Table 1.
Summary of available options for hormonal contraception in adolescent and young adult women.
| Therapeutic strategy | Effectiveness and advantages | Limitations | Disadvantages |
|---|---|---|---|
| Combined oral contraceptives | Correct and consistent use effectiveness is as high as 99.7%. | No use by patients with thrombosis, thrombophilia, migraine with aura. | Nausea, inter-menstrual spotting/bleeding, mild headache, breast tenderness, and mood changes. COCs containing drospirenone may cause elevations in potassium among individuals who take potassium-sparing medications. |
| Transdermal contraception | Effective in pregnancy prevention and compliance. | The same as COCs. Higher failure in women weighing over 90 kg: patch is not recommended. |
Disadvantages: lack of privacy when the patch is worn on a visible area, possible skin irritation and pigment change at application site. |
| Vaginal ring | Discrete; requires removal and insertion only once per month | The same as COCs. | The same as COCs. Vaginitis, leucorrhea, discomfort. |
| Progestin-only pills (mini-pills) | Safe for women with estrogen contraindications. | Strict adherence in timing of daily dose, difficult for adolescent schedules. | Changes in menstrual bleeding (irregular bleeding, spotting or amenorrhoea). Mild headaches and oiliness of the skin/acne nausea, mood changes and breast tenderness. |
| Depot medroxyprogesterone acetate | Safe for women with contraindications to estrogen. | Intramuscular injection; reinjection timely. | Irregular, unpredictable, prolonged or heavy bleeding or spotting. Appetite changes/weight gain. Headache. Decreased bone density with long-term use |
| Progestin-only implantable | Long duration of action, highly effective contraceptive. May be offered if contraindication to estrogen. |
Requires minor procedure for insertion; higher upfront costs. Insertion/removal problems. |
Changes in menstrual bleeding, including lighter bleeding, irregular bleeding, infrequent bleeding and amenorrhoea. Acne. |
| Levonorgestrel-containing intrauterine system (LNG-IUS) | Safe for most women regardless of age. | An IUCD should not be used if the patient has a current STD, pelvic inflammatory disease, or unexplained vaginal bleeding. Discomfort with placement. | Irregular bleeding. Dysmenorrhea. Migration, uterine perforation (rare), expulsion. |