Chapter 3 Index

A. General

B. Skin

C. Orthopedics

D. Genitourinary

Hormonal Contraception for Adolescents

Lee Heery, MD

Reminder to All Sexually Active Adolescents: You Must Use Condoms to Prevent STDs!

• Estrogens: Inhibit ovulation by suppressing FSH and LH; also inhibits ovulation and implantation; accelerates ovum transport; breakdown corpus luteum: dec. plasma prog.
• Progesterones: Thicken cervical mucus which hampers sperm transport; also inhibits capacitation - enzymes for sperm to penetrate ovum; slows ovum transport; also affects midcycle FSH and LH so that ovulation is inhibited.  Androgenic side affects a problem.
• Contraindications: Pregnancy, unexplained abnormal vaginal bleeding, hx of breast cancer, thrombophlebitis.

I. The Pill: Combined oral contraceptives. Desogren, Lo-Ovral, ON 7/7/7 most often used Combination of Estrogen and Progesterone (30, 35 mcg estrogen, progestin >25 available)

Advantages of the pill: ease of use, effectiveness, relieves dysmenorrhea, mittelschmerz, reduces menstrual flow, protects against PID, improves acne and sex drive, protects against ovarian and endometrial cancer, lowers ovarian cyst incidence.

Disadvantages of the pill: must take daily, expensive ($25/month); no protection against STDs or HIV (teenagers often think there is such a protection from the pill)

Side effects: Missed periods, nausea, headaches, depression, weight gain, thrombophlebitis (particularly if overweight, smoker, hypertensive, etc.); hepatocellular adenoma - rare.

Danger Signs:

• A - Severe abdominal pain
• C - Chest pain, cough, shortness of breath  
• H - Severe headache, dizziness, weakness, numbness
• E - Eye problems (loss of vision, blurring), speech problems
• S - Severe leg pain in calf or thigh

II. Progestin Only Contraceptives: Depo-Provera, Norplant, and Minipill:

Advantages: No estrogen side effects or complications; Disadvantages: Menstrual irregularity.

1. Depo-Provera:

• (Depomedroxyprogesterone acetate) Injection of 150 mg in 1cc given q 3 mos
• Effective within 2 weeks of first shot; fails in 3 per 1000 cases used.  May have a 4th month of protection from the injection. About $148/shot

Major Side Effect: Bleeding difficulty: mostly gone after six months since about 80% of women are anovulatory by this time; many become amenorrheic as a result.  However bleeding is enough of a problem, many women do not want to continue taking this medication.

2.  Norplant - levonorgestrel. Requires Minor Surgical Procedure to Implant 6 Silastic Capsules:

• Expensive: $500 to implant; lasts for 5 years. Cost effective if used for that period of time, but woman must know that she doesn’t want a pregnancy in 5 years.
• Major side effects: bleeding, which worsens over time - high discontinuation rate in teenagers
• Some problems at the site of the implantation.
• Mechanisms of action: does not produce anovulation, but does thicken cervical mucus

3. Minipill -Progestin Only Pill: Must take at same time of day; indicated during lactation, if woman is older; otherwise other forms should be used.

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Department of Pediatrics  |  Medical College of Georgia
Please email comments, suggestions or questions to:
John T.  Benjamin M.D.,  jbenj@mcg.edu

February 27, 2004