New guidelines aim to take worry out of birth control for teens

The teenage girl had been taking her birth-control pills regularly, but she decided on her own to stop when she and her boyfriend broke up.

It made sense to her, said psychologist Larry Ro-Trock, a family therapist in Kansas City. She figured she didn’t need the pills because she was no longer in a sexually active relationship.

But the news frightened her parents. In the on-again, off-again world of teen love, such a decision can be risky.

Now doctors are trying to take some of the uncertainty — and worry — out of birth control among teenagers.

New contraceptive guidelines issued Monday by the American Academy of Pediatrics put long-lasting and highly reliable birth control methods — intrauterine devices (IUDs) and hormonal implants — at the top of the list of what doctors should recommend to adolescent girls. They follow similar guidelines by the American College of Obstetricians and Gynecologists in 2012.

Kansas City area pediatricians have already started advising their patients and their parents about the advantages of long-acting reversible contraceptives, or LARCs. At the University of Kansas Hospital, hormonal implants are now a more popular option than birth-control pills among new teen patients.

“We’re really trying to promote them and we’re doing a lot of them,” said Lore Nelson, an adolescent medicine specialist at KU Hospital. “Most patients and parents are interested in it and most are receptive to it.”

Area doctors insist that they always counsel their adolescent patients about abstinence and postponement of sexual intercourse as the one 100 percent-effective method of birth control.

“We do support abstinence, but talking about abstinence won’t keep our patients from getting pregnant,” said Romina Barral, an adolescent medicine specialist at Children’s Mercy Hospital. “Most of the time, parents are relieved to have a professional talking to their teens (about contraception) rather than have it be their friends or the Internet.”

The new guidelines in favor of LARCs come two decades into a historic steady decline in teen pregnancies in the U.S., from 116.9 pregnancies per 1,000 teen girls in 1990 to 57.4 in 2010. Researchers attribute some of the decline to teens delaying sexual activity, but most has been due to greater use of contraceptives.

But with about 750,000 adolescent girls still becoming pregnant each year, an unmet need remains for effective contraception, the American Academy of Pediatrics said.

The most popular contraceptives among girls and women ages 15 to 19 are birth control pills and condoms; only about 4.5 percent have ever used LARCs. But the real world failure rate is 18 percent for condoms and 9 percent for the pill.

For IUDs and implants, the failure rates are less than 1 percent. IUDs remain effective for three to 10 years, implants for three years.

“There’s no user errors. There’s nothing for you to have to remember,” Nelson said.

Ro-Trock said the matter of teenagers reliably taking their medication comes up often. Parents say they have to remind their teens to take their ADD and ADHD medicine, he said.

“But with something as crucial as birth control, forgetting could have life-altering consequences,” he said. “If you have safe, long-term birth control methods that don’t cause side effects, why not use them?”

Adoption of IUDs and implants has been held back by “a lot of myths and misconceptions about these methods,” Barral said.

Previous generations of IUDs, which are removeable devices inserted into the uterus, had been associated with infections that could lead to infertility. But infection risks were overestimated, Barral said, and research has found IUDs to be safe for teenagers. “It is clear that they’re not concerns anymore.”

Hormonal implants also have had a difficult history. Current implants, a rod about the size of a matchstick, are inserted just under the skin of the upper arm. “It’s a very, very simple procedure,” Barral said. Older versions used five such rods and had to be inserted more deeply. When it was time to remove them, “we had to go fishing to find the five rods,” she said.

Barral said the Kansas City area doesn’t have enough physicians and nurse practitioners who know how to insert and remove LARCs.

“The ideal would be to get more and more providers trained so they can use them themselves, rather than have to refer their patients,” she said.

This story was originally published September 29, 2014 at 7:17 PM with the headline "New guidelines aim to take worry out of birth control for teens."