with Karen Teelin, MD
Q Why are the rates of sexual activity among American teens the same as in other developed countries, but our rates of teen pregnancy and abortion are higher?
A “That’s partially because of the use of highly effective contraception in other countries.
“There is a 2011 Centers for Disease Control and Prevention study showing 50 percent of teens by 12th grade have had sex, and if you go up to age 20, it’s about 70 percent. There is a decreasing age of menarche (age at a woman’s first period) and an increasing age of first marriage, so there is a longer period of fertility when women need birth control.
“Eighty to 82 percent of teen pregnancies in America are unplanned. It’s a huge public health problem and a very stubborn public health problem and a difficult one to address. Part of the answer, really, is education and contraception.”
Q What is the most effective contraceptive?
A “The LARCs — long-acting reversible contraceptives — are as effective as sterilization, but they are reversible. That would include the implant and two types of intrauterine devices.
“The current implant is one little rod, a couple centimeters long. It goes into the arm. It’s called Nexplanon, and it releases a small amount of progesterone. It lasts for three years. The procedure to implant it is very simple. It takes about 5 minutes. It hurts as much as getting a shot would, or even less than that. Once it’s in there you can completely forget about it for three years.
“The IUD is a small T-shaped device a couple centimeters long that is inserted by a doctor into the uterus. It can be put in teenagers, young women or women who have had children or women . It stays in the uterus. There is one with no hormones that stays in for 10 years. The progesterone IUDs release a small amount of progesterone locally. The Mirena will last five years, and the Skyla, which is smaller and has less progesterone, and will last three years. They’re both highly effective.
“Back in the ‘70s and early ‘80s there was an IUD (the Dalkon Shield) that had been associated with an increased risk of pelvic infections, however those studies were fraught with methodological errors. In the more current studies, there is actually a decreased risk of pelvic infections with some of these IUDs.
“There are noncontraceptive benefits, too. The Mirena, for instance, can reduce menstrual bleeding and menstrual pain, and many women don’t get periods on it. That is one of the reasons they’re so popular.”
Q Are other methods still used?
A “We have a lot of young women who choose the pill, and it can work, but you do need to take it every day.
“The patch is like a birth control pill, except instead of taking it every day, you have a sticker, a little bit bigger than a Bandaid, that you change every week. Some people really like the patch because you don’t have to think about it every day — but you have to remember it each week.
“The shot is commonly referred to as Depo, (short for Depo-Provera.) That is a shot that you would get every 12 weeks. That is also progesterone-only, like the implant, but there might be more side effects.
“The ring is like the birth control pill, with the same medicines of estrogen and progesterone, but it is inserted into the vagina, and it stays for three weeks, and it releases a small amount of the hormones. Some people really like that. The teens can put it in themselves. It’s a small ring. It’s flexible. You just sort of bend it and put it in.”
Listen to an interview with Dr. Teelin on HealthLink on Air