Primer offers pediatricians information on long-acting reversible contraceptives

A primer that recently appeared in Pediatric Annals provides information on long-acting reversible contraceptives so that primary care pediatricians feel comfortable talking to patients about them.

“When counseling adolescents about contraception, it’s ideal to discuss the most effective methods of contraception first,” wrote Sabrina Fernandez, MD, a primary care pediatrician at the University of California, San Francisco, Benioff Children’s Hospital, and assistant professor of pediatrics at UCSF. “Despite this, some pediatricians may feel uncomfortable talking about [long-acting reversible contraceptive (LARC)] methods.”

With many of the approximately 750,000 pregnancies each year among teenagers unplanned, there is a need for contraception that is available and effectual among this age group, she wrote. In addition, data released by the CDC suggest that the use of LARCs is increasing among sexually active teenagers.

According to Fernandez, the two most common LARCs are intrauterine devices (IUDs), such as varying doses of levonorgestrel and Copper T (ParaGard, Teva), and the implantable rod device etonogestrel (Nexplanon, Merck).

She wrote that patients who use LARCs typically fall into one of two categories:

•typical, where one who begins a contraceptive method and experiences accidental pregnancy in the first year of use; or

•perfect, where one who uses a contraceptive method consistently and correctly and still experiences accidental pregnancy.

In both instances, she stated, the LARC has a failure rate of less than 1%

Fernandez also wrote that the Contraceptive CHOICE Project, a prospective cohort study of nearly 10,000 females, found that LARC seemed to be the birth control method of choice on several fronts.

“More teens and young women chose LARC methods over other contraceptive options. More patients were satisfied with their choice in using the LARC method, and more patients were still using their LARC method after 1 year,” she wrote.

Fernandez pointed out a few things medical professionals should know when discussing contraceptives with their patients.

“Adolescents should be screened for sexually transmitted infections at the time of counseling and/or insertion, and pediatricians need not wait for negative test results prior to insertion in an asymptomatic patient. Pediatricians should counsel patients that with all LARC methods, irregular bleeding and/or spotting can occur, but generally improve after the first several months of use,” she wrote. “When possible, offer LARC insertion on the day of counseling to eliminate the need for a future visit. If insertion is not immediately available, one may bridge the patient with a short-acting method until their LARC insertion appointment. The Copper T IUDs are the only LARC methods approved as emergency contraception if used in the first 5 days after unprotected sex.”

Fernandez also discussed myths surrounding LARC. Addressing the mindset that using them could lead to pelvic inflammatory disease, she stated the occurrence is similar to the general population. On the issue of IUD expulsion rates in females who have not given birth, Fernandez wrote that the studies conflict. She also addressed the potential link between IUDs and infertility, noting that females using these devices are no more likely to experience infertility compared with their gravid counterparts.

Specific state laws regarding a minor’s ability to consent to LARC can be found by using the Guttmacher Institute’s State Center or State Minor Consent Laws: A Summary. – by Janel Miller

References:

Center for Adolescent Health & the Law. State Minor Consent Laws: A Summary. http://www.freelists.org/archives/hilac/02-2014/pdftRo8tw89mb.pdf.

Fernandez S. Pediatr Ann. 2017;doi:10.3928/19382359-20170220-03.

Guttmacher Institute. An Overview of Minors’ Consent Law. https://www.guttmacher.org/state-policy/explore/overview-minors-consent-law. Accessed March 23, 2017.

Romero L, et al. MMWR Morb Mortal Wkly Rep. 2015;64:1-8.

Disclosure: Fernandez reports no relevant financial disclosures.