Contraception in adolescence

Abstract 

There are no contraceptive methods that are contraindicated on the basis of age alone. For a woman of any age, efficacy and compliance are optimized if she is using her own choice of method. Nevertheless, there are special issues that must be taken into account by clinicians advising adolescents about contraceptive choices. Specific legal and ethical issues pertain. Clinicians must document that they have applied the Fraser criteria in assessing a young woman’s competence to provide valid consent. Clinicians must be alert to Child Protection issues and familiar with local procedures; they must understand their duty of confidentiality and circumstances where confidentiality may have to be breached. Although no contraceptive methods are contraindicated, risks and benefits must be weighed in making choices. Considerations of efficacy and compliance mean that the progestogen-only pill is generally less suitable for young women, who have inherently high fertility and may have chaotic lifestyles. If considering depot medroxyprogesterone acetate, concern about bone mineral density must be balanced against user-independence. Beneficial effects on bone mineral density and acne favour combined oral contraception.

Keywords:  contraception , adolescence , child protection , confidentiality , consent

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