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Bull World Health Organ. 1984;62(2):331-44.

Contraception in adolescence: a review. 2. Biomedical aspects.



Although none of the currently available methods of contraception can be considered ideal for use by adolescents, many come reasonably close. The present article reviews the relative benefits and risks associated with each method. Oral contraceptives (OCs) appear to bear few specific risks for adolescents. Pills containing 30-50 mcg of ethinyl estradiol and 0.5-1.0 mg norethisterone, or their equivalents, offer a high degree of protection and are well tolerated. There is no evidence that the pill interferes with either pubertal growth or the achievement of regular ovulation. Risks of cardiovascular complications are lower for adolescents than any other age group; however, changes in lipid profiles, which are thought to contribute to increased atherogenesis, may restrict total lifetime use of OCs. While the minimal compliance requirements of the IUD might suggest it as an appropriate method for adolescents, cramping and increased menstrual blood flow often make it unacceptable. Expulsion rates are higher in nulligravidae than in parous females, although copper wound or progestogen-impregnated devices are better retained. The increased risk of pelvic inflammatory disease in unmarried adolescents using the IUD is of sufficient magnitude to warrant the restriction of the device to those who have failed to use other methods. Depot medroxyprogesterone acetate (injectable hormonal contraceptive) may be of use in particular groups of adolescents. Both the World Health Organization and the American Academy of Pediatrics recommend its use in selected groups of adolescents for whom other methods are contraindicated. Oral progestogen-containing minipills are not suitable for teenagers, since compliance requirements are fairly rigid, and there is often excessive breakthrough bleeding, and a relatively low protection rate. All barrier methods have a significant place for use by adolescents, although younger teens are often reluctant to insert the diaphragm. The condom, used alone or with spermicidal foam, has a particular advantage since it does not require a prescription, is widely available, and suits the spontaneous, unplanned nature of coitus among this age group. Rhythm and other forms of natural birth control are not suitable for adolescents. They depend on regular ovulation and require extensive instruction, a high degree of motivation, and the ability to plan ahead for coitus. None of these factors is characteristic of the teenage girl. (author's modified)

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