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  • Title: [Contraception for adolescents: methods and modes of action].
    Author: Hedon B.
    Journal: Rev Int Pediatr; 1988 Feb; (178):55-6. PubMed ID: 12282573.
    Abstract:
    Contraception for adolescents has become a topic of concern for parents, educators, and physicians in recent years because of the trend toward more widespread and early sexual activity among young people and because of the devastating consequences of unprotected sexual activity at early ages. Reasons for high adolescent pregnancy rates include lack of knowledge of contraceptives or of risks of pregnancy, the unanticipated and unprepared nature of many sexual encounters, lack of access to contraceptives, and fear of their possible side effects. There is no ideal contraceptive method for adolescents. Successful use of contraception by this age group requires careful and complete explanations of the use of the method. Abstinence is a satisfactory method only for adolescents who are not yet sexually active. Periodic abstinence may in theory be a way of learning about the physiology of reproduction and of preparing for mature sexual life, but the requirements of periodic abstinence conflict with the unpredictability of a sporadic sex life and the menstrual irregularity of many adolescents. Withdrawal should be presented as a less effective method, but 1 is better than no method at all and that is available at all times. Condoms and spermicides are considered unsatisfactory by many adolescents because they are less sure, they may tear, and they decrease sensation. But they may be acquired without prescription and have been widely publicized for their protective effects against sexually transmitted diseases and AIDS. They have no side effects and are suited to the sporadic sexual encounters of many adolescents. Diaphragms require a considerable investment of time in order to be effective. IUDs increase the risk of infection in adolescents with potentially serious effects on later fertility. They should be used only in exceptional cases. Oral contraceptives seem to offer advantages for adolescents in that they reduce excessive menstrual bleeding, prevent functional uterine bleeding, almost completely control dysmenorrhea, and reduce the risk of upper genital tract infections. Their great effectiveness and remoteness from the sexual act are also positive features. But some longterm effects of OCs such as their possible effects on hepatobiliary functioning are largely unknown. Adolescents are at great risk of discontinuing the method because of annoying though minor side effects. It is extremely important to explain the workings of OCs and their possible side effects in detail, to be accessible in case of concerns, and to encourage conscientious follow-up. Any combined OC can be used by adolescents, but those with low estrogen doses seem to cause fewer annoying side effects. Less androgenic progestins are preferred. Low-dose progestin-only formulations should be avoided if possible. Postcoital contraception should be reserved for exceptional cases.
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