By Dr. Tara Gallasch,
Health Columnist
Dear Doc:
My daughter is 17-years-old and has had a boyfriend for about a year. She is a great kid, does well in school and is involved with lots of extra-curricular activities. We have a good relationship and have had open conversations about sex. She understands that her father and I prefer that she waits until she is older to become sexually active and so far we believe she has respected this. However, recently another girl in her school became pregnant and this has been a wakeup call for us. I would like to take her to the doctor to start birth control. I have heard there are some newer methods of birth control available but I don’t know much about them. What are the best options for my daughter?
Dear Reader:
First, I want to say that it is wonderful that you are being proactive thinking about your daughter’s contraceptive needs. As parents we would often rather bury our heads in the sand than think about our little babies turning into sexually active young adults. Whether we choose to believe it or not, sex is a part of many teens lives. It is a parent’s job to protect their children even from themselves, and sometimes that means helping them find effective contraception. Birth control options have greatly improved over the past 10-20 years. Pills are still the most commonly used method of female birth control and typically contain a low dose of estrogen and progesterone. Side effects are common but are usually mild and go away over time. These include irregular bleeding, breast tenderness, bloating, headaches and mood irritability. Benefits of the pill can include a reduction in acne; lighter, less painful and more regular periods; as well as a reduction in lifetime risk of ovarian and uterine cancers. Overall birth control pills are well tolerated by most women. Unfortunately they are also one of the least effective methods with failure rates around 9 percent.
As an alternative, many young women have turned to the use of Depo-Provera. This is progesterone that is given every three months as an injection in the doctor’s office. The effectiveness is increased from the pill but it still has a 6 percent failure rate. Women using Depo-Provera will often notice some irregular light bleeding or their menses may stop. When using any progesterone method of birth control the lining of the uterus does not grow so a regular ‘shedding’ or cycle is NOT needed. Some women may notice weight gain as Depo-Provera may increase appetite. Long term use of Depo-Provera has also been shown to cause a reversible loss in bone density.
In recent years the medical community has been focused on promoting Long Acting Reversible Contraception or LARC methods. LARC methods include a progesterone implant called Nexplanon and intrauterine devices (Paragard, Mirena and Skyla). Studies have shown that these are the most effective methods of contraception. The Nexplanon is a small plastic rod that is inserted underneath the skin in the upper inner arm. It slowly releases progesterone and can be used for as long as three years. Its failure rate is 0.05 percent. Women using Nexplanon may experience some irregular vaginal bleeding but typically the bleeding is less than their menstrual bleeding. Insertion and removal are done in the office using local anesthesia such as lidocaine. The procedure is very well tolerated by patients.
The Paragard IUD is a plastic T-shaped device with some copper wrapped around it. It is placed into the uterus in the office. The Paragard has no hormones, so women will continue to have a regular monthly cycle. Some women may note that their periods are a little heavier or longer but this is typically not bothersome to them. The Paragard’s failure rate is just 0.8 percent and it may be used for as long as ten years. This is a great option for women who have not been able to tolerate hormonal birth control due to side effects.
Lastly there are two progesterone based IUDs. The Mirena and the Skyla have a failure rate of about 0.2 percent. Again, these are plastic T-shaped devices that are placed into the uterus in the office. The Mirena has a higher dose of progestin resulting in light or no periods for women. It can be used for five years. Skyla was designed as a smaller IUD with a lower dose of hormones. The Skyla lasts for three years and women are more likely to continue to have a monthly cycle. IUD insertions are easily done in the office. Some medical providers will recommend premedication with Motrin to reduce cramping or a prostaglandin to soften the cervix to make insertion a little easier.
Ultimately your daughter will need to consider all the options and choose something that she feels most comfortable with. As a mom, you can help her to educate herself about her choices and continue to express your preference that she waits until she is older to become sexually active. The LARC methods (IUDs and Nexplanon) are well proven to be the most effective methods and can give both you and your daughter confidence that her birth control needs are covered. LARC methods and an increase in access to affordable birth control due to improved insurance coverage have been seen as major factors contributing to the decreasing teen pregnancy rate in the US.
Prevention of unintended pregnancy is critically important, however we need to remember that pregnancy is not the only risk of teen sexual activity. Please speak to your daughter about prevention of sexually transmitted diseases. The only ways to prevent STDs are the use of condoms 100 percent of the time or abstinence. Again, I think it is wonderful that you are being proactive about your daughter’s health and I encourage you to make her an appointment with a gynecologist as soon as possible.
Tara Gellasch, MD, is the Chief of Obstetrics and Gynecology at Newark-Wayne Community Hospital (NWCH) and sees patients at The Women’s Center at NWCH, a Rochester General Medical Group practice. Dr. Gellasch earned her Medical Doctorate from McGill University in Montreal, Quebec and completed her residency in Obstetrics and Gynecology at Emory University. This column is meant to be educational and not intended to be used to make individual treatment decisions. Prior to starting or stopping any treatment, please confer with your own health care provider. To send questions on women’s health, please email, Monica Decory at Monica.Decory@rochesterregional.org and write “Ask a Doc” in the subject line.
