Saturday, December 20, 2014

Why should teens consider long-acting reversible contraceptive (LARC) methods?

The American College of Obstetrics and Gynecology, the Society for Adolescent Health and Medicine, and other international organizations now recommend that LARC methods be offered as "first line" contraceptive options for adolescents. Find out more LARC methods here.

Why should teens consider long-acting reversible contraceptive (LARC) methods?

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The use of LARC methods (intrauterine devices and contraceptive implants) for teens was a “hot topic” when I recently attended the North American Society for Pediatric and Adolescent Gynecology’s Annual Meeting. Why? The American College of Obstetrics and Gynecology, the Society for Adolescent Health and Medicine, and other international organizations now recommend that LARC methods be offered as “first line” contraceptive options for adolescents. Needless to say, my interest in the LARC methods took one giant step forward.

About half of teenagers have had sex by the time they graduate high school, and so, I find myself having a recurrent conversation:

My female teenage patient:  “Yes, I have sex. No, I don’t want a pregnancy!”

Me:  “You’re 17 years old.  If you were to have a baby someday, how old would you like to be when this happens?”

My patient:  “After I’m done school and I’m financially stable ... maybe when I’m 25.”

Me: (Good answer!) “Then we need to help you not get pregnant for at least eight years.”

Condoms, birth control pills, the patch and the vaginal ring only work if they are used correctly. Between school, texting, sports, homework, texting, friends, Facebook, texting, music, eating, texting and sometimes sleeping, our teens R 2 BZ!  As a result, many are not using their contraceptives correctly. Take birth control pills, for instance. In a study of 123 girls aged 14 to17, one quarter of those who used the pill said that they missed taking two or more pills per cycle. These teens were not protected from pregnancy and were at risk for becoming a statistic:

  • 3 in 10 become pregnant before the age of 20
  • 2,800 get pregnant each day

For girls like these, and for others who know that they don’t want a pregnancy for years, LARC methods are safe and effective options. According to a recent three-year study of 7,500 sexually active females aged 14 to 45, a LARC method was 20 times better at preventing unintended pregnancies than short-term hormonal methods like the birth control pill, patch or ring. Less than 1 percent of those using a LARC method became pregnant within one year – regardless of age.

Why a LARC? Three reasons: they’re safe, reversible and require no attention.

  • An intrauterine device (IUD) is a small plastic T-shaped device that is inserted into the uterus and prevents pregnancy primarily by preventing sperm from fertilizing an egg. The ‘Mirena’ and ‘Skyla’ IUDs release a small amount of the hormone progestin into the uterus; ‘Mirena’ prevents pregnancy for 5 years and ‘Skyla’ for 3 years. The copper IUD ‘ParaGard’ releases a small amount of copper into the uterus, which also works as a spermicide. ‘ParaGard’ prevents pregnancy for 10 years.
  • A contraceptive implant (‘Implanon’ or ‘Nexplanon’) is a thin plastic rod the size of a “match-stick” that is inserted under the skin of the upper arm and releases a small amount of progestin. An implant also works primarily by preventing sperm from fertilizing an egg and prevents pregnancy for 3 years.

Some teens may find it easier to stick with a LARC method. In one study of over 4,000 females aged 14 to 45, the continuation rate for a LARC method for all ages was 86 percent at 12 months, compared with 55 percent for the pill, patch or ring. A “B” versus an “F”; that’s why we’re having this blog.

Weighing the pros and cons: a teenager’s medical care provider should review all of the pregnancy prevention options and their side-effects.  For example, teens who choose a LARC method can expect changes in their menstrual bleeding; ‘Mirena’ often causes a decrease in bleeding over time, ‘ParaGard’ can cause periods to be heavier and the implant can cause irregular bleeding.

My advice:


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Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
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The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

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Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Mario Cruz, M.D. Pediatrician, Associate Director of Pediatric Residency Program at St. Christopher’s Hospital for Children
Magee DeFelice, M.D. Division Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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