1 / 41

What’s New in Adolescent Contraception?

What’s New in Adolescent Contraception?. Rachel S-D Fortune, MD, FAAP Medical Director, Newport Academy. Pretest questions. All of the following are ABSOLUTE contraindications to the use of combined hormonal contraceptives in adolescents, EXCEPT:

loring
Télécharger la présentation

What’s New in Adolescent Contraception?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. What’s New in Adolescent Contraception? Rachel S-D Fortune, MD, FAAP Medical Director, Newport Academy

  2. Pretest questions All of the following are ABSOLUTE contraindications to the use of combined hormonal contraceptives in adolescents, EXCEPT: Known thromboembolic mutation (i.e. factor V leiden, protein C, protein S, etc) Current cigarette smoker (<35 years of age) Family history of DVT/PE Personal medical history of stroke True or False: Intrauterine devices can be safely used in adolescent patients: True False

  3. Rachel S-D Fortune, MD, FAAP Medical Director, Newport Academy

  4. Disclosures I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

  5. Objectives • Review current trends in adolescent sexual activity • Explore eligibility criteria for various contraceptive methods • Provide update on hormonal and non-hormonal methods of contraception • Explore long acting reversible contraceptive (LARC) methods in depth

  6. Youth Risk Behavior Surveillance Survey 2011Trends in Adolescent Sexual Behaviors

  7. Trends in Adolescent Pregnancy Rates Among 15-19 yo, pregnancy rates declined 27% from 1991  2000 117 68

  8. Trends in Adolescent Pregnancy Rates 86% attributable to changes in contraceptive prescribing Decreased pregnancy rate for 15-19yo 14% attributable to decreased sexual activity

  9. Selecting a Contraceptive • Eligibility • Availability/Cost • Mechanism of Action • Feasibility • Effectiveness • Reversibility • Side Effects

  10. Contraceptive Eligibility Eligibility Availability/Cost Effectiveness Mechanism of Action Feasibility Reversibility Side Effects Gordon and Pitts, 2012

  11. Contraceptive Eligibility

  12. Contraceptive Eligibility

  13. Contraceptive Eligibility

  14. Availability/Cost • Medicaid covers: • Long Acting Reversible Contraceptives (LARC) • OCPs, NuvaRing, Ortho Evra patch • Depoprovera shots • Private insurance companies cover*: • Long Acting Reversible Contraceptives (LARC) • OCPs, NuvaRing, Ortho Evra patch • Depoprovera shot • For patients who cannot use their insurance: • Planned Parenthood provides services at a cost Eligibility Availability/Cost Effectiveness Mechanism of Action Feasibility Reversibility Side Effects

  15. Effectiveness Eligibility Availability/Cost Effectiveness Mechanism of Action Feasibility Reversibility Side Effects

  16. The Basics • Abstinence • 100% effective • Condoms • Perfect use is only 85% effective • Should be used in combination with all other methods • Emergency Contraception (Plan B) • Available to all • No contraindications for anyone • Very effective within 72 hours of unprotected sex • Works by delaying ovulation; no effect on existing pregnancy

  17. Combined Hormonal Contraceptives • Oral contraceptive pills • Vary in concentration of ethinyl estradiol • Vary in type of progestin • Mechanism of action: • Ovulation inhibition • Changes in cervical mucous (thickens) • Needs high level of compliance • Difficult for adolescent adherence • Complex schedule for forgotten doses • ~91% effective at preventing pregnancy • Quick return to fertility

  18. Combined Hormonal Contraceptives • Side Effects • 3-4x increase in risk of thromboembolic event • Headaches • Nausea • Minor weight gain • Contraindications • Migraine with aura • Past medical history of thromboembolism • Untreated hypertension • Lupus with vascular disease, nephritis or antiphospholipid Abs • Less than 3 weeks post partum • High triglycerides

  19. Combined Hormonal Contraceptives • Important points: • Understand how/when to start OCPs* • Counsel on minor side effects to avoid self discontinuation • Low dose OCs may reduce bone mineral density • Familiarize yourself with a couple of “go-to”, cheap pill options, such as Ortho Cyclen • Follow up blood pressure and weight after 2-3 months • Give plenty of refills! Be familiar with what is out there in the popular press!

  20. Combined Hormonal Contraceptives • OrthoEvra transdermal patch • 150 mcg norelgestromin and 20 mcg ethinyl estradiol • Mechanism of action: • Ovulation inhibition • Changes in cervical mucous (thickens) • Needs a moderate level of compliance – once weekly • ~91% effective at preventing pregnancy • Quick return to fertility

  21. Combined Hormonal Contraception • Side Effects • 3-4x increase in risk of thromboembolic event– may be higher • Headaches • Minor weight gain • Site irritation • Contraindications • Migraine with aura • Past medical history of thromboembolism • Untreated hypertension • Lupus with vascular disease, nephritis or antiphospholipid Abs • Less than 3 weeks post partum • High triglycerides • Should not be used in patients >90kg (relative) • Allergy to component of patch

  22. Combined Hormonal Contraception • NuvaRingintravaginal ring • 120 mcg etonogestrel and 15 mcg ethinyl estradiol • Mechanism of action: • Ovulation inhibition • Changes in cervical mucous (thickens) • Needs a moderate level of compliance – once monthly • Requires a high level of comfort with body • ~91% effective at preventing pregnancy • Quick return to fertility

  23. Combined Hormonal Contraception • Side Effects • 3-4x increase in risk of thromboembolic event – may be higher • Headaches • Leukorrhea • Contraindications • Migraine with aura • Past medical history of thromboembolism • Untreated hypertension • Lupus with vascular disease, nephritis or antiphospholipid Abs • Less than 3 weeks post partum • High triglycerides

  24. Progestin-only pills (POPs) • Progestin only pills • 0.35 mg norethindrone • Mechanism of action • Ovulation suppression • Changes in cervical mucous (thickening) • Endometrial thinning • Needs a HIGH level of compliance – very short half life • Quick return to fertility • Safe for patients with estrogen contraindication

  25. Progestin-only pills (POPs) • Side effects • Headache • Breast tenderness • Acne/Hirsutism • Nausea • Spotting • Contraindications • Known or suspected pregnancy • Genital bleeding of unknown etiology • Liver tumors • Acute liver disease

  26. Depo Provera • Depo Provera – “birth control shot”, DMPA • 150 mg medroxyprogesterone acetate IM every 12 weeks • Mechanism of Action • Ovulation inhibition • Changes in cervical mucous (thickens) • Requires a lower level of compliance – every 12 weeks • ~97% effective at preventing pregnancy • Delayed return to fertility

  27. Depo Provera • Side Effects • Irregular bleeding • Weight gain (can be significant) • Hair loss • Bone loss • Headaches • Acne • Contraindications • Known or suspected pregnancy • History of thromboembolic events • Liver disease • Genital bleeding of unknown etiology

  28. The Land of LARC

  29. Why LARC is BEST! • Contraceptive Choice Project • 9,256 adolescents and women (St Louis) • 23% age 14-20 • 69% of 14-17 year olds chose LARC • Implant>IUD • 61% of 18-20 year olds chose LARC • IUD>Implant • Continuation rates better than non-LARC methods • Copper IUD 75% • Levonorgestrel IUD 81% • Implant 82%

  30. Why LARC is BEST!

  31. Implanon/Nexplanon • Etonogestrel implant • Implanted in upper arm • Placed by trained provider • Simple office procedure • Mechanism of action • Ovulation inhibition • Changes cervical mucous (thickens) • Thins endometrium • Prevents pregnancy at >99% for 3 years • Rapid return to fertility after quick removal

  32. Implanon/Nexplanon • Side Effects: • Irregular bleeding • Headache • Weight gain • Acne • Contraindications • Known or suspected pregnancy • PMH of deep vein thrombosis • Liver tumors • Genital bleeding of unknown etiology • >130% IBW (relative)

  33. Levonogestrel Intrauterine Device (Mirena IUD/Skyla IUD) • Levonogestrel-releasing IUD (5 years and 3 years) • Inserted into uterus • Office procedure • Tolerated by nulliparous women • Mechanism of Action • Changes cervical mucous (thickens) • Inhibits sperm from reaching or fertilizing your egg • Thins uterine lining • >99% effective at preventing pregnancy • Rapid return to fertility after removal of IUD

  34. Levonogestrel Intrauterine Device (Mirena IUD/Skyla IUD) • Side effects • Expulsion • Irregular bleeding • Ovarian cyst • Acne • Contraindications • Pregnancy or suspicion of pregnancy • Uterine anomaly • Acute pelvic inflammatory disease (PID) or high risk of developing PID • Recent infected abortion in past 3 months • Known or suspected uterine or cervical neoplasia or abnormal Pap smear • Genital bleeding of unknown etiology • Untreated cervicitis

  35. Copper IUD (Paragard) • Copper IUD (10 years) – continuous release of copper into uterus • Inserted into uterus • Office procedure • Safe for nulliparous women • Mechanism of Action • Prevents sperm from reaching/fertilizing egg • May prevent egg from attaching to the uterus • >99% effective at preventing pregnancy • Rapid return to fertility after removal of IUD

  36. Copper IUD (Paragard) • Side effects • Expulsion • Heavier, crampier periods • Anemia • Vaginitis and/or vaginal discharge • Contraindications • Pregnancy or suspicion of pregnancy • Uterine anomaly • Acute PID or high risk of developing PID • Recent infected abortion in past 3 months • Known or suspected uterine or cervical neoplasia or abnormal Pap smear • Genital bleeding of unknown etiology • Untreated cervicitis • Wilson’s Disease

  37. Quick Start Approach

  38. Post-test questions • All of the following are ABSOLUTE contraindications to the use of combined hormonal contraceptives in adolescents, EXCEPT: • Known thromboembolic mutation (i.e. factor V leiden, protein C, protein S, etc) • Current cigarette smoker (<35 years of age) • Family history of DVT/PE • Personal medical history of stroke • True or False: Intrauterine devices can be safely used in adolescent patients: • True  • False

  39. Summary • Contraception should be addressed with all adolescent patients in a primary care setting • Knowledge of your patients current needs and medical history will guide your contraceptive decisions • Being aware of emergency contraception and quick start contraceptive initiation WILL help prevent pregnancy in your patients

  40. Thank You

More Related