Current challenges in contraception in adolescents and young women
- 1 March 2013
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Current Opinion in Obstetrics and Gynecology
- Vol. 25 (Supplement), S1-S10
- https://doi.org/10.1097/gco.0b013e32835e06fd
Abstract
Although developing countries have made much progress in expanding the availability and use of family planning services, the need for effective contraception is large, and growing because the largest cohorts in human history are entering their reproductive years. Not only regarding developing countries but also in developed countries, where the usual contraceptive methods, such as the oral contraceptives, intrauterine devices (IUDs) and condoms, have been available for decades, there have been many new advances in contraceptive technology in the last several years. New formulations of oral contraceptives, extended and continuous use of oral contraceptives and long-acting reversible contraceptives (LARC) may have a wider role in contraception and their increased implementation could help to reduce unintended pregnancy. Today's oral contraceptive regimens are safer and more tolerable, with equal or improved efficacy as compared to early formulations. Incremental decreases in the estrogen dosage have helped to alleviate some of the unwanted estrogenic side effects of combined hormonal contraceptives. Progestogens have also been controversial in connection with findings of increased venous thromboembolism risks but they have evolved over time, and, in general, newer generations of progestins have minimal side effects. Currently available 'LARC' methods, such as IUDs, the intrauterine system, injectable contraceptives and implants require administration less than once per cycle or month. They are more cost effective than the combined oral contraceptive pill even at 1 year of use. Increasing the access and availability of new formulations of oral contraceptives and LARC methods will reduce the number of unintended pregnancies. Evidence-based guidelines about the safety of contraceptive methods among women with comorbid medical conditions can help guide providers in determining the best method of contraception for each woman, depending on whether they are in their adolescent, postpartum or perimenopause years. As most patients can safely use highly effective methods of contraception, health providers should promote their use in order to further efforts to reduce unintended pregnancy. This promotion should be done by enabling women to make an informed choice among all contraceptive options.Keywords
This publication has 21 references indexed in Scilit:
- Practice Bulletin No. 112: Emergency ContraceptionObstetrics & Gynecology, 2010
- Disparities in Rates of Unintended Pregnancy In the United States, 1994 and 2001Perspectives on Sexual and Reproductive Health, 2006
- Advanced provision of emergency contraception to postnatal women in China makes no difference in abortion rates: a randomized controlled trialContraception, 2005
- Direct Access to Emergency Contraception Through Pharmacies and Effect on Unintended Pregnancy and STIsJAMA, 2005
- Advanced provision of emergency contraception does not reduce abortion ratesContraception, 2004
- The effects of advance provision of emergency contraception on adolescent women's sexual and contraceptive behaviorsJournal of Pediatric and Adolescent Gynecology, 2004
- Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomised trialThe Lancet, 2002
- The extent of pregnancy mistiming and its association with maternal characteristics and behaviors and pregnancy outcomes.Perspectives on Sexual and Reproductive Health, 2002
- Emergency contraception: Advance provision in a young, high-risk clinic populationObstetrics & Gynecology, 2000
- Unintended Pregnancy in the United StatesFamily Planning Perspectives, 1998