AAP updates recommendations on contraceptives and adolescents
The AAP’s Committee on Adolescence issued new documents covering research on the safety and efficacy of different forms of contraception.
In a revised policy statement, “Barrier Protection Use by Adolescents During Sexual Activity,” the AAP noted that use of barrier methods — particularly external condom use — has declined among adolescents, whereas rates of sexually transmitted infections have increased.
The AAP recommended that pediatricians:
- Discuss with patients abstaining from sexual activity, as it is the most effective way in preventing genital STIs, HIV and unintended pregnancies;
- Support and encourage consistent and correct uses of barrier methods;
- Support the provision of free or low-cost barrier methods;
- Promote communication between parents and adolescents regarding sexual activity.
If an adolescent patient continues to participate in sexual activity, long-acting reversible contraceptives (LARCs) are the most effective option for preventing pregnancies while also offering noncontraceptive benefits, according to a new clinical report published at the same time in Pediatrics.
According to Seema Menon, MD, associate professor at Froedtert & Medical College of Wisconsin, and the AAP Committee on Adolescence, although LARCs are safe and effective, their rate of use remains low.
The clinical report “[provides] guidance for pediatricians on how to incorporate LARC into their practice when providing contraception counseling,” Menon told Healio.
As of now, there are six available LARC methods — one progestin subdermal implant, and five intrauterine devices (IUDs), according to the report. The progestin subdermal implant suppresses ovulation, whereas the copper intrauterine device and the protein-releasing intrauterine device (LNG-IUD) prevent fertilization.
“LARC methods are the most effective forms of contraception, with less than 1% of users becoming pregnant during the first year of use,” Menon wrote.
She said that all forms of LARC are safe and effective, although they do not provide any protection from STIs. Thus, prevention education is important, she said.
According to the report, the rate of condom use is significantly lower in those having sexual intercourse with someone using an LARC. Adolescents were found to use condoms 16.4% less when having intercourse with someone using an LARC, and 37.3% less when having intercourse with someone using oral contraceptive pills.
Noncontraceptive benefits also play a large role with the use of IUDs. One benefit is the treatment of menstrual cycle concerns, Menon wrote. This has been established in clinical practices, and it is estimated that 82% of adolescents are taking an oral contraceptive for noncontraceptive purposes.
According to the report, adolescents with physical and/or a cognitive impairment often seek options to reduce menstrual blood flow. Review is often required in this group of adolescents because of certain policies on consent and confidentiality. Although confidentiality may not be possible, physicians should try to speak with adolescents when possible, Menon wrote.
“While these methods are the most efficacious in terms of pregnancy prevention, clinicians should approach contraception counseling with the goal of providing accurate information and not to direct or pressure an adolescent to choose one of these methods,” Menon said.
The report lists recommendations for pediatricians and physicians to increase access to LARCs for adolescents:
- Recognize LARCs are safe options for adolescents;
- Have a clear discussion of side effects, including changes in bleeding patterns;
- Recognize LNG-IUD as a promising option for reducing issues with menses;
- Seek and obtain required training for placement and removal;
- Understand that LARC placement does not need to be delayed for STI screening;
- Emphasize dual therapy with condoms in LARC users to prevent STIs;
- Be aware that confidentiality can be compromised when delivering LARC services during the consent process and inadvertently through insurance billing;
- When providing same-day LARC services, ensure all contraceptive methods and side effects are discussed, medical eligibility is considered and personal safety is assessed;
- Provide LARC counseling within the reproductive framework to directive and coercive counseling;
- Focus on an end goal of improving the availability of LARC services to adolescents and not on increasing adolescent use.
Disclosures:
References:
- Grubb LK, et al. Pediatrics. 2020;doi:10.1542/peds.2020-007245.
- Menon S, et al. Pediatrics. 2020;doi:10.1542/peds.2020-007252.
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