Providers examine teen contraceptive use
Chalk it up to increased condom use, the rise of injectable and implant contraceptives, or a leveling-off in teen sexual activity, but statistics now show that America’s teens were less likely to become pregnant in 1997 than at any time since 1976, when national data on pregnancy rates first became available.1
The teen pregnancy rate fell 19% from its all-time high in 1991 to reach a record low of 94.3 pregnancies per 1,000 women ages 15-19 years in 1997, according to the new report from the National Center for Health Statistics in Hyattsville, MD. The report analyzes the most recent data in tracking the effects of changes in sexual activity, marriage patterns, contraceptive use and attitudes, and economic and educational opportunities on pregnancies and pregnancy rates in the United States.
Survey respondents to the Contraceptive Technology Update 2001 Contraception Survey report that use of the contraceptive injectable Depo-Provera (depot medroxyprogesterone acetate [DMPA], marketed by Pharmacia Corp., Peapack, NJ) continues to be a popular choice among teens.
According to Linda Hedlund, MD, medical supervisor at Arlington (VA) County Department of Human Services, DMPA is well-liked among teens in her practice. More teens use oral contraceptives, though, she notes.
The recent introduction of the monthly injectable Lunelle, also marketed by Pharmacia Corp., will provide yet another option for adolescents. (For more information on Lunelle, see CTU’s special news bulletin inserted in the November 2000 issue, the article in the December 2000 issue, p. 144, and the special Contraceptive Technology Reports inserted in the March 2001 issue. Also see the article on Lunelle use in this issue, p. 102.)
DMPA is OK for teens
Almost 97% of 2001 CTU survey respondents say they will prescribe DMPA for young teens. This figure rose slightly from the 94% figure recorded in 2000. (See chart, below.)
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What precautions do providers take in prescribing DMPA, given the possibility that it may have a diminishing effect on bone mass? Providers continue to examine DMPA’s impact on bone mass following research published in the early 1990s, which indicated that users of DMPA may develop decreased bone density.2 A subsequent study of some of the original DMPA users who discontinued the method found that bone density tended to increase after the method was stopped.3 The concern for adolescent bone health comes from the fact that nearly half of adult bone mass is formed during this time.4
About 50% of providers participating in the 2001 survey say they inform patients of the possible side effect. About 10% do not take any special precautions, while about 5% offer estrogen replacement therapy to those who exhibit low levels of the hormone. (See chart on precautions to take in prescribing DMPA, given the possibility that it might diminish bone mass, below.)
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More than 30% of those responding to the 2001 survey use a variety of methods to address the bone mineral density issue. Most providers note they counsel on increased calcium intake.
According to calcium guidelines recommended in 1997 by the Washington, DC-based National Academy of Sciences, adolescents should take in 1,300 mg of calcium each day.4 Data from the Washington, DC-based U.S. Department of Agriculture shows that about eight out of 10 teen girls fail to meet even the former daily level of 1,200 mg.
Up the calcium intake
All adolescents need to increase calcium intake, says Anita Nelson, MD, professor in the obstetrics and gynecology department at the University of California at Los Angeles (UCLA) and medical director of the women’s health care clinic and nurse practitioner training program at Harbor-UCLA Medical Center in Torrance.
What are some ways you can help teens boost their calcium levels? Stress the intake of such food items as dark green leafy vegetables, including broccoli, kale, and bok choy; calcium-fortified foods and juices; soy milk; and tofu made with calcium. Also use the following suggestions, offered by the Rosemont, IL-based National Dairy Council:
• Whip up a fruit and yogurt smoothie.
• Grab a milk (or a milkshake) to go at the drive-through window.
• Add a slice of cheese to a sandwich.
• Go for a string cheese snack. (See the enclosed patient handout on calcium and osteoporosis, available in both English and Spanish versions.)
References
1. National Center for Health Statistics. Trends in Preg-nancy Rates for the United States, 1976-97: An Update. Hyattsville, MD: Public Health Service; 2001.
2. Cundy T, Evans M, Roberts H, et al. Bone density in women receiving depot medroxyprogesterone acetate for contraception. BMJ 1991; 303:13-16.
3. Cundy T, Cornish J, Evans MC, et al. Recovery of bone density in women who stop using medroxyprogesterone acetate. BMJ 1994; 308:247-248.
4. National Dairy Council. New guidelines widen teen calcium gap. Press release. Rosemont, IL; Aug. 13, 1997.
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