Hormonal Contraception in Teenager Girls. The Role of Counseling to Ensure Effective Contraceptive Use

Abstract

Teenager girls represent a particular risk group for unwanted pregnancy and abortion with important consequences on their health, school and professional education and social life. In order to avoid this problem appropriate counseling during contraceptive process is of paramount importance. Apart confidentiality the contraceptive counselor must also demonstrate other important qualities like expertise, trustworthiness and availability. In hormonal contraception adolescents may be particularly bothered by side effects and it is important that they are counseled about these side effects prior to method initiation. Combined hormonal contraceptive methods with estrogens and progesterone are commonly used among adolescents, but the failure rate is higher compared to adult women, a possible explanation being lower adherence and higher rates of discontinuation. Depot medroxyprogesterone acetat (DMPA) is a highly effective injectable contraceptive appealing for adolescents because of its dosing schedule of four times per year. When using DMPA they should be counseled for changes in menstrual pattern or amenorrhea and the possible decrease in the bone mineral density if it used longer than to years. Long-acting, reversible contraception may be particularly suitable for many adolescents and are considered very effective methods. Anyhow with intrauterine devices (IUDs) the risk of contracting sexually transmitted diseases is higher and dual protection is mandatory in cases where IUD is used. Adolescents should be advised on the use of backup contraception and also barrier contraception for sexually transmitted infections prevention.