Hormonal contraception

Abstract

Increased sexual activity among adolescents demands that the health care provider have a thorough understanding of contraceptive methods and application. In this article, the principles of hormonal contraception are discussed, providing relevant information for use in advising and managing the sexually active adolescent.

PIP: An updated review on oral contraception opens with history and mechanism of action and concentrates on clinical management of users, especially adolescents. Other types of hormonal contraception are mentioned in passing. Since the introduction of Enovid in 1960, the steroid dose of pills has fallen about 10-fold, reducing side effects and especially complications to the minimum. Despite this, the public is more suspicious than ever of the danger of pills. Orals work by preventing the estrogen surge, usually blocking ovulation, and reducing endometrial development. Currently the latest low dose pills are the triphasics, which offer the lowest total dose of both estrogen and progestin to date. Some of them have such low progestin content that estrogen side effects become a problem. Guidelines for patient selection, and patient management are listed and tabulated. The ideal pill user has a mature menstrual cycle, frequent sexual activity, poor compliance with other methods, a need for maximal protection and no contraindications such as history of risk of factors for thromboembolism, cancer, migraine, sickle cell disease, or depression. Lab tests, history, and a physical exam are recommended. Instructions and danger signals are listed. Estrogenic versus androgenic pills, how to deal with breakthrough bleeding, weight gain, breast pain, and other side effects are discussed. All complaints of headache should be seriously evaluated. Use of minipills, medicated IUDs, implants, vaginal rings and injectables are briefly noted.