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  • Title: [Contraception in adolescents. Taking responsibility and indications].
    Author: Thibaud E.
    Journal: Rev Int Pediatr; 1988 Feb; (178):57-9. PubMed ID: 12282574.
    Abstract:
    Although information on contraception is readily available and a 1974 French law allows adolescents to receive contraceptives in family planning centers at no cost and without parental consent, over 1/2 of French adolescents have their 1st sexual intercourse with contraceptive protection and 13,000 adolescents under 17 become pregnant each year. Factors in the imperfect access of adolescents to contraception include conflicts with adult sources of contraception information, faulty perception of the risk of pregnancy, and presentation of contraceptive information in rational and technical terms to the exclusion of affective and relational aspects. Practical difficulties in finding a physician and paying for the consultation and fear of the examination itself are obstacles for some adolescents. The ambivalence of family planning providers faced with very young clients can be a significant barrier to access. At the 1st consultation, the adolescent should be seen alone. A complete medical consultation should be carried out including discussion of the adolescent's activities, habits, and affective life. Information on sexually transmitted diseases should be provided in a straightforward way, with possible symptoms included. The consultation usually ends in prescription of a combined oral contraceptive (OC), but for undecided adolescents or those with episodic sex lives several prescriptions may be given to provide a choice between OCs, condoms and spermicides, or the morning-after pill. Follow-up usually entails evaluation of weight and blood pressure, a gynecological examination with annual Pap smear, and management of secondary effects. A breast examination is necessary because of the sensitivity of breasts to estrogen at this age. OCs with a progestin dominance should be chosen for adolescents. In case of menstrual headaches the OC should be modified or terminated. Minor side effects such as acne are often the cause of termination and should not be ignored. Follow-up should be frequent and regular in the 1st year. Very young adolescents should be given standard-dose OCs. In case of absolute contraindications to combined OCs, a low-dose progestin pill may be selected. A low-dose pill and dietary counselling may be provided in case of weight gain, and an estrogen-dominant pill may help in case of moderate acne. OCs should be stopped in the event of hepatitis or expected surgery. Combined OCs are usually without medical contraindications and well tolerated by adolescents.
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