Is your teenager asking about birth control? Or do you think your teenager should be asking about birth control? We asked Dr. Andrea Bonny, a pediatrician at MetroHealth Medical Center and Dr. Lisa Perriera, an assistant professor of obstetrics and gynocology, at Case Western Reserve School of Medicine for some birth control advice.
Q: Can you get birth control without a parent?
Bonny: By state law, teens do not need parental consent. That being said, in my opinion, teens who make decisions with their parents often make better decisions.
Perriera: In the state of Ohio, teens can receive birth control, sexually transmitted infection testing, and treatment of STDs without parental consent.
Q: What are the most common forms of birth control?
Bonny: Hormonal contraception is currently the most common method used by adolescents. These include birth control pills, the patch, and Depo-Provera. Depo-Provera is an injection that is administered every 12 weeks. This form of contraception is most effective for high-risk teens that may not be compliant with using other forms of contraception. Condoms are the most effective protection against STDs but not pregnancy.
Q: What are the most effective forms of birth control?
Perriera: Intra-uterine Device (IUD) and Implanon are the most effective forms of birth control that protect against pregnancy. The most effective form of STD protection is the male or female condom. I don’t consider condoms an effective form of birth control since the failure rate with typical use is about 14%. I tell my patients to use condoms every time they have sex, to prevent STDs, but to choose something more effective, in conjunction with condoms, to prevent pregnancy.
Q: Explain the importance of dual protection.
Bonny: Dual protection protects against pregnancy and STDs. Sexually active teens should use both contraception and a barrier method (condoms). Condoms are not effective birth control; however, they are very effective in preventing some sexually transmitted diseases. It is important to counsel girls and boys on the importance of using both.
Q: Do birth control pills have side effects?
Bonny: Not many. Hormone doses are low, so many side effects are either slight or nonexistent. Some adolescents experience headaches or nausea associated with the estrogen.
Perriera: The main side effects are pregnancy-like symptoms: breast tenderness and nausea. The symptoms usually resolve by about three months. There are also positive side effects, such as regulated menstrual cycle, lighter flow, less cramps, decrease in acne and decrease in facial hair growth.
Q: What other methods are appropriate for adolescents?
Perriera: All methods of birth control are appropriate for adolescents. The best contraception is the method the adolescent likes and will use effectively.
Q: Can you describe the patch?
Perriera: The patch contains synthetic estrogen and progesterone. It works like the pill. The estrogen and progestin in the patch prevent the ovaries from releasing an egg every month. The progestin in the patch also makes the mucus in the cervix really thick so that the sperm can’t get into the uterus and travel into the fallopian tube to fertilize the egg. The side effects are the same as those already described for birth control pills. When compared, the patch causes slightly more nausea and breast tenderness than the pill.
Q: How often should a teen on birth control visit her doctor?
Bonny: My recommendation depends on the patient and the method. Usually three to six months for patients taking the pill, three months for those using the Depo-Provera shot and once a year for college students.
Perriera: After the initial use of the pill, patch, or Nuvaring, the patient should return for a three-month follow-up to check blood pressure and to discuss the adjustment. Otherwise, teens should be screened for sexually transmitted infections annually or each time there is a new sexual partner.
Q: Which contraception is the most accessible and affordable?
Perriera: Teens might say condoms because you don’t need a prescription, and you can purchase them many places. However, I don’t consider condoms birth control. The most cost-effective birth control is long-acting, like the IUDs and implants. The initial cost is high, but by two years of use, they become less expensive than pills (or other monthly methods).
Q: How should parents educate their teens about birth control?
Bonny: Talk to your teens. Teens make better decisions when the parents are involved. Parents should discuss their own value system with their kids, and if they are not comfortable with the subject, find a good pediatrician or adolescent specialist to help them with the conversation.
Perriera: The most effective education is through an open and honest discussion. Parents are not expected to be birth control experts, and they should not pretend to be when they’re talking to their teen. If they need help, they should take their daughter or son to a doctor, or they should turn to a reliable website, such as www.plannedparenthood.org.
Q: What are the main concerns for adolescents?
Bonny: Often, teens do not seek help until after the fact. Girls who are comfortable with their pediatrician may seek help before. Also, some adolescents have difficulty with compliance (if they are on the pill), so it’s important to find an appropriate form of contraception for those teens.
Perriera:Teens are always concerned about side effects, particularly ones that affect body image. They may believe common myths about various contraceptives, such as the misperception that the pill causes weight gain. Adolescents need a realistic understanding of the side effects. Also, birth control is not a one-time, permanent decision. If they are not happy with their birth control method, they can try something else.
Q: When is estrogen not appropriate for teens?
Bonny: Estrogen is not appropriate if there is a personal history of clotting problems or certain chronic diseases such as epilepsy or complicated migraines.
Perriera: Estrogen is not appropriate for teens with a personal history of blood clotting disorders, migraine headache with aura, high blood pressure, and some chronic diseases (mainly ones that increase risk for blood clots).
Q: What is emergency contraception?
Perriera: Emergency contraception prevents pregnancy after having unprotected sex. There are two types. The first is called Plan B, which consists of two pills containing synthetic progestin. These are taken within five days of unprotected intercourse. It is best to take these pills as soon as possible. They DO NOT induce abortion. They work by preventing ovulation. Therefore, if you’ve already ovulated, they will not prevent pregnancy.
The second is the Paragard IUD. It can be placed into the uterus within seven days of unprotected sex, and it kills the sperm to prevent pregnancy. Paragard IUD is actually more effective than Plan B pills. Once inserted, the IUD provides 10 years of birth control.
Q: Do teens need a prescription for emergency contraception?
Bonny: Teens under 18 need a prescription. Otherwise, it is purchased behind-the-counter.
Q: Explain long-term contraception options?
Perriera: The main methods of long-term contraception are IUDs and Implanon. The Mirena Intrauterine System, a T-shaped device that contains hormones, is placed inside the uterus for up to five years. The IUD causes a thickening of the cervical mucus that blocks the sperm from entering the uterus. The Paragard IUD, a copper wire on a T-shaped device, contains no hormone. The copper wire kills the sperm and inhibits implantation of the fertilized egg. It can remain in the uterus for up to 10 years.
These devices are great at preventing pregnancy and do not increase the risk of acquiring a sexually transmitted infection. There is some slight discomfort when they are inserted. The Mirena makes periods lighter, and about 20% of women won’t have any monthly bleeding. The Paragard IUD slightly increases flow and cramps.
Implanon, a small rod containing Progestin, is inserted in the upper arm and can remain for up to three years. This device prevents ovulation and thickens the cervical mucus to block sperm from the uterus.
Once counseled about birth control options, teens should choose whichever method they prefer.
Q: In your opinion, does teaching birth control condone sexual activity?
Bonny:The decision to have sex has nothing to do with teaching safety. Education improves the decisions and behaviors of adolescents.
Perriera: Absolutely not. The average age of sexual debut in this country is 17 years old. That number has been constant, regardless of whether teens were receiving abstinence-only education or being taught about contraception. The only distinction with abstinence-only education is that teens are less prepared when they become sexually active.
Dr. Andrea Bonny is an Assistant Professor of Pediatrics, Division of Adolescent Medicine at MetroHealth Medical Center. Dr. Lisa Perriera, MPH, is an Assistant Professor of Obstetrics and Gynecology at Case Western Reserve School of Medicine and an ob/gyn at University Hospitals.