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  • Title: Contraception update: implantable and injectable methods.
    Author: Gold MA.
    Journal: Pediatr Ann; 1995 Apr; 24(4):203-7. PubMed ID: 7596649.
    Abstract:
    There are currently more options available to pediatricians caring for sexually active adolescents who wish to prevent pregnancy. The two progestin-only methods, levonorgestrel subdermal implants and DMPA injections, minimize or entirely remove the obstacle of patient compliance from contraceptive efficacy. Adolescents considering a progestin-only method of contraception should be counseled explicitly about the likelihood of menstrual irregularity with use. Perhaps more importantly, adolescents should be reminded that hormonal methods of contraception do not provide protection from sexually transmitted disease. Thus, male condom use should not only be recommended, but also concrete discussion and instruction on appropriate use should be given. Two new progestin-only contraceptive methods--levonorgestrel subdermal implants and Depo-Provera injection--have the potential to overcome adolescents' traditional poor compliance with family planning methods. Both methods provide safe, highly effective, reversible fertility control, but require virtually no ongoing patient compliance. The levonorgestrel implants provide continuous contraception for up to five years and have a failure rate under 1%. The primary side effect is an alteration in menstrual patterns: prolonged bleeding in 40%, irregular bleeding in 38%, intermenstrual spotting in 32%, more frequent bleeding in 16%, and amenorrhea in 12%. An average weight gain of five pounds over the five-year period of use is expectable given the appetite stimulation associated with progestins. Depo-Provera, injected every three months, has a failure rate of 0.1-0.7% in the first year of use. Amenorrhea is the most commonly reported menstrual side effect. Although both methods are highly effective in preventing pregnancy, they confer no protection against sexually transmitted diseases; thus, adolescent acceptors should be counseled to use condoms concomitantly.
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