Birth control education is important for teenagers and young adults alike.  Many teenagers and young adults are faced with unwanted pregnancy every year due to lack of knowledge or improper use of birth control methods. According to the statistics by Guttmacher Institute (2010), a non-profit organization, teenage pregnancy increased by 3% in 2006, the first increase in the last 10 years.

Birth control education is essential, not only to avoid unwanted pregnancy but also to prevent various STD’s (sexually transmitted diseases). While some birth control methods are available over the counter in pharmacies, many of them require a prescription from a doctor or from a medical professional in a clinic. Hesitation and embarrassment to visit a doctor becomes a barrier for teenagers to learn more about birth control methods.

Abstinence (avoidance of sexual intercourse) is the most effective option for birth control.  However, some fundamental knowledge about birth control methods will help teenagers make good decisions and avoid unwanted consequences. Additional information that is helpful includes: birth control options, side effects of certain methods, risks, and ease of use.

Birth Control Methods

• Abstinence
• Rhythm or withdrawal methods
• Hormonal medications
• Barrier methods
• Intrauterine devices

Abstinence

Clearly this is the most effective option.  Teenagers and young adults are under significant peer pressure to become sexually active at an early age.  Abstinence can be encouraged by a caring family and establishing excellent role models for children.  Teenagers should be reassured that abstinence is an honorable and safe option.

Rhythm or withdrawal methods

Attempting to avoid intercourse at times of high fertility is a method of birth control called the "rhythm method."  The "withdrawal method" involves attempting to interupt intercourse at the time of ejaculation.  These are the most unreliable and ineffective methods available.

Hormonal Methods

Hormonal methods involve the use of medications (hormones) which prevent the ovary from releasing an egg. When an ovum or ova (female egg) is not released, fertilization cannot take place.  This method is up to 99.9% effective.  Nonetheless, hormonal methods have potential side effects and do not prevent STD’s.  Some of the side effects of hormonal methods are: irregular menstrual cycle, weight gain, loss of bone density, acne, headaches, mood swings, dizziness, hair loss, stomach bloating, high blood pressure, fatigue, etc. Some of the hormonal methods available are:

Oral contraceptives

Oral contraceptives are the most widely used method of birth control in US.  They are available in easy-to-use packs containing 21 or 24 active pills. Oral hormone medications are effectively abdsorbed by the body and have potential systemic side effects.  These should be discussed with your doctor.  One significant risk includes the development of blood clots.  This risk is higher in women who smoke.  Though oral contraceptives are proven to be the most effective form of birth control, women and young girls should be aware of the risks before choosing this birth control method.

Skin Patch

The skin patch is an adhesive birth control patch which is applied once a week for 3 consecutive weeks. The patch applied for the 4th week contains no active medication and allows for a regular menstrual cycle. The estrogen level in the patch is higher when compared to the low-dose contraceptive pill and hence may cause more side effects. However, this is an effective birth control method when used properly. The patch can be applied on the upper back, buttocks, lower abdomen and back of the arm.

Vaginal ring

The vaginal ring is a flexible plastic ring inserted into the vagina to prevent pregnancy. It has to be worn for period of 21 days and then removed for 7 days. A new vaginal ring needs to be inserted every month.  A word of caution is that vaginal rings do not work immediately and require 7 days to be in effect. Therefore another birth control method should be used until the time the ring is active. As long as the female is comfortable using it, vaginal ring is an effective form of birth control.

Birth control shot

The birth control shot is given once every 3 months and is given in the buttock or upper arm. However, delays in application of the shot can result in pregnancy.

Implants 

A contraceptive implant is an insertion of a small rod in the upper arm under a local anesthesia. This is effective for 3 years and needs to be removed by a clinician after this duration.

Barrier Methods

The barrier methods work by preventing sperm from the reaching the female egg. These are temporary methods used during sexual intercourse but some may be applied several hours prior to intercourse. The different types of barrier methods are condoms (male/female), spermicides, diaphragm, cervical cap and sponge. Condoms can be purchased at drug stores and are an effective method for decreasing the risk of STD transmission and unwanted pregnancies. Spermicides are chemicals inserted into the vagina to kill sperm. They are available in the form of gel, foam, thin films, suppositories and cream.The diaphragm (a dome-like rubber material), the sponge (a doughnut-shaped device coated with spermicide) and the cervical cap (a thin latex dome shaped cap) are prevention methods which can be inserted into the vagina to prevent sperm from entering the uterus. Purchase of a diaphragm or cervical cap requires a prescription from a doctor.

Intrauterine Device

The intrauterine device (IUD) is T-shaped plastic device which is inserted and attached to the inside of the uterus. These are available in 2 types: copper (lasts up to 10 years) and hormonal (lasts up to 5 years).  Sometimes the shape and the size of the female’s uterus may not permit the use of IUD. Many women do not use IUD because continued placement of the device must be verified on a regular basis.  Some IUD's have a string that can be felt by inserting the finger into the vagina, to verify the string, and therefore the IUD, is in place. Females with abnormal menstrual bleeding may not be good candidates for an IUD.  IUD's are generally considered to be safe for teenagers and young women.

Emergency pill

The emergency pill or the ‘Morning After’ pill is a high-dose contraceptive pill used after an unprotected sex.  This pill can be used within 5 days of the unprotected sex. However, it is best when taken within 24 hours. Emergency pills are available without a prescription for those 18 years or older. This pill should not be considered as a regular contraceptive method but may be considered as a rescue birth control method.

Written by: Irene J

Edited by: Michael K. Davis, MD

References

1. Guttmacher Institute, 2010, U.S. Teenage Pregnancies, Births and Abortions: National and State Trends and Trends by Race and Ethnicity, http://www.guttmacher.org/pubs/USTPtrends.pdf
2. ACOG, The American Congress of Obstetricians and Gynecologists, Birth Control, http://www.acog.org/publications/patient_education/bp112.cfm
3. USHealths, Health news for Americans, Women, Teens On The Pill Risk Breast Cancer, Major Study Says, http://ushealths.net/2010/09/women-teens-on-the-pill-risk-breast-cancer-major-study-says/
4. ACOG, 2007, Intrauterine Device, http://www.acog.org/publications/patient_education/bp014.cfm
5. John Sanford, 2010, Teens advised to consider benefits of IUD use for birth control, http://med.stanford.edu/ism/2010/june/iud-0621.html