- Email: [email protected]
Contraceptive Counseling and Teens
J Pediatr Adolesc Gynecol (2009) 22:377e378
Perspectives of the Allied Healthcare Professional Section Editors: Angela Nicoletti, MS, RNC, WHNP and Margaret Tonelli, RN, MSN, NP
Contraceptive Counseling and Teens Margaret Tonelli, RN, MS, NP Brigham and Women’s Hospital, Boston, MA 02115
Jill, a 15-year-old, was excited, believing she was pregnant with twins. Further work-up revealed she had a molar pregnancy. Her plan for birth control was abstinence. Bonnie, a 16-year-old, presented requesting her intra-uterine device IUD to be removed. She had recently had a first trimester abortion and an IUD was inserted at the time of the abortion. She felt the IUD was not her decision but her mother’s. She wanted the IUD removed because she wanted to be pregnant. Ana, a 19-year-old, G3 P3, wants an IUD, but friends have told her it would hurt when inserted and she is afraid of the pain. Jenny, a 17-year-old, presented for her prenatal appointment. She had been using the contraceptive patch without problems but had stopped using the patch two months prior because she heard on TV that use of the patch increased her risk of a blood clot. The 14-year decline in the teen pregnancy rate, 1990e2006, has been attributed to better contraceptive use and to the increased use of the long-acting and highly effective contraceptive, Depo-Provera. The advent of the contraceptive patch, vaginal ring, Implanon, and Mirena Intra-Uterine System fueled hope for a continued decline in teen pregnancy rates as more teens would ultimately choose to use highly effective and reversible methods of contraception. Unfortunately, the last two years has seen an increase in the teen pregnancy rates for the United States. Today, providers have a variety of hormonal and nonhormonal contraceptives to offer teens, but a teen’s full compliance with a birth control method remains the challenge. The recent increase in teen pregnancies and STI rates compel providers to better understand how to match a contraceptive with a teen’s individual needs to improve compliance. Oral contraceptives, condoms, and withdrawal continue to be the three most commonly reported
Published by Elsevier Inc
contraceptives used by teens.1 These methods are also more likely for teens to use inconsistently and/or discontinue. Up to 50% of teens discontinue use of OCPs in the first three months. Factors contributing to teens’ inconsistent pill use include multiple sex partners, low evaluation of personal health, feelings of hopelessness, ambivalence about becoming pregnant, and previous abortion.1 The available highly effective and reversible methods of contraception: Depo-Provera injections, intrauterine devices,2 and implanon, none of which are contraindicated for the nulliparous or parous adolescent, are all greatly underutilized by this population. Providers have a critical role to provide counseling about sexual health and to dispel misconceptions that often impede consistent contraceptive use. Providing a confidential, open, and nonthreatening environment is essential to assess a teen’s cognitive level and psychosocial influences. Education needs to address reproductive health, contraceptive options, responsible sexual behavior, and STI prevention. Cognitive skills will influence decision making and contraceptive behaviors as well as the influences of mothers, peers, boyfriends and the teens’ own reproductive history. It is not uncommon for a young teen to express concerns about her ability to get pregnant in the future. Many teens wonder why they did not get pregnant when they did not use protection and worry if that could mean they may be unable to get pregnant. A study of 300 pregnant adolescents showed a large proportion, 42%, did in fact express fear about their ability to conceive.3 Counseling needs to explain how each method works, address fears, and provide factual information on side effects, potential benefits on personal health, and future impact on fertility. Many do not understand the greater risk of STI infections and its impact on future fertility. Often a young teen will ask me what I think is the best method for her. This presents an opportunity to 1083-3188/09/$36.00 doi:10.1016/j.jpag.2009.03.005
378
Tonelli: Contraceptive Counseling and Teens
review with the teen what is most important to her in choosing a contraceptive and/or discussing sex within her relationships: does she want convenience, does she need privacy, what would a unplanned pregnancy mean for her, does she want a regular menses, is she good at remembering to take a pill everyday, does she worry about using hormones, does she plan to breastfeed, can she easily store medications at home, will her partner cooperate in birth control, does she have multiple partners, does she worry about gaining weight, how does she feel about touching herself to insert a NuvaRing, does she use tampons, what methods have friends or her mother used and what have they told her about the use and side effects of a particular birth control method? Often I suggest for a teen to try a method; if she does not like how
she feels or is uncomfortable with method, she can change. A follow-up appointment is booked in six to eight weeks to review compliance and satisfaction. Complete contraceptive counseling always includes a discussion and often a prescription for Plan B.
References 1. Whitaker A, Gilliam M: Contraceptive care for adolescents. Clin Obstet Gynecol 2008; 51:268 2. Gold M, Johnson L: Intrauterine devices and adolescents. Curr Opin Obstet Gynecol 2008; 20:464 3. White E, Rosengard C, Weitzen S, et al: Fear of inability to conceive in pregnant adolescents. Obstet Gynecol 2006; 108:1411
Perspectives of the Allied Healthcare Professional Section Editors: Angela Nicoletti, MS, RNC, WHNP and Margaret Tonelli, RN, MSN, NP
Contraceptive Counseling and Teens Margaret Tonelli, RN, MS, NP Brigham and Women’s Hospital, Boston, MA 02115
Jill, a 15-year-old, was excited, believing she was pregnant with twins. Further work-up revealed she had a molar pregnancy. Her plan for birth control was abstinence. Bonnie, a 16-year-old, presented requesting her intra-uterine device IUD to be removed. She had recently had a first trimester abortion and an IUD was inserted at the time of the abortion. She felt the IUD was not her decision but her mother’s. She wanted the IUD removed because she wanted to be pregnant. Ana, a 19-year-old, G3 P3, wants an IUD, but friends have told her it would hurt when inserted and she is afraid of the pain. Jenny, a 17-year-old, presented for her prenatal appointment. She had been using the contraceptive patch without problems but had stopped using the patch two months prior because she heard on TV that use of the patch increased her risk of a blood clot. The 14-year decline in the teen pregnancy rate, 1990e2006, has been attributed to better contraceptive use and to the increased use of the long-acting and highly effective contraceptive, Depo-Provera. The advent of the contraceptive patch, vaginal ring, Implanon, and Mirena Intra-Uterine System fueled hope for a continued decline in teen pregnancy rates as more teens would ultimately choose to use highly effective and reversible methods of contraception. Unfortunately, the last two years has seen an increase in the teen pregnancy rates for the United States. Today, providers have a variety of hormonal and nonhormonal contraceptives to offer teens, but a teen’s full compliance with a birth control method remains the challenge. The recent increase in teen pregnancies and STI rates compel providers to better understand how to match a contraceptive with a teen’s individual needs to improve compliance. Oral contraceptives, condoms, and withdrawal continue to be the three most commonly reported
Published by Elsevier Inc
contraceptives used by teens.1 These methods are also more likely for teens to use inconsistently and/or discontinue. Up to 50% of teens discontinue use of OCPs in the first three months. Factors contributing to teens’ inconsistent pill use include multiple sex partners, low evaluation of personal health, feelings of hopelessness, ambivalence about becoming pregnant, and previous abortion.1 The available highly effective and reversible methods of contraception: Depo-Provera injections, intrauterine devices,2 and implanon, none of which are contraindicated for the nulliparous or parous adolescent, are all greatly underutilized by this population. Providers have a critical role to provide counseling about sexual health and to dispel misconceptions that often impede consistent contraceptive use. Providing a confidential, open, and nonthreatening environment is essential to assess a teen’s cognitive level and psychosocial influences. Education needs to address reproductive health, contraceptive options, responsible sexual behavior, and STI prevention. Cognitive skills will influence decision making and contraceptive behaviors as well as the influences of mothers, peers, boyfriends and the teens’ own reproductive history. It is not uncommon for a young teen to express concerns about her ability to get pregnant in the future. Many teens wonder why they did not get pregnant when they did not use protection and worry if that could mean they may be unable to get pregnant. A study of 300 pregnant adolescents showed a large proportion, 42%, did in fact express fear about their ability to conceive.3 Counseling needs to explain how each method works, address fears, and provide factual information on side effects, potential benefits on personal health, and future impact on fertility. Many do not understand the greater risk of STI infections and its impact on future fertility. Often a young teen will ask me what I think is the best method for her. This presents an opportunity to 1083-3188/09/$36.00 doi:10.1016/j.jpag.2009.03.005
378
Tonelli: Contraceptive Counseling and Teens
review with the teen what is most important to her in choosing a contraceptive and/or discussing sex within her relationships: does she want convenience, does she need privacy, what would a unplanned pregnancy mean for her, does she want a regular menses, is she good at remembering to take a pill everyday, does she worry about using hormones, does she plan to breastfeed, can she easily store medications at home, will her partner cooperate in birth control, does she have multiple partners, does she worry about gaining weight, how does she feel about touching herself to insert a NuvaRing, does she use tampons, what methods have friends or her mother used and what have they told her about the use and side effects of a particular birth control method? Often I suggest for a teen to try a method; if she does not like how
she feels or is uncomfortable with method, she can change. A follow-up appointment is booked in six to eight weeks to review compliance and satisfaction. Complete contraceptive counseling always includes a discussion and often a prescription for Plan B.
References 1. Whitaker A, Gilliam M: Contraceptive care for adolescents. Clin Obstet Gynecol 2008; 51:268 2. Gold M, Johnson L: Intrauterine devices and adolescents. Curr Opin Obstet Gynecol 2008; 20:464 3. White E, Rosengard C, Weitzen S, et al: Fear of inability to conceive in pregnant adolescents. Obstet Gynecol 2006; 108:1411