hormonal contraception adolescent vietnam - en

Hormonal Contraception in Adolescents Hormonal Contraception in Adolescents Rebecca Jackson, MD Associate Professor Obstetrics, Gynecology & Reproductive Sciences and Epidemiology & Biostatistics San Francisco General Hospital Preview  Why contraception in teens is important  Hormonal methods and issues specific to adolescents Acknowledgement Slides adapted with permission from presentations by Jody Steinauer, MD and Tina Raine, MD Sex* by Age (US) Mosher WD, Chandra A, Jones J. Sexual behavior and selected health measures: Men and women 15–44 years of age, United States, 2002 . Advance data from vital and health statistics; no 362. Hyattsville, MD: National Center for Health Statistics. 2005. *Heterosexual vaginal intercourse 6.3 Million U.S. Pregnancies 52 % Intended 25 % Unintended Despite method use 23 % Unintended No method used Henshaw, Family Planning Perspectives, 1998 Half of unintended pregnancies end in abortion Teen Pregnancy  The majority (78%) of teen pregnancies are unintended.  About 45% of teen pregnancies end in abortions; roughly 250,000 abortions per year.  Half of women with an unintended pregnancy report using a contraceptive method in the month that they conceived Henshaw et al. Unintended Pregnancy in the United Sates. Fam Plann Perspect. 1998; 30:4-29. Consequences of adolescent pregnancy  Increased morbidity/mortality during pregnancy  Unsafe abortion  Sexually transmitted infections  Social and personal consequences of early pregnancy  Poverty  Unable to complete education  26% of females used no contraception at first sex  Contraceptive use at first sex is more likely for teens who are older at first sex  Teens who do not use contraception at first sex are much more likely to have a birth before reaching age 20 Teen Contraceptive Use – First Sex Abma et al. Teenagers in the United States: Sexual activity, contraceptive use, and childbearing, 2002. National Center for Health Statistics. Vital Health Stat 23(24). 2004. Teens - Contraception Used At Last Sex Source: 1995 National Survey of Family Growth Hormonal Methods  Combined Estrogen & Progesterone  OCPs  Skin patch, Vaginal Ring, Injectables  Progesterone-only  Injectable (DMPA)  Implant (Implanon)  IUD (Mirena)  Emergency contraception Contraception for teens  Can safely use all methods (except sterilization)  Need to make choice themselves  Side effects more problematic to teens  Often don’t initiate or fill the prescription (consider quick start) [...]... http://www.who.int/reproductive-health/publications/RHR_00_2_medical_eligibility_criteria_3rd/ Prescribing combined methods in Women with Migraines Lower & consistent estrogen levels with ring Consider 20 or 25 mcg pills Consider eliminating the placebo week in women who have migraines triggered by withdrawal of estrogen Regular follow-up in 1-3 months after initial Rx Need to discontinue method if headaches worsen Migraine... et al Contraception 1991 IUC: Dispelling Common Myths In fact: DO NOT cause pelvic infection DO NOT decrease the chance of future pregnancies DO NOT cause ectopic pregnancies CAN be used for women who have not been pregnant Emergency Contraception Appropriate for use by all women (including teens) No Class 3 or 4 restrictions by WHO Risk with repeat use Disruptive to menstrual cycles No evidence of...Starting a Teen on Hormonal Contraceptives Take a medical history (Illnesses, Migraines ) Assess weight and blood pressure Pelvic exam not necessary: Screen for STIs… using urine if no problems Determine when a Pap test is needed Provide education, counseling, and support  Patient preference Past method use and problems Offer condoms Effectiveness of Methods Failures per 100 women in first year... Category 3 Contraindications Current liver disease or tumor Multiple risk factors for Arterial vascular disease (age over 35, smoking, hypertension, diabetes) Current DVT/PE Current ischemic heart disease Worsening Migraine with aura on DMPA Past breast cancer (Teens may have these) http://www.who.int/reproductive-health/publications/RHR_00_2_medical_eligibility_criteria_3rd/ Depo-Medroxyprogesterone (DMPA)... Depo-Medroxyprogesterone (DMPA) Used by 8% of contracepting teens in US 44% of women of all ages discontinue use by 1 year 73% of high-risk teens discontinue by 1 year Abnormal bleeding is the reason for discontinuation most Polaneczky M, Liblanc M J Adolesc Health 1998 Aug;23(2):8 1-8 common Depo-Medroxyprogesterone (DMPA) Other side effects: Transient bone mineral density loss Weight gain Mood changes Delayed return... Hormonal Contraception Category 3 Contraindications Breast feeding: 6 wks-6 months; past breast cancer Postpartum . Hormonal Contraception in Adolescents Hormonal Contraception in Adolescents Rebecca Jackson, MD Associate Professor Obstetrics, Gynecology & Reproductive Sciences and Epidemiology. Francisco General Hospital Preview  Why contraception in teens is important  Hormonal methods and issues specific to adolescents Acknowledgement Slides adapted with permission from presentations. Pregnancies 52 % Intended 25 % Unintended Despite method use 23 % Unintended No method used Henshaw, Family Planning Perspectives, 1998 Half of unintended pregnancies end in abortion Teen Pregnancy  The