Adolescent use of oral contraceptives
Babington, M.A.
Pediatric Nursing 10(2): 111-114
1984
ISSN/ISBN: 0097-9805 PMID: 6561506 Document Number: 227964
By age 16, 1/4 of all unmarried women have had at least 1 sexual experience, and 1/5 of American births are to teenagers. Of these 2/3 are unintended. Teenage pregnancies are associated with infant mortality rates 2-3 times those of the general population and maternal mortality 60% higher than that for young adult women. Early termination of school is another hazard of adolescent pregnancy. The ideal adolescent candidate for oral contraceptives (OCs) is one who has intercourse somewhat frequently, has no medical contraindications to OCs, has established regular menses, and complies with her medication schedule. 2 major types of OCs are available: the combined containing an estrogen and a progestogen for 21 days of the cycle, and the minipill containing only .35 mg of norethindrone, a progestogen. The minipill exerts its effects primarily peripherally and would not be a good choice for an adolescent because the failure rate is 2.54/100 woman-years with the rate greatly increasing when a single dose is missed. The side effects of OCs are caused by hormonal excess or deficiency, allowing the contraceptive provider to choose the agent based on the woman's response to the side effects. If the side effects are not too severe, a 3-month trial should be allowed prior to switching agents since most side effects related to hormone dose decrease in severity with time. Adverse effects in general are seen more frequently in women over 35 and depend in part on behavioral habits such as smoking and drinking as well as underlying disease states such as diabetes or hypertension. Most reported adverse effects were reported from longterm follow-up studies begun in the 1960s and 1970s, when OCs contained higher doses of estrogens. Some important drug interactions may occur but are probably of limited relevance to adolescents. Adolescent compliance with OCs, necessary for their full effectiveness to be gained, can be increased by providing a feeling of privacy and confidentiality in the counseling area, establishing a mutual relationship between the provider and user, using terminology the adolescent can understand, encouraging the adolescent to ask questions and give feedback, and providing detailed instructions. Instructions should be provided for missed doses, lost pills, and self-discontinuation of medication.