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Contraception Donald E University of Kentucky UKnowledge Pediatrics Faculty Publications Pediatrics 2010 Contraception Donald E. Greydanus Michigan State University Hatim A. Omar University of Kentucky, [email protected] Lyubov A. Matytsina Donetsk Medical University, Russia Artemis Tsitsika University of Athens, Greece Right click to open a feedback form in a new tab to let us know how this document benefits oy u. Follow this and additional works at: https://uknowledge.uky.edu/pediatrics_facpub Part of the Obstetrics and Gynecology Commons, and the Pediatrics Commons Repository Citation Greydanus, Donald E.; Omar, Hatim A.; Matytsina, Lyubov A.; and Tsitsika, Artemis, "Contraception" (2010). Pediatrics Faculty Publications. 261. https://uknowledge.uky.edu/pediatrics_facpub/261 This Book Chapter is brought to you for free and open access by the Pediatrics at UKnowledge. It has been accepted for inclusion in Pediatrics Faculty Publications by an authorized administrator of UKnowledge. For more information, please contact [email protected]. Contraception Notes/Citation Information Published in Pediatric and Adolescent Sexuality and Gynecology: Principles for the Primary Care Clinician. Hatim A. Omar, Donald E. Greydanus, Artemis K. Tsitsika, Dilip R. Patel, & Joav Merrick, (Eds.). p. 413-470. © 2010 Nova Science Publishers, Inc. The opc yright holder has granted the permission for posting the book chapter here. This book chapter is available at UKnowledge: https://uknowledge.uky.edu/pediatrics_facpub/261 In: Pediatric and Adolescent Sexuality... ISBN: 978-1-60876-735-9 Ed: H. A. Omar et al. © 2010 Nova Science Publishers, Inc. Chapter 8 CONTRACEPTION Donald E Greydanus*, MD, Hatim A Omar, MD, Lyubov A Matytsina, MD, PhD and Artemis Tsitsika, MD, PhD Pediatrics and Human Development, Michigan State University, College of Human Medicine, East Lansing, Michigan, United States of America, Adolescent Medicine and Young Parent Programs, Kentucky Clinic, University of Kentucky, Lexington, Kentucky, United States of America, Donetsk Medical University, Donetsk, Ukraine, Russia, Adolescent Health Unit, Second Department of Pediatrics, University of Athens, P & A Kyriakou Children's Hospital, Athens, Greece Contraception is an important concept for sexually active adolescent females to understand who do not wish to become pregnant. This chapter reviews important, effective, and safe contraceptive methods that can be used by female youth. These methods include abstinence, oral contraception, contraceptive patch. * Correspondence: Donald E. Greydanus, MD. Professor, Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing, Michigan, United States E-mail: [email protected] 414 Donald E. Greydanus, Hatim A. Omar et al. mini-pills, emergency contraceptives, injectable contraception implants (lmplanon), intravaginal ring, vaginal contraceptives, intrauterine devices, and natural family planning. Promotion(DMPA). of se1rnal responsibility should be the charge ofbarrier health professionals caring for adolescents and young adults. INTRODUCTION An important issue for human beings is the acquisition of normal sexual healtl1, including the understanding and application of reproductive health when needed (1-5). Unfortunately, comprehensive sexuality education is not a topic provided to many of our children, adolescents or college students in the United States (5). The median age at first intercourse of 16 years in the United States is comparable to the age of coital initiation in other developed countries such as Canada, countries of Western Europe (France, Great Britain), countries of Eastern Europe and Eurasia (Russia) (6-11). Students who were sexually active in high school may continue to be at risk for pregnancy and sexually transmitted diseases in their college life; those youth who chose abstinence at one point may abandon this concept as they mature, choosing coital behavior with one or more partners in junior high school, high school, or college (8,12-14). There are over 15 million cases of sexually transmitted diseases in the United States, and over 60% of these occur in young people under 25 years of age) (4,7). All youth who are sexually active, including those with chronic illness, should be provided with appropriate contraceptive counselling and contraceptive prescription if they are not willing to accept abstinence (1,2,15-17). Since millions of female adolescents are sexually active, it is important that clinicians caring for them provide appropriate sexuality counselling, covering such topics as safe sex. contraception, and STD/AIDS prevention (12,18-21). Reasons for not using contraception include being abstinent, wishing to become pregnant, concluding they or their partners were sterile, fear of contraceptive "side effects" (such as }. breast cancer or gain), religious objections regarding ,, contraception, lack of clinician education about contraceptives, history of Contraception 415 contraception or abortion, failure of insurance to cover contraception, and others (1,2,22-27). Approximately half of adolescent pregnancies occur within the first six months after the initiation of coital behaviour, while adolescents wait one year or more after starting coitus to seek advice from clinicians about effective contraception. Higher socioeconomic status and education are factors that lead to an increase in delay in coitus and willingness to use effective contraption if sexually active (28). Although adolescent pregnancy rates have dropped 33% in the United Sates from the early 1990s to 2003, the rates in the U.S. are the highest in developed countries with a birth rate in 15 to 19 year olds at 41.7/1 ,000 (14,29). A number of safe and effective contraceptive methods are available (1-4,15,18,20,30,31) (see table 1). The gap between efficacy of perfect use of contraceptives (e.g., correct, consistent, and continued use of a chosen contraceptive method) and typical use leads to millions of unintended pregnancies each year (1,2,4,32-36). Efficacy rates of contraceptives are noted in table 2 (35,36). The barrier methods (i.e., condoms, diaphragms, cervical caps, vaginal sponges, female condoms, and vaginal spermicides) can be used quite effectively by motivated high school or college students who are taught how to use them; periodic abstinence has higher pregnancy rates, but is potentially an effective contraceptive method. The female's comfort for insertion of barrier methods is crucial for maximum contraceptive efficacy for these methods, and thus, they are not appropriate for many adolescent who do not have this comfort level. Norplant, an effective method in which six progesterone capsules are inserted subcutaneously into the upper arm, was removed from the United States market in 2000. Implanon, a single progesterone rod implant, has now replaced Norplant in the Uniled States. The intrauterine device is an excellent contraceptive, but has been tainted with the image of inducing pelvic inflammatory disease ( 1,37). These contraceptive methods are discussed later in this discussion. Donald E. Greydanus, Hatim A. Omar et al. 416 Table 1. Contraceptive methods Abstinence Combined Oral Contraceptives (COCs) Contraceptive patch Mini-pills (Progestin-only pills; POPs) Emergency contraceptives Injectable Contraceptives Depo-Provera® (Depo-medroxy-progesterone acetate Lunelle® (estradiol cypionate and medroxyprogesterone acetate) Implants Norplant I (withdrawn from the US market in 2000) Implanon ( one rod system with etonogestrel) Jadelle (Norplant II: two silastic rods with levonorgestrel) Intravaginal ring (NuvaRing) Intrauterine Devices Progestasert® IUD (with progesterone) ParaGard® (Copper T380A IUD) Mirena® (IUD with levonorgestrel) Vaginal barrier contraceptives Cervical cap (Prentif Cavity-rim®) Condoms (male) Contracepti ve sponge (v aginal) Diaphragm Female condom (Reality®) Spermicides (vaginal) Sterilization (female sterilization, vasectomy) Physiological methods/natural family planning Coitus interruptus Contracepti on 417 Table 2. Efficacy of contraceptives (40,41) Contraceptive Efficacy First Year Failure Rate Typical Use Perfect Use Combined OCs 3-8 0.1 Progesterone IUD 2 1.5 Copper T IUD 0.8 0.6 Mirena IUD 0.2 0.1 DMPA 0.3 0.3 Norplant 0.05 0.05 The choice of methods has females currently availablethat contraceptive lifestyles.increased considerablynumber in contraceptiverecent years, offeringmethods have receivedof reproductive United age a variety of different methods retlect their variousthe needs and A includingof emergency contraceptives (Preven, States Food Depo-Provand eDrugra Administration cervical(FDA) approvalcap, Lunelle over (injectablepast two decades (see table 3), (an IUD Plana B), (DMPA), the contraceptivesuch aswith Implanon estrogen), (28,38-40). Mirena with levonorgestrel), contraceptive patch (Evra), an intravaginal ring (NuvaRing), and implants Table 3. FDA approval history for contraceptives 12/90: Norplant (Withdrawn from US Market 2000) 2. 10/92: Depo-Provera 13..9/98: Preven Kit in 4. 7/99: Plan B 5. 10/00: Lunelle, "injectable pill" (withdrawn from the US Market) 6. 12/00: Mirena IUD 7. 10/01: Nuva Ring (vaginal ring) 8. 11/0l: Evra Patch 9. 2006 Implanon (single rod) 418 Donald E. Greydanus, Hatim A. Omar et al. Technology has expanded over the past decade to include various ways of contraceptive steroid release (see table 4), leading to a number of potential advantages (see table 5). After OCPs were developed over 45 years ago, the emphasis has been on having newer
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