August 24, 2016

Not your mother’s birth control: teens and contraception


Teens now have more options for reliable birth control. Here’s a look.

As part of my practice, I care for many children and teenagers with a wide variety of gynecologic concerns. I see many teenagers who want to discuss their birth control options, and I particularly love it when they do so proactively, before they have become sexually active. Although I always talk to teenagers on their own during their visits, sometimes I have the opportunity to review birth control options with parents or guardians present.  I often get the same reaction from moms: “I wish this was around when I was her age.”

Long-acting reversible methods

For teenagers particularly, long-acting reversible contraceptive (LARC) methods, which include intrauterine devices (IUDs) and contraceptive implants, are now the preferred form of birth control. LARC is being used in much greater numbers among teenagers. And for good reason. IUDs and implants are more than 99 percent effective at preventing pregnancy, a rate that exceeds that of every other birth control method — comparable to tubal ligation without being permanent. With IUDs and implants, the dependence on a user’s ability to remember to take a daily pill is eliminated. When pursuing birth control options, what teenager, or parent for that matter, does not want the most reliable birth control that also happens to be maintenance free?

The contraceptive implant is a small piece of plastic the size of a matchstick that is placed in the patient’s arm. It secretes a low dose of progesterone and is effective for up to 3 years when left in place. Numbing medicine is applied prior to placement in the arm, and teenagers will often say they don’t even feel the placement at all. IUDs are small, T-shaped implants placed into the uterus through a vaginal exam. Like implants, they usually can be placed in the office. Sometimes premedication is given to help facilitate an easier placement, which can cause cramping. However, most teenagers tolerate the procedure very well. The hormone-free IUD lasts for up to 10 years. The progesterone-containing IUD lasts up to 5 years with the added advantage of a decrease in the amount of period bleeding compared to the hormone-free IUD. The most common side-effect of the contraceptive implant and IUDs is irregular bleeding, which usually subsides with time.

The ring

The contraceptive ring is another great option for teenagers that their mothers did not have. The vaginal ring supplies contraceptive hormones that are absorbed through the vaginal lining, taking the place of three weeks of traditional pills. The flexible plastic ring is changed monthly and again reduces the amount of user maintenance required to maintain effective contraception. If teenagers can use tampons, they are certainly candidates for the ring, which they place and remove themselves.


Even pills are radically different than they were 30 years ago. Today’s birth control pills are much lower in hormones than older pills, often more than 50 percent less. This leads to fewer side effects such as nausea. Some pills are chewable. Others allow the user to safely have only one period every three months.

Other considerations

Every birth control method has some contraindications, and a conversation with a healthcare provider will help determine what methods are best for your teenager. None of the birth control methods discussed here prevent sexually transmitted infections, so condoms are always recommended to protect against infections and provide a backup to the selected birth control method.

I encourage parents to be proactive about gynecologic care and contraception. When it’s time to talk birth control, I think most teenagers will find something that really works for them and fits into their increasingly busy routines. And moms can learn something new about birth control, too.

This post was written by Celeste Hemingway, MD, MHPE, who was raised in San Antonio, Texas, before coming to Vanderbilt to complete her undergraduate degree in Chemistry and Molecular Biology. She completed her medical training and residency in Obstetrics and Gynecology at Vanderbilt as well and is now an Assistant Professor of Obstetrics and Gynecology with special interest in Pediatric and Adolescent Gynecology.

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