Wednesday, February 10, 2016

When teen pregnancy is NOT an option

We need to help our teenagers learn how to prevent an unintended pregnancy. It starts with talking ... really talking .... with your teen.

When teen pregnancy is NOT an option

Teenage girls learn lessons on how to deal with babies in Miami during a girl scout program on teen pregnancy. (AP Photo/J. Pat Carter)
Teenage girls learn lessons on how to deal with babies in Miami during a girl scout program on teen pregnancy. (AP Photo/J. Pat Carter)

Rima Himelstein, M.D.

Most parents tell their teenage children that it would be better for them to wait until they are older to have sex. Doctors tell their teenage patients the same thing. Still, the facts are that almost half of all teens in the United States have had sex by the time they graduate from high school.

This is when parenting is put to the test. Tears, anger, and shock are some of the reactions parents have if they find out that their child has had sex. Parents need to understand that they have not failed as parents if their teen has decided to have sex. Their teens are still the lovable kids they have always been.

And they need their parents now more than ever, because many are risking sexually transmitted diseases (STDs) and pregnancy. Fewer than two thirds of sexually active teens used a condom—and only one-in five used “the pill” — the last time they had sex. Moreover, the United States has the highest teen pregnancy rates of any developed country.

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Putting these facts together means that we need to help our teenagers learn how to prevent an unintended pregnancy. Parents may benefit from becoming familiar with the contraceptive options for teenagers, and teenagers may benefit from hearing these options from their parents. 

Condoms are necessary to prevent STDs. But condoms alone are not enough to prevent pregnancy: they fail about 15 percent of the time. So teenagers who might decide to have sex need to use two forms of protection: condoms to prevent STDs plus an effective contraceptive to prevent pregnancy.   

Here are some options:

  • “The pill” is the most commonly used contraception. It is made of two hormones: estrogen and progestin. The pill works mainly by temporarily preventing ovulation and changing the lining of the uterus. The young woman takes a pill once a day for 21 days, followed by seven days of hormone-free pills.
  • “The patch” (‘Ortho-Evra’) also contains estrogen and progestin. The young woman places a new patch on her skin once a week for three weeks, followed by one week with no patch. The patch continuously releases low levels of the hormones.
  • “The ring” (‘Nuvaring’) also contains estrogen and progestin.  The young woman places it into her vagina like a tampon and leaves it there for three weeks; she removes it for the fourth week. The ring continuously releases low levels of the hormones.

Who should not use the pill, the patch or the ring? Young women who cannot take estrogen, including those with: clotting disorders, undiagnosed vaginal bleeding, or migraines with aura or neurological symptoms. 

Here are some options that do not contain estrogen:

  • Depo” (‘Depo-Provera’) is given as in injection.  Low levels of progestin are slowly released. The first injection is given during the first five days of a young woman’s menstrual period, and then every 12 weeks (four times a year).  Depo’s effects are similar to the pill in preventing pregnancy.
  • An implant. For example, ‘Implanon’ is a small rod the size of a matchstick. It is inserted under the skin, and low levels of progestin are slowly released for up to three years. The effects of ‘Implanon’ are also similar to the pill in preventing pregnancy.
  • An IUD (‘Mirena’ or ‘Paragard’).  An intrauterine device (IUD) is a small, “T”-shaped device, which is placed into the young woman’s uterus by a health professional. There are two types of IUDs prescribed for teens: the ‘Mirena’ IUD releases low levels of progestin for up to five years; ‘Paragard’ releases copper instead of progestin for up to 10 years. IUDs work by temporarily changing the lining of the uterus.
  • Emergency contraception. This is an option if a teen has had unprotected sex. It provides a short burst of hormone. It is most effective if taken as soon as possible, but it may be taken up to five days later.   

Choosing an effective option. Make sure that your teen has a doctor who knows all of these options. To be effective, contraception must be used on a consistent schedule. Depo, ‘Implanon’, and the IUD don’t require the teenager to remember something every day, every week, or every three weeks, so these contraceptives are more likely to be effective. The American College of Obstetrics and Gynecology has said that “IUDs should be offered as a first-line choice” for contraception in teens.

My advice: talk with your teenager ... really talk. Start before you think she or he might be sexually active. Talking about sex and contraception does not mean a parent is saying “okay” to teen sex. On the contrary, providing this information in a sensitive way, along with the reasons why it would be better to wait to have sex, may encourage a teenager to delay his or her first sexual experience. And this talk may prevent an unintended pregnancy. 

Have you and your teen talked ... really talked?

Rima Himelstein, M.D., is a Crozer-Keystone Health System pediatrician and adolescent medicine specialist. 

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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.
Magee DeFelice, M.D. 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
Emiliano Tatar, M.D. Pediatrician at Einstein Healthcare Network Roxborough Plaza
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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