Contraceptive considerations for adolescents.

CONTRACEPTIVE CONSIDERATIONS FOR ADOLESCENTS

METHOD                    ADVANTAGES

LESS EFFECTIVE *

Abstinence (complete)     * Protects against HIV and other
                            sexually transmitted infections
                            (STIs)
                          * Available at any time

Abstinence (periodic)     * Can alternate use with other
                            contraceptives (such as condoms)
                            during fertile days

Withdrawal                * Can be used by a man at any age
                            if he can predict ejaculation and
                            ensure ejaculate will not touch
                            his partner's genital area

Condoms (male or          * Protect against HIV/STIs
female)                   * Male condom typically afford-
                            able, accessible, and available
                          * Women can initiate use of the
                            female condom

Diaphragms, caps          * Women can initiate use
                          * Do not require a daily regimen

Spermicides               * Women can initiate use
                          * Do not require a daily regimen

EFFECTIVE *

Lactational               * Important option for breastfeed-
Amenorrhea Method           ing women
(LAM)                     * Does not require a daily regimen

Combined oral             * Regular, less painful menses
contraceptive pills       * Protect against ovarian cancer,
(COCs)                      endometrial cancer, and pelvic
                            inflammatory disease

Progestin-only pills      * Good estrogen-free choice for
(POPs)                      breastfeeding women

Emergency contra-         * Can be used after unplanned
ceptive pills (ECPs):       intercourse, coercive sex, failure
COCs or POPs                to use a method, or after a con-
                            dom slips or breaks

MORE EFFECTIVE *

Combined injectable       * Effective for a month
contraceptives (CICs)

DMPA: progestin-only      * Effective for 3 months
injectable                * May protect against endometrial
                            cancer

Subdermal implants        * Effective for 5 to 7 years

Intrauterine device       * Effective for at least 12 years
(IUD): Copper T 380A      * May protect against endometrial
                            cancer

Levonorgestrel            * Effective for at least 7 years
intrauterine system
(LNg-IUS)

Sterilization (male or
female)

METHOD                    DISADVANTAGES

LESS EFFECTIVE *

Abstinence (complete)     * Requires high degree of motiva-
                            tion, self-control, and commit-
                            ment from both partners

Abstinence (periodic)     * Requires high degree of motiva-
                            tion, self-control, and commit-
                            ment from both partners
                          * No HIV/STI protection

Withdrawal                * Requires high degree of motiva-
                            tion, self-control, and commit-
                            ment from both partners
                          * No HIV/STI protection

Condoms (male or          * Must be used correctly with each
female)                     act of intercourse
                          * Female condoms may not be
                            available or affordable

Diaphragms, caps          * Must be used correctly with each
                            act of intercourse
                          * Protection against HIV/STIs
                            unknown

Spermicides               * Must be used correctly with each
                            act of intercourse
                          * No HIV/STI protection

EFFECTIVE *

Lactational               * Effective, but only if a woman
Amenorrhea Method           meets three LAM criteria: less
(LAM)                       than six months postpartum,
                            fully or near-fully breastfeeding,
                            and amenorrheic
                          * No HIV/STI protection

Combined oral             * Must be taken daily
contraceptive pills       * May require a clinic visit
(COCs)                    * Need for supplies may compro-
                            mise privacy
                          * No HIV/STI protection

Progestin-only pills      * Must be taken daily, and regimen
(POPs)                      requires stricter compliance than
                            for COCs
                          * Need for supplies may compro-
                            mise privacy
                          * No HIV/STI protection

Emergency contra-         * Often require a clinic visit
ceptive pills (ECPs):     * No HIV/STI protection
COCs or POPs

MORE EFFECTIVE *

Combined injectable       * Require a provider visit every
contraceptives (CICs)       month for reinjection
                          * No HIV/STI protection

DMPA: progestin-only      * Requires a provider visit every 3
injectable                  months for reinjection
                          * May make bleeding patterns
                            unpredictable; often causes
                            amenorrhea
                          * Delays return to fertility
                          * No HIV/STI protection

Subdermal implants        * Require a clinic visit for inser-
                            tion and removal
                          * May make bleeding patterns
                            unpredictable
                          * No HIV/STI protection

Intrauterine device       * Requires a clinic visit for inser-
(IUD): Copper T 380A        tion and removal
                          * No HIV/STI protection

Levonorgestrel            * Requires a clinic visit for inser-
intrauterine system         tion and removal
(LNg-IUS)                 * No HIV/STI protection

Sterilization (male or    * Irreversible
female)                   * Not recommended for adoles-
                            cents: young age and low parity
                            associated with high levels of
                            regret
                          * No HIV/STI protection

METHOD                    CONCERNS/
                          COUNSELING ISSUES

LESS EFFECTIVE *

Abstinence (complete)     * Emphasize need to use condoms
                            or other contraception if pene-
                            trative sex is initiated

Abstinence (periodic)     * Determining fertile days requires
                            training; may be difficult if
                            menses are irregular
                          * Counsel condom use if client is
                            at risk of HIV/STIs

Withdrawal                * Important to discuss with sexually
                            active youth because may be
                            only method available
                          * Counsel condom use if client is
                            at risk of HIV/STIs

Condoms (male or          * Explain, demonstrate, and help
female)                     client practice correct use with a
                            model

Diaphragms, caps          * Counsel condom use if client is
                            at risk of HIV/STIs

Spermicides               * Use of spermicides alone and
                            frequent use are not recom-
                            mended
                          * Counsel condom use if client is
                            at risk of HIV/STIs

EFFECTIVE *

Lactational               * Discuss other contraceptive
Amenorrhea Method           options and provide chosen
(LAM)                       method before LAM criteria
                            expire
                          * Counsel condom use if client is
                            at risk of HIV/STIs

Combined oral             * Tell client what to do if pills are
contraceptive pills         missed
(COCs)                    * Counsel condom use if client is
                            at risk of HIV/STIs

Progestin-only pills      * Tell client what to do if pills are
(POPs)                      missed
                          * Counsel condom use if client is
                            at risk of HIV/STIs

Emergency contra-         * Counsel that effectiveness great-
ceptive pills (ECPs):       est when method started early
COCs or POPs              * Not meant for repeated use

MORE EFFECTIVE *

Combined injectable       * Clients must remember to return
contraceptives (CICs)       for monthly reinjection
                          * Counsel condom use if client is
                            at risk of HIV/STIs

DMPA: progestin-only      * Not a first choice for women
injectable                  younger than 18 due to theoreti-
                            cal concerns about effects on
                            bone development
                          * Counsel condom use if client is
                            at risk of HIV/STIs

Subdermal implants        * Counsel condom use if client is
                            at risk of HIV/STIs

Intrauterine device       * Nulliparous women may be at
(IUD): Copper T 380A        greater risk for expulsions
                          * Counsel condom use if client is
                            at risk of HIV/STIs

Levonorgestrel            * Nulliparous women may be at
intrauterine system         greater risk for expulsions
(LNg-IUS)                 * Counsel condom use if client is
                            at risk of HIV/STIs

Sterilization (male or    * Counsel about permanency of
female)                     sterilization and option of long-
                            term, reversible methods
                          * Counsel condom use if client is
                            at risk of HIV/STIs

* Effectiveness is defined here as: "less effective" for most users
(becoming "effective" when used consistently and correctly),
"effective" for most users (becoming "more effective" when used
consistently and correctly), and "more effective" for all users.
Definition of effectiveness adapted from Trussell J. Contraceptive
efficacy. In Hatcher RA, Trussell J, Stewart F, et al., eds.
Contraceptive Technology, Seventeenth Revised Edition. New York:
Ardent Media, 1998.

Source: Rivera R, Cabral de Mello M, Johnson SL, et al. Contraception
for adolescents: social, clinical and service-delivery considerations.
Int J Gynaecol Obstet 2001;75(2):149-63.