Contraindications and side effects are the same as those in COCs.
Intramuscular injection of 150 mg of medroxyprogesteroneacetate (Depo-Provera) every 12 to 14 weeks is an effectiveform of birth control. Progestogen-only contraception is associated with menstrual irregularities (70% amenorrhea and 30%frequent menstrual bleeding). Medroxyprogesterone acetate(Depo-SubQ Provera 104) is designed for subcutaneous useevery 12 to 14 weeks and may be self-administered with minimal training. An implant containing the progestin etonogestrel(Implanon) is now available on the U.S. market. This single rodimplant is inserted subcutaneously and is effective for 3 years.These forms of contraception are userand coital-independentand reduce failure secondary to missed doses.
Intrauterine devices (IUDs) are inserted into the uterus wherethey release either copper (ParaGard) that is spermicidal or levonorgestrel (Mirena) that prevents implantation by inducingan atrophic endometrium. The copper IUD, which lasts up to10 years, may increase the amount and duration of bleeding aswell as dysmenorrhea. The levonorgestrel-releasing intrauterine system is highly effective for up to 5 years while decreasing bleeding and dysmenorrhea, even causing amenorrhea.Although a small increased risk of pelvic inflammatory diseaseexists for 21 days after insertion of an IUD, the risk followingthat transient period lowers and continues at a low rate for theremainder of time that the young woman uses an IUD. Adolescents should be screened for STIs at the time of IUD insertion, with treatment provided as soon as possible for positive resultsor if there is a concern of compliance at the time of IUD insertion. Insertion in nulliparous women can be aided by the use of a paracervical block. IUDs require no active involvement bythe user, thus eliminating error and can be considered as oneof the first line options for adolescent contraception. Condomsshould be encouraged to reduce the risk of STI.
Emergency postcoital contraception should be discussed at every visit. A prescription should be given in advance of need when no over-the-counter access is available. Emergency contraception reduces the risk of pregnancy after unprotected intercourse if used within 5 days, although efficacy is greatest when used as early as possible. Other indications and contraindications to emergency postcoital contraception are listed in Table 69-7. There are two forms of emergency contraception: (a) Plan B (0.75 mg of levonorgestrel), one pill taken twice, 12 hours apart, or two tablets given once and (b) using a CHC pill the equivalent of 50 mg of ethinyl estradiol and 250 μg of norgestrel, each repeated in 12 hours. Plan B is also associated with significantly less nausea and vomiting than the CHC regimen. Mifepristone is also an effective postcoital contraceptive; however it is not approved for this use in the United States. A copper IUD can be inserted 7 days from the act of unprotected intercourse and has an efficacy of greater than 99%. This method is not generally recommended for adolescents.
No method of contraception being used Condom breaks Diaphragm dislodged/removed <6 h Missed birth control pills >1 wk late for Depo-Provera Ejaculation on external genitalia Sexual assault
Known pregnancy If strong contraindications to estrogens, use progestin.