9 and octoxynol 9 High contraceptive failure rate when used alone Effective in reducing pregnancy and STDs when
used with condoms Efficacy comparative to OCPS if used with
condoms Pros
No Rx required Inexpensive
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Oral Contraceptive Pills (“The Pill” or OCPs) Monophasic (Ortho Cyclen), Multiphasic
(Ortho TriCyclen, Loestrin) Best for teens who:
Desire regular menses Motivated and organized to take pill every day
Condom must be used to protect against STI
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OCPs Pros
Helps dysmenorrhea Regulates menses Treat DUB Decrease risk of osteoporosis Treat Acne Protection against:
Ovarian and endometrial CA Ectopic pregnancy Ovarian Cysts Iron deficiency anemia Benign breast disease
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OCPs Quick start
Gyn exam and PAP (if indicated ) within next 3 mo
Frequent follow up and monitoring
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Enhance compliance with patient education and problem solving
If teens miss 1–2 pills: Take a pill as soon as pt remembers Take the next pill at the usual time
If teens miss 3 or more pills: Do not finish pack Throw away remaining pills Start next pack
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Depo Provera (“The Shot”) Medroxyprogesterone Acetate) Long acting progestin Suppresses ovulation Thickens cervical mucus Creates a thin, atrophic endometrium Given 150 mg IM dose every 12 weeks Best for teens who:
Chronic illness (sickle cell, seizures, MR) Are lactating At risk for complication with estrogen Pts who do not remember to take pills
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Depo Provera Pros
Protection against endometrial cancer and iron deficiency anemia
Convenient Effective pregnancy prevention
Cons Irregular menses Need for injection Side effects- weight gain, headaches, bloating,
depression and mood changes Associated with delayed return to fertility Possibly reversible osteopenia
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Nuvaring (“The Ring”) Combined hormonal ring Etonogestrel and Ethinyl estradiol Inserted once a month
Stays in vagina for 3 weeks Must be removed 21 d after insertion New ring is inserted 7 d later
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Ortho Evra Patch(“The Patch)
Norelgestramin/ethinyl estradial Transdermal
Change once a wk Avoid placing on breast
Pros Easy to remember Effective
Cons Increased risk of thromboembolic events Not flesh colored
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Long Acting Reversible Contraception (LARC) Pros
Safe, Effective Higher continuation rate (LARC 86% vs short
acting 55%) Decrease unintended pregnancy rate (22x
higher for short acting contraceptives vs LARC) Barriers
Inaccessible The provider!
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Intrauterine Device (IUD) Mirena (Levonorgestrol) Reversible Protection up to 5 years Expulsion rate range from 5-22 % Changes in menstrual bleeding esp. in 1st
month
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Implant (Implanon, Etonogestrel) Reversible, up to 3 years High rates of infrequent bleeding or
amenorrhea Higher hemoglobin levels
Reduction in dysmenorrhea and pelvic pain Minimal or no weight gain
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Emergency Contraceptive Pills (Plan B) Levonorgestrel Progestin only pill Effective up to 72 hrs after sex Pregnancy test done before administration
of pills and 3 weeks after administration to detect
Rx required for <18 yrs old Provide refill for future use
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Follow Up Annual Pap Screen for STIs every 6 mo-1 yr Follow up Quarterly (sooner when initiating
contraceptives) CONDOMS, CONDOMS, CONDOMS…
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References
ACOG. Adolescents and Long-Acting Reversible Contracpetion: Implants and Intrauterine Devices. Number 539. October 2012
CDC. Youth Risk Behavior Surveillance Unite dstates 2011. MMWR vol 62. no 4 June 2012
AAFP. Managing Adverse Effects of Hormonal Contraceptiin Am Fam Physician 15:82 (12) 1499-1506. December 2010
AAP. Contrapception and Adolescents. Pediatrics Vol 104 No. 5 November 1999
http://www.nydailynews.com/opinion/astronomical-bronx-teen-pregnancy-rate-cries-action-article-1.979415#ixzz29dxRv5B8