Let’s say you’ve seen this adolescent in your office. You’ve discussed all these risks and benefits
of all these different options. It’s important to take a good history. We need to ask some key questions.
What sort of sexual activity are they engaged in? How many current partners and how many lifetime
partners do they have? What is their risk of STIs or do they have any symptoms of sexually
transmitted infections? Have they ever been pregnant before? What were the past forms
of birth control that either worked or didn’t work for them? Are there any medical problems
that are contraindications for estrogen products, examples of them being thrombotic disorders
or migraines with aura? We need to ask all these questions to try and get at what selection would be best
for these patients. We also need to do an exam. Remember, Pap smears are generally not beneficial
in adolescents and children. We don’t need to do them until they're adults. So, I’m not going to discuss
Pap smears and I would not do one in an adolescent patient. However, a thorough exam
with a speculum is important to evaluate for lesions, other problems that might be going on
and certainly structural problems. Additionally, a bimanual exam is important to evaluate for tenderness
of ovarian tissue to see what’s going on there and make sure that’s physiologically normal.
Before we start any contraception, we generally want to do a pregnancy test on our adolescent girls.
We don’t want to start a hormonal contraceptive while they’re pregnant. Additionally, we may screen
for thrombotic disorders if there’s a family history of people with early demise.
We typically do STD testing. Let me be clear about sexually transmitted diseases testing.
You want to do that as frequently impossible as possible in any patient who is sexually active.
The CDC for example recommends yearly HIV testing in all of these patients. So, we’ve decided to start
oral contraceptive pills. It’s important to note there are three ways to start. One is called the Sunday start.
Here, we tell patients, “Start on Sunday after your next menses.” The next one is the first day start.
Begin this on the first day of your next menses or you can do a quick start. This reduces your chances
of becoming pregnant before the next period. These are all options. Generally, if we’re going to put
patients on contraceptives, we want to follow up in three months to do two things.
We need to assess compliance. Are they actually complying with their pill for example?
And tolerance, tolerance especially in some of these long-acting reversible contraceptive methods
since they sometimes have problems with it especially the next one on with spotting
or the IUD with cramping. We need to monitor side effects of these contraceptive methods
and encourage additional use of barrier methods to prevent sexually transmitted infections.
We need to educate patients about emergency contraceptive. They should know about what we call
in the United States, plan B, which is a large dose of estrogen. This is available over the counter
in most pharmacies. Remember that the Depo-shot causes bone loss. If a patient is on Depo,
give them calcium supplementation and some vitamin D as well. We need to always counsel these patients
about safe relationships. It’s easy enough to think only about the condom use
or the sexually transmitted infections or making sure they have long acting reversible contraception
and then miss the fact that the boyfriend is for example too old for that patient
or that they're in an abusive relationship where they don’t want to be having sex but they feel pressured into it.
These are all issues we have to drill down on when we’re talking to patients in our offices.
So, that’s a review of contraceptive options in adolescent patients. Thanks for your time.