Teen OC use is more than contraception
By Anita Brakman, MS
Director of Education, Research & Training
Physicians for Reproductive Choice and Health
New York City
Melanie Gold, DO, FAAP, FACOP
Clinical Professor of Pediatrics
University of Pittsburgh School of Medicine
Staff Physician
University of Pittsburgh Student Health Service
Combination oral contraceptives (OCs) are the most common form of hormonal contraception used by sexually active females ages 15-19, with 56% of this group reporting ever having used OCs, and 30% reporting use at last intercourse.1 New research from the Guttmacher Institute in New York City found that a significant percentage of women report they use OCs for their noncontraceptive benefits rather than for pregnancy prevention. This group includes many young women and adolescents, some of whom have never had sexual intercourse and some of whom are not currently sexually active.
While pregnancy prevention remains the primary reason for taking OCs among the 18% of women who report current use, 14% of current users (1.5 million women) report they take the medications solely for noncontraceptive reasons. More than half (58%) of OC current users report using them for more than one reason, indicating most users consider the noncontraceptive benefits of OCs to be at least part of the reason for use. Additionally, 9% of all OC current users report they are not currently sexually active (within the past three months). Most (86%) of this group report noncontraceptive reasons for using OCs.2
Nine percent of virginal women report using OCs in the past three months. Of this group, 95% do so for noncontraceptive reasons. Most virginal women are teens, and 8% of virginal 15- to 19-year-old female adolescents report that they have taken OCs in the past three months. The Guttmacher study found the following noncontraceptive reasons for using OCs: 54% use OCs for menstrual pain, 33% for menstrual regulation, 30% for reducing acne, and nearly 20% for other reasons.2
Menstrual issues are key
Early and middle female adolescents are a population that is more likely to use OCs for noncontraceptive reasons because they experience high rates of menstrual-related health issues and might be less likely to be sexually active compared to older women. Eighty-two percent of 15- to 19-year-old current OC users report using OCs for reasons beyond contraception, and 33% report using OCs solely for noncontraceptive reasons. This number is in contrast to the pattern of use reported by older women; 90% of current OC users over age 20 report pregnancy prevention as the primary motivation for use.2
Because menstrual irregularities and disorders are more common during adolescence, it follows that many female adolescents use OCs to provide relief for dysmenorrhea, menorrhagia, oligomenorrhea, dysfunctional uterine bleeding, or other menstrual-related conditions. In some studies, up to 91% of female adolescents report painful periods.3,4
Women who wish to avoid menstrual-related health problems can eliminate the hormone-free interval of OCs to achieve continuous or extended cycling through a dedicated product or by altering the 21/7 or 24/4 regimens of regular OCs to provide relief from painful periods, cramping, heavy bleeding, or other symptoms that accompany periods such as migraines.5
OCs also protect against ectopic pregnancy; pelvic inflammatory disease; and ovarian, endometrial and colorectal cancer; and they might improve bone health in some women.6 High-dose OCs might protect against benign breast disease. OCs can also reduce anemia and treat dysfunctional uterine bleeding.6 Some OCs can also decrease premenstrual syndrome.7
The contraceptive patch and vaginal ring have similar components, properties, and side effects to OCs. Thus, women who desire relief from menstrual disorders or irregularities but prefer a method without a daily regimen might prefer to obtain noncontraceptive benefits from these hormonal methods.
The levonorgestrel intrauterine system reduces blood loss and anemia as well as cramping. It can be used to treat endometriosis or menorrhagia.7 Progestin-only methods can be used while breastfeeding, which may be beneficial for adolescent mothers wishing to delay subsequent pregnancies.8 The injectable contraceptive depot medroxyprogesterone acetate can reduce seizure risk in women with epilepsy, reduces sickle cell crises in women with sickle cell anemia, and might protect against ovarian and endometrial cancers.8
Noncontraceptive benefits such as cancer prevention or even diminished menstrual symptoms also might provide additional motivation for female adolescents to continue and adhere to a method. This motivation can be especially useful for teens who might have difficulty tolerating side effects and adhering to a method requiring daily maintenance.
All of this data provides insight into the noncontraceptive benefits that young women seek from contraceptives even when they are have never been or are not currently sexually active. In caring for female adolescents who use OCs or request to start any contraceptive method, this information highlights the necessity of taking a family, medical, dermatologic, menstrual, and sexual history to fully understand a patient's needs. This data also might be helpful for alternative coding when a religious insurance plan will not cover contraception for pregnancy prevention, but it might allow coverage for medical indications.
References
- Martinez G, Copen CE, Abma JC. Teenagers in the United States: Sexual activity, contraceptive use, and childbearing, 2006–2010 National Survey of Family Growth. National Center for Health Statistics. Accessed at http://www.cdc.gov/nchs/data/series/sr_23/sr23_031.pdf.
- Jones RK. Beyond Birth Control: The Overlooked Benefits of Oral Contraceptive Pills. New York: Guttmacher Institute; 2011.
- Andersch B, Milsom I. An epidemiologic study of young women with dysmenorrhea. Am J Obstet Gyencol 1982; 144:655-660.
- Parker M, Sneddon A, Arbon P. The menstrual disorder patterns of teenagers (MDOT) study: Determining typical menstrual patterns and menstrual disturbance in a large population-based study of Australian teenagers. BJOG 2010; 117:185-192.
- Gold MA, Duffy K. Extended cycling or continuous use of hormonal contraceptives for female adolescents. Curr Opin Obstet Gynecol 2009; 21:407-411.
- Burkman R, Schlesselman JJ, Zieman M. Safety concerns and health benefits associated with oral contraception. Am J Obstet Gynecol 2004; 190 Suppl 4:S5-22.
- Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit. FFPRHC Guidance (April 2002). The levonorgestrel-releasing intrauterine system in contraception and reproductive health. J Fam Plann Reprod Health Care 2004; 30:99-108.
- Trussell J, Guthrie KA. Choosing a contraceptive: Efficacy, safety, and personal considerations. In: Contraceptive Technology. 20th ed. Eds Hatcher RA, Trussell J, Nelson A, et al. New York: Ardent Media, 2011.
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