Adolescence and contraception
Young people are highly fertile and require effective contraception to prevent unintended pregnancy.
Contraception (excluding sterilisation) can be provided without parental consent to adolescents assessed as being able to consent to their own medical treatment1. Clinicians should be aware of mandatory reporting requirements in their jurisdiction for young people assessed as being at risk of harm (eg nonconsensual sexual activity, significant age gap or power differential between the young person and the sexual partner).
Provide information about prevention of sexually transmitted infections (STIs) (including dual contraception with condoms and another effective method) and the availability of emergency contraception without the need for a prescription.
Long-acting reversible contraception (LARC) (the etonogestrel implant and intrauterine contraceptive devices [IUDs]) is the first-line option in adolescence. These methods are highly effective, and have high continuation and user satisfaction rates. IUDs can be safely used by young nulliparous individuals.
Combined hormonal contraception (combined oral contraceptives [COCs] and the contraceptive vaginal ring) are sometimes preferred by adolescents because they can be easily stopped and restarted, and allow manipulation of the menstrual cycle with a tailored regimen (eg to avoid unnecessary withdrawal bleeding). They are also useful in the management of acne, dysmenorrhoea and heavy menstrual bleeding, which are common in adolescence. The cost of some formulations of COCs and the vaginal ring may limit their use in adolescence. Combined hormonal contraception requires greater patient involvement than long-acting contraceptives; unintended pregnancy is more likely in those younger than 21 years compared to older users.
Progestogen-only pills (POPs) that contain levonorgestrel or norethisterone are less effective in younger people than LARC, DMPA, combined hormonal contraception, or POPs that contain drospirenone. Younger people have higher background fertility; failure rates for these POPs are higher in those younger than 25 years compared to older people.