A 15-year-old girl is brought to the office by her mother to discuss contraception. The patient recently became sexually active with her boyfriend of a year and uses condoms most of the time. She revealed to her mother that she has been sexually active, and they decided that she needs a reliable form of contraception. The patient reports no vaginal spotting or abnormal vaginal discharge. She has no chronic medical conditions or previous surgeries. She started menstruating at age 12; menses occur every 29 days and consist of 2-3 days of light bleeding and no cramping. Family history is noncontributory. The patient takes no medications and does not use tobacco, alcohol, or illicit drugs. She does well in school and is a member of the debate team. Blood pressure is 120/80 mm Hg and pulse is 68/min. BMI is 23 kg/m². The rest of the physical examination is unremarkable. Sexually transmitted infection screening is performed. Urine pregnancy test is negative. In addition to condom use, which of the following is the best contraception option for this patient?

Question

Quizplus · Accepted Answer

Explanation: 11ec2b69_c141_d4b7_8f63_edf8bd98a41c_MD0005_00 Most adolescent pregnancies are unintended as few adolescents use effective contraception regularly. Barriers to contraception use in adolescents include poor access, prohibitive cost, misconceptions about the risk of pregnancy, concerns about confidentiality, and miseducation about contraception side effects. Because barrier methods (eg, condoms) are the only type of contraception that prevents sexually transmitted infections, all patients should be advised to use them. However, because condoms are associated with a significant failure rate, an additional contraceptive method is indicated to further decrease the risk of pregnancy. Long-acting reversible contraception (LARC) is the first-line contraceptive method for adolescents given its efficacy (>99%), safety, high rate of satisfaction, long duration of use, and quick return to fertility on discontinuation. LARCs include intrauterine devices (IUDs) and contraceptive implants. The copper-containing IUD is effective for up to 10 years, the progestin-releasing IUD for 5 years, and the subdermal implant for 3 years; however, all can be removed earlier. The progestin-releasing IUD is recommended for patients with heavy menstrual bleeding and dysmenorrhea. The copper-containing IUD is recommended for patients who have light menstrual periods, desire long-term contraception, and wish to avoid hormonal contraception. Contraindications to IUD insertion include uterine anomalies and active pelvic infection. Nulliparity is not a contraindication to IUD use. copper-containing IUD (Choices A and D) Neither the contraceptive patch nor oral contraceptives are as effective as LARCs (91% vs. 99%), even with ideal use. Method failure is commonly due to improper use or missed doses. (Choice C) Depot medroxyprogesterone, an intramuscular injection given every 3 months, has a lower efficacy rate (94%) than a LARC. In addition, the need for serial injections decreases the likelihood of long-term continuation. (Choice E) Spermicides immobilize sperm by damaging cell membranes. Their effectiveness is low when used alone (eg, 80% failure rate); therefore, spermicides should be used with cervical caps or diaphragms. In addition, spermicides may cause damage to genital epithelium and increase susceptibility to sexually transmitted infections. Educational objective: Long-acting reversible contraceptives (eg, intrauterine devices, subdermal implants) are first-line contraceptive methods for adolescents. They are safe, are effective, and result in a high rate of satisfaction, a long duration of use, and a quick return to fertility on discontinuation. References: Contraception for adolescents. (http://www.ncbi.nlm.nih.gov/pubmed/25266430) Long-acting reversible contraception: an essential guide for pediatric primary care providers. (http://www.ncbi.nlm.nih.gov/pubmed/28292451)

A 15-Year-Old Girl Is Brought to the Office by Her