Birth control, also known as contraception, for teens is an important topic to discuss. Whenever the subject of birth control comes up in clinic, I can guarantee someone asks the question about safety.  It’s the same question I would ask if a medical provider discussed any new medication with me.  However, birth control also comes with personal stories: a friend who used one form of contraception and gained 20 pounds, or a mother who had an intrauterine device (IUD) and had horrible complications.  The good news is that birth control has had a makeover during the past decade and there are many options that are extremely effect and safe to use.  Hopefully, this blog can serve as an overview and alleviate some fears. To learn more about how birth control is used for medical reasons other than contraception, see our recent post. Today’s post will be the first in a series of 3 posts on birth control and teens.

I want to start by stating that the only way to prevent pregnancy 100% of the time is to not have sex at all.  That being said, most parents expect their children to grow up, get married or partnered, and have families of their own.  Well, grandkids can only occur after having sex…but with children come a lot of responsibilities that teens likely will not be equipped to handle. In the US, about 46% of all high school kids have had sex. Only 23% were on birth control and 61% had used a condom the last time they had sex (CDC).

As parents, having open communication with your teens about expectations and family values is an effective way to help your teen wait to have sex until they are older.   Talking with teens early and often is also a great opportunity to teach them how to be aware of consequences and how to protect themselves from pregnancy and sexually transmitted infections if they decide to take the leap of becoming sexually active.

There are many types of birth control and it is best to pick a method that fits into a person’s lifestyle and can be used as optimally as possible.  If your teen is interested in birth control, speak with their doctor to find a method BEFORE they start having sex if at all possible.  I’ll summarize the hormone containing methods available for young women and some other methods (like condoms) throughout the series, but keep in mind that birth control and sexual health is a topic everyone, both young women and young men (regardless of whether gay, straight, or questioning their sexuality) need to know about! These descriptions do not outline everything about the options, but are meant to provide a brief overview of available methods in the US.  Talk with your teen’s doctor if any of them sound like a method of interest or if you have more questions after reading.

Estrogen containing (short acting)Contraception:

Most people think of birth control as ‘the pill.’ There are more than 50 types of birth control pills on the market, but almost all have both estrogen and progesterone (2 hormones our bodies naturally make) as active ingredients (the exception is the ‘mini pill’ which only has progesterone).

The pills are small, easy to swallow, and come in handy packages that are easy to carry in a purse. Taking the pill also can help with acne and is useful for people with heavy periods and menstrual cramps. Pills are very effective at preventing pregnancy (>95%) when taken as prescribed.

However, the pill needs to be taken everyday around the same time in order to be most effective, which can be really challenging for a busy teen. Anyone with a history of blood clots, liver disease, or a family history of a specific breast cancer gene should not take the pill or other birth control methods containing estrogen (speak with your teen’s doctor before starting and tell them your family’s past medical history). The common side effects are spotting or light bleeding when first starting the pill, headache, nausea, or breast tenderness. These all tend to go away after a month or two.

In addition to the pill, there are newer methods with both estrogen and progesterone called the Ortho Evra patch and the Nuva Ring.  The patch is placed on specific areas of the body and changed every week.  It has an adhesive similar to a bandaid. It is not as effective in women who are overweight or obese.  The Nuva Ring is a small flexible ring that is placed inside the vagina similar to a tampon.  It’s changed once a month.  A lot of teens like this method because it’s easy to use and they don’t have to remember to take a pill everyday, but some people aren’t comfortable placing something inside the body.

Progesterone only (long acting)contraception:

The methods that don’t have estrogen only have progesterone.  These are the methods that may be safe for people who cannot use the pill, patch, ods (like condoms) throughout the series, but keep in mind that birth control and sexual health is a topic everyone, both young women and young men (regardless of whether gay, straight, or questioning their sexuality) need to know about! These descriptions do not outline everything about the options, but are meant to provide a brief overview of available methods in the US.  Talk with your teen’s doctor if any of them sound like a method of interest or if you have more questions after reading.

Estrogen containing (short acting)Contraception:

Most people think of birth control as ‘the pill.’ There are more than 50 types of birth control pills on the market, but almost all have both estrogen and progesterone (2 hormones our bodies naturally make) as active ingredients (the exception is the ‘mini pill’ which only has progesterone).

The pills are small, easy to swallow, and come in handy packages that are easy to carry in a purse. Taking the pill also can help with acne and is useful for people with heavy periods and menstrual cramps. Pills are very effective at preventing pregnancy (>95%) when taken as prescribed.

However, the pill needs to be taken everyday around the same time in order to be most effective, which can be really challenging for a busy teen. Anyone with a history of blood clots, liver disease, or a family history of a specific breast cancer gene should not take the pill or other birth control methods containing estrogen (speak with your teen’s doctor before starting and tell them your family’s past medical history). The common side effects are spotting or light bleeding when first starting the pill, headache, nausea, or breast tenderness. These all tend to go away after a month or two.

In addition to the pill, there are newer methods with both estrogen and progesterone called the Ortho Evra patch and the Nuva Ring.  The patch is placed on specific areas of the body and changed every week.  It has an adhesive similar to a bandaid. It is not as effective in women who are overweight or obese.  The Nuva Ring is a small flexible ring that is placed inside the vagina similar to a tampon.  It’s changed once a month.  A lot of teens like this method because it’s easy to use and they don’t have to remember to take a pill everyday, but some people aren’t comfortable placing something inside the body.

Progesterone only (long acting)contraception:

The methods that don’t have estrogen only have progesterone.  These are the methods that may be safe for people who cannot use the pill, patch, or ring because of estrogen. Most of these methods are also longer acting than the methods described above.  They may be ideal for busy teens who often forget to take medications.

Depo Provera is an injection that needs to be repeated about every 12 weeks. A person may have spotting or irregular bleeding for the first 1-2 cycles (3-6 months) while on Depo and it can sometimes increase appetite, so some people have weight gain.  Recent studies show that being on Depo for extended periods of time (such as 1-2 years) can lead to decreased bone density in developing teens, so this method is often switched for one of the longer term methods I’ll cover next.

Implanon is a small rod (a little shorter than a toothpick) that is placed just under the skin on the inner part of the arm (at the bicep area).  It lasts for 3 years after placement!  Many parents may remember a similar method called Norplant.  This is different, it is only one rod and has not had the problems of migration and scarring that were associated with the earlier method.  It should only be placed by a skilled provider who has completed certification for Implanon placement. The downside to Implanon is that about 20-30% of women have unpredictable irregular menstrual bleeding.  Not so great if you are a busy teen, but it is an extremely effective method of birth control.

The Mirena IUD is a excellent method for busy teens who aren’t good at remembering to take a pill, or just don’t want another thing to remember or schedule.  It lasts for 5 years!  The Mirena is an intrauterine device (IUD) that is safe to place in a woman who has not had a child.  It also does not increase the risk of sexually transmitted infections (STI’s).  This is a big source of concern because most parents remember the Dalkon Shield IUD which had a very different design, was made out of a different material, and caused infertility due to scarring.

The Mirena is shaped like a small T and is placed inside the uterus in a procedure similar to a pap smear.  This can be done right in the office and takes about 5-10 minutes.  It should only be placed by a skilled health care provider as complications such as puncturing the uterus, while extremely rare, can occur. If a person has an STI before it is placed, there can be complications, so providers typically check for infections like gonorrhea and chlamydia before the Mirena is placed (a pregnancy test is performed before any hormone containing method is started). The Mirena contains progesterone which is slowly released over 5 years. If the decision is made to start a family, the Mirena can easily be removed by a skilled health care provider and there are no long-term effects on fertility.

This post has a lot of information! If any of the methods sound like they’d be a good choice for your teen, talk with their health care provider for more information and please stay tuned for the upcoming post: Barrier methods.

Check out these posts for more information on teens and birth control:

The Birth Control Pill: Not Just for Birth Control

Emergency Contraception

Plan B Back Behind the Counter