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July 2017

Long-Acting Reversible Contraception for Adolescents: A Review

Author Affiliations
  • 1Department of Pediatrics, Division of Child and Adolescent Health, Section of Adolescent Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York
  • 2New York–Presbyterian Hospital, Ambulatory Care Network, New York
  • 3New York–Presbyterian Hospital, Ambulatory Care Network, Center for Community Health and Education, School-Based Health Centers, New York
  • 4Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York
JAMA Pediatr. 2017;171(7):694-701. doi:10.1001/jamapediatrics.2017.0598

Importance  Adolescents have higher rates of unintended pregnancies than any other age group. Contraceptive implants and intrauterine devices (IUDs) are long-acting reversible contraceptives (LARCs) that are known to be highly effective in preventing pregnancy. New devices have recently been approved for use in adolescents, yet pediatricians may be less familiar with how to counsel adolescents about implants and IUDs.

Observations  LARC methods should be described in basic terms to adolescents, including hormone dose, method of insertion, and method of pregnancy prevention. Clinicians should appreciate the developmental stages of adolescents, discuss the most effective methods of contraception, and ensure confidentiality from their parents. Short-acting contraception methods (eg, oral contraceptives) can be used as a temporary bridge to provide coverage until a LARC method can be placed. The most common adverse effect of LARC is nuisance bleeding, which can be managed with short courses of oral contraceptives or nonsteroidal anti-inflammatory drugs.

Conclusions and Relevance  LARC devices constitute first-line contraceptive methods for adolescents. All clinicians, including pediatricians, can counsel about LARC even before suggesting an oral contraceptive or another less effective contraceptive method. Effective, confidential communication with sensitive language to inform adolescents of the different types of LARC is necessary to normalize offering LARC as a contraceptive option and improve its uptake among adolescents. Special clinical populations can also be offered appropriate contraceptive options inclusive of LARC.

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