By: Mary A. Ott, MD, MA, FAAP & Elizabeth Alderman, MD, FAAP
Parents are the first and most influential sex educators for teens. It's important to learn ways to guide them toward safe and healthy choices in relationships. This includes knowing how to avoid pregnancy and sexually transmitted infections (STIs). They need accurate and complete information about contraception from a trusted source–you!
Providing information for healthy choices
The American Academy of Pediatrics (AAP) recommends parents talk with their adolescents about abstinence (not having sexual intercourse), as well as reliable contraception and condom use.
The AAP also recommends that pediatricians spend one-on-one time with adolescents starting at the 11- to 13-year-old checkups. The pediatrician will ask about sexual behaviors, and, if indicated, talk with the young person about birth control and ways to prevent sexually transmitted infections. Time alone with the pediatrician to talk about sensitive topics should continue yearly across adolescence. Many pediatricians can provide or prescribe contraception in the office; others give referrals to other providers and resources in the community.
Contraceptives for medical treatment
If you child has a gynecological condition, their pediatrician may also recommend hormonal contraceptives for medical treatment. Common conditions treated with hormonal contraceptives include heavy menstrual bleeding, painful periods, iron deficiency anemia, irregular menstrual bleeding and polycystic ovarian syndrome. Acne can also be treated with hormonal contraceptive pills.
Long-acting reversible contraceptives: IUDs & implants
Long-acting reversible contraceptives (LARCs) include contraceptive implants and intrauterine devices (IUDs). LARCs are the most effective contraceptives to prevent pregnancy. Less than 1% of users become pregnant during the first year using them. Your pediatrician may also recommend hormonal IUDs or implants for heavy or painful periods. The hormonal IUD can also be used to stop periods.
Teens who use LARCs, should also use a condom or other type of barrier protection during sexual activity to prevent sexually transmitted infections.
What it is:
A thin, flexible plastic implant that contains a progestin hormone called etonogestrel, which prevent the ovary from releasing an egg. The implant is about the size of a matchstick. It is placed under the skin (subdermal) of the upper arm.
Nearly 100% effective at preventing pregnancy with typical use.
Provides safe, long-term birth control.
Adolescents don't have to remember to do anything every day, week or month to stay protected from unintended pregnancy.
Does not need to be replaced for 3 to 5 years.
Intrauterine device (IUD)
What it is:
A small, flexible, T-shaped birth control device that is inserted into the uterus by a health care provider. There are two types: the copper IUD, which does not contain hormones, and the levonorgestrel (hormonal) IUD, which contains a progestin hormone.
- Provides safe, effective long-term birth control.
- The copper IUD is up to 99% effective and the levonorgestrel IUD is more than 99% effective for preventing pregnancy.
- Don't have to remember to do anything every day, week or month to stay protected from unintended pregnancy.
- The copper IUD does not need to be replaced for 10 to 12 years, and the levonorgestrel IUD does not need to be replaced for 3 to 8 years.
- May have less cramping and lighter periods with the levonorgestrel IUD. Many adolescents stop having periods altogether.
- Both IUDs can be used for emergency contraception (see more, below).
Can cause pain or cramping for a short time after insertion.
Levonorgestrel IUD may include irregular bleeding or spotting. This often gets better over time.
Copper IUD may lead to increased menstrual cramping, spotting and heavier bleeding. This usually improves over time
There is a very small risk of infection or perforation with insertion of an IUD.
In addition to the implant and levonorgestrel IUD, hormonal contraceptives come in a variety of forms—pill, patch, injection and vaginal ring. All are more than 90% effective in preventing pregnancy. They should be used with a condom or other type of barrier protection to prevent sexually transmitted infections.
Progestin injection (DepoProvera)
96% effective at preventing pregnancy with typical use.
Long-lasting protection; only requires visits to the doctor every three months.
The shot also protects against endometrial cancer and iron deficiency anemia.
May have less cramping and lighter periods. Many teens stop having periods after several doses.
Contraceptive vaginal ring
What it is:
The contraceptive vaginal ring has combined progestin and estrogen hormones (etonogestrel/ethinyl estradiol) that prevent the ovaries from releasing an egg. You place the ring in your vagina once a month. It stays in place for 3 weeks and is then removed for a week. During that week, the user has a period.
Some users forget to replace the ring each month.
May cause headaches, nausea, vaginal discharge or breast tenderness.
May increase the risk of blood clots.
What it is:
There are two combined estrogen and progestin contraceptive patches (ethinyl estradiol and either norelgestromin or levonorgestrel). The hormones are absorbed through the skin (transdermal), and prevent the ovaries from releasing an egg. You remove the patch and put on a new one each week for three weeks. Then, you do not wear a patch for one week. During that week, you have a period.
The patch is less effective for people with overweight or obesity; these individuals should talk to their health care providers about the patch.
Some users forget to change the patch each week.
May increase the risk of blood clots.
Other people might see the patch if it is not covered by clothes. This may bother some teens.
May cause headaches, nausea, skin irritation or breast tenderness.
Combined oral contraceptive pills
What they are:
Combined oral contraceptive pills contain both estrogen and a progestin, and are taken daily. They come in a variety of formulations, with different progestins, different doses of estrogen and different lengths of time between periods.
Serious but rare side effects may include blood clots and stroke.
May cause headaches, nausea or breast tenderness.
Must be taken every day. This can be hard for some teens to remember. The health care provider will explain what to do if a dose is missed.
Progestin-only oral contraceptive pills
May be less effective at preventing pregnancy than combination oral contraceptive pills.
May cause irregular bleeding or spotting, especially during the first few months of taking them.
Fewer non-contraceptive benefits like improved acne.
Over-the-counter birth control pills
A progestin-only pill containing norgestrel is the first nonprescription birth control pill approved
by the U.S. Food & Drug Administration. It is expected to be sold over-the-counter (OTC) at stores and online in 2024. There will be no minimum age limit; so, like condoms and emergency contraception, adolescents will be allowed to purchase the new OTC pill.
The new norgestrel OTC pill is similar to the norethindrone progestin-only pill: it needs to be taken at roughly the same time every day, has no hormone-free interval, and its main side effect is irregular bleeding and spotting.
Barrier methods of contraception
Barrier methods are hormone-free methods to prevent pregnancy and include condoms, contraceptive gels and spermacides, along with diaphragms and cervical caps. Condoms also prevent sexually transmitted infections and pregnancy.
Because sexually transmitted infections are common among teens, it is recommended that teens use condoms together with more effective hormonal contraceptive methods.
External condom (male condom)
What it is:
A latex or synthetic (nitrile or polyurethane) sheet that is a barrier users place over the penis, vulva, vagina, mouth, anus or any part of the body.
Contraceptive gel & spermicides
What they are:
A spermicide is a gel, cream or foam that is applied inside the vagina before having sex. Spermicides contain nonoxynol-9, a chemical that is toxic to sperm that can be used with other methods to help prevent pregnancy. Phexxi is a new prescription contraceptive gel that raises the acidity in the vagina, which makes it harder for sperm to swim.
Not as effective at preventing pregnancy as other forms of contraception when used alone. (Nonoxynol-9 is 79% effective; Phexxi's manufacturer reports a typical use effectiveness of 86%.)
No protection against sexually transmitted infections. In fact, among populations at high risk for HIV, nonoxynol-9 may increase HIV risk.
Phexxi must be applyed immediately before, or up to an hour before, sexual intercourse and then reapplied every afterward.
Emergency contraception can work after sexual intercourse, but timing is important. All forms of emergency contraception are more likely to prevent pregnancy if used as soon as possible after sex (ideally within six hours of intercourse). Emergency contraception will not interfere with an established pregnancy.
Types of emergency contraception currently available:
Levonorgestrel (Plan B Onestep, NextChoice) is an oral form of emergency contraception medicine that contains the same type of progestin hormone as combined oral contraceptives. Levonorgestrel is available over-the-counter as an emergency contraception without a prescription or age restrictions, so adolescents can access it.
Ulipristal Acetate (Ella) is another emergency contraception medicine, but it is only available with a prescription.
Having an IUD placed within five days of sexual intercourse is another emergency contraception option. This needs to be done by a doctor, but it stays in place and continues to help prevent pregnancy.
Withdrawal, abstinence & periodic abstinence
In withdrawal, the penis is taken out of the vagina before ejaculation. It is a difficult skill for young people to learn. Also, it does not protect against STIs, as the penis releases fluids into the vagina before ejaculation. It is only 78% effective at preventing pregnancy in adults (adolescent data is not available).
Fertility awareness natural birth control method
With fertility awareness (also called periodic abstinence or "rhythm method") approaches, people keep track of their periods, take their temperature each morning and inspects the color and/or texture of cervical mucus every morning. During the week that they have signs of ovulating, they do not have sex. Fertility awareness places a high responsibility on users. Also, it may be less effective for adolescents, since their periods are often irregular and ovulation may not be predictable. Fertility awareness mobile apps are available, but have not been tested in adolescents.
As a contraceptive method, abstinence is 100% effective when used perfectly. However, in national surveys, many adolescents who plan to be abstinent become sexually active, making the actual real-world effectiveness much lower. Becaues of this, we should not rely on abstinence counseling alone. Instead, we should provide teens with complete sexual health information including birth control.
It may feel awkward to talk with your adolescent about contraception, but it is an important part of protecting their health and well-being. Your pediatrician is available for support and guidance.
About Dr. Ott
Mary A. Ott MD MA, FAAP, is board-certified in Pediatrics and Adolescent Medicine. She is a Professor of Pediatrics at the Indiana University (IU) School of Medicine and provides health care at Riley Hospital at IU Health. Her research includes implementation sciences approaches to community-based adolescent pregnancy prevention, adolescent contraceptive access, research ethics with vulnerable populations, and global adolescent health. Dr. Ott sits on the Adolescent Subboard for the American Board of Pediatrics and the PROS steering committee for the American Board of Pediatrics. She is on the editorial boards for Perspectives in Sexual and Reproductive Health and the Journal of Pediatrics, and consults on adolescent health policies and programs locally, nationally and internationally.
About Dr. Alderman
Elizabeth M. Alderman, MD, FAAP, is Chair of the American Academy of Pediatrics Committee on Adolescence. Dr. Alterman is also a Professor of Pediatrics and a Professor of Obstetrics & Gynecology and Women's Health at the Albert Einstein College of Medicine. She is also Chief of the Division of Adolescent Medicine at the Children’s Hospital at Montefiore.