Adolescent contraception.

Despite a decreasing incidence of teenage pregnancy in Canada, most pregnancies in adolescents are unplanned

In Canada, 5.3% of live births in 2000, 4% in 2010 and 1.7% in 2019, were to mothers younger than 19 years old.1 More than 80% of adolescent pregnancies, however, are unplanned and many end in termination.2 The Canadian Pediatric Society recommends quick-start methods of contraception and year-long prescriptions to decrease unplanned pregnancies and increase continuation rates.3

Adolescents face multiple barriers when accessing contraception

Many adolescents have concerns with their ability to pay for contraceptives and express difficulty accessing confidential contraceptive care.2 Clinicians should emphasize the benefits of physician–patient confidentiality while explaining the exceptions, including the need to disclose self-harm and activities occurring in a position of vulnerability.

Long-acting reversible contraceptive (LARC) methods are recommended as first-line interventions

In populations in which LARC use is high, adolescent pregnancy rates have declined.3 Levonorgestrel and copper intrauterine devices (IUDs) are effective LARC interventions available in Canada.3 The etonogestrel-releasing implant (Nexplanon) was approved for use in 2020. As it is implanted in the upper arm and does not require a pelvic examination, it may become a popular option among adolescents. After counselling, most adolescents chose a LARC method when it is offered at no cost, with similar uptake of implants and IUDs.4

When prescribing hormonal contraceptives, consider optimization of bone mineral density

Bone mineralization during adolescence represents up to 40% of adult bone mass accrual.5 Prospective studies suggest that oral contraceptives containing ≤ 30 μg of ethinyl estradiol may be insufficient for optimizing bone density. 5 Long-term users of medroxyprogesterone acetate (Depo-Provera) may have decreased bone mineral density; stopping medication can reverse density loss.5 Implants and IUDs do not appear to affect bone accrual.

Encourage concomitant use of barrier contraception to prevent sexually transmitted infections

About 50% of all sexually transmitted infections occur in the 15- to 24-year-old age group, but adolescents using LARCs are 60% less likely to use condoms than those using oral contraceptives.6

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