Sexuality and Reproductive Health
Seventy percent of adolescents have engaged in intercourse by age 19. In general, contraceptives controlled by the individual (e.g., oral contraceptives, condoms) have higher failure rates among teens because of incorrect or sporadic use. Of options readily available for teens, only abstinence is 100% effective!
Hormonal agents may benefit dysmenorrhea and decrease menstrual flow. Unwelcome effects include nausea, bloating, and edema. Major complications are rare but include thromboembolism, cerebral vascular accident, pulmonary embolism, and cholestatic jaundice. Progestin only methods may lead to symptoms of estrogen deficiency such as depression, hot flashes, acne, and atrophic vaginitis. These are similar to menopausal symptoms.
Caution: concurrent use of certain medications may reduce the efficacy of hormonal contraceptives. Antacids, cholesterol binding agents and some antibiotics decrease intestinal absorption of contraceptive hormones. Anticonvulsants, sedatives and some antibiotics may increase the hepatic metabolism of the hormones leading to low serum levels.
Oral contraceptive pills usually contain both estrogen and a progestin although the "minipill" is progestin only. The major drawback to the pill is that it must be taken daily.
The patch (OrthoEvra) and the vaginal ring (NuvaRing) release both estrogen and progestin. They avoid the first pass metabolism through the liver which occurs with oral agents. The patch requires weekly placement while the ring is replaced monthly.
Medroxyprogesterone (Depo-provera) requires an intramuscular injection every twelve weeks. It causes irregular bleeding which progresses to amenorrhea in many women. Prolonged use of Depo-provera has been associated with reduced bone density.
One of the advantages of barrier contraceptives, such as condoms, is that they provide some protection from sexually transmitted infections. The disadvantage is that the methods must be used in relation to coitus unlike hormonal methods which are administered unrelated to the actual act.