Contraception for teens: Whats new? Ppt Powerpoint Presentation slides-Medical Slideshow Contraception Today: Whats new?

Contraception for teens: Whats new?

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Slide 1 :

Contraception for teens:What’s new? Tony Ogburn MD University of New Mexico

Slide 2 :

Conflicts of interest Paragard IUDs for immediate PP insertion study “Consultant” for Organon to train providers on Implanon insertion Parent of two teens

Slide 3 :

Objectives At the completion of this presentation the learner will: - Be able to discuss the issues and barriers with teens and contraception - Understand the need for increased use of better contraceptive methods in teens - Be aware of several “new” contraceptive methods for use in teens

Slide 4 :

What would you recommend? Carrie is a 17 yo G1P0 undergoing a D&C for a 9 week anembryonic pregnancy. Two lifetime partners, current x 4 months. Uses condom “most of the time”. Pills Patch/Ring Implanon Depo-Provera IUD Condoms

Slide 5 :

The problem Teen pregnancy in the US Highest of all industrialized nations U.S 68/1000 England 44/1000 Healthy People 2010 goal 43/1000 Approximately one million teen pregnancies annually 90% unplanned Decrease by almost half in the past decade Due to Increased/improved use of contraceptives (75%) Delay in onset of intercourse Not due to an increase in abortions

Slide 6 :

Why are we the worst? Lack of access Most other countries have universal health care – we don’t!! Highest costs for teens among all nations (Darroch, 2001) Even in populations with coverage (e.g. IHS) options are often limited We don’t use enough of the “best methods” - IUDs!!!!

Slide 7 :

Why are we the worst? Abstinence until death education Hundreds of millions of dollars spent to convince teens… Sex before marriage will kill you or at least ruin your life Contraception doesn’t work STIs are deadly and can’t be prevented or treated

Slide 8 :

A better message?

Slide 9 :

Why are we the worst? Perception that most teens don’t use contraception Wrong! They don’t use contraception correctly!!

Slide 10 :

Teens and contraception Over 50% report they were using contraception in the month they conceived (Moore 2002) Only 12% of sexually active teens report not using contraception (NSFG 2002) Teen pregnancy rates 54% due to contraceptive “failure” 46% due to non use of contraception (Santelli 2006)

Slide 11 :

Lack of use Privacy, fear of a lack of confidentiality (Reddy 2002, Guttmacher 2002) Fear of side effects Weight gain, acne, bleeding, future infertility

Slide 12 :

If many are contracepting…What’s wrong? Perfect use How well the method prevents pregnancy if used as directed Typical use How well the method prevents pregnancy when used in real life

Slide 13 :

Common methods used by teens OCPs 20-25% of teen contraceptors Up to 50% report incorrect use At least half discontinue within one year Typical use efficacy 70-92%

Slide 14 :

Common methods used by teens Condoms Up to 60% of teen contraceptors (some dual users) To be effective must … Use them every time Use a new one every time Put on correctly Hold base on withdrawal Typical use efficacy 80% at best

Slide 15 :

Common methods used by teens Depo Provera Very high discontinuation rate in teens Side effects Repeated visits required Cost Unwarranted concerns of providers and patients about bone health

Slide 16 :

Methods to consider Implanon ® Nuvaring ®

Slide 17 :

Methods to consider Intrauterine contraceptive devices Mirena intrauterine system Levonorgestrel 5 years Paragard Copper containing 10 years

Slide 18 :

Implanon ™ FDA approved July 2006 Available worldwide since 1997 Approximately 3 million implants inserted since 1998 Single rod implant (As opposed to six for Norplant) 68mg 3-keto-desogestrel (etonogestrel) Achieve ovulatory inhibitory levels within 8 hours of insertion

Slide 19 :

IMPLANON™ Rate-controlling membrane: (0.06 mm) 100% EVA 4 cm 2 mm Core: 40% ethylene vinyl acetate (EVA) 60% etonogestrel (68 mg) Release Rate: 60 ?g/day to 70 ?g/d initially then decreases to 25 ?g/d to 30 ?g/d by end of third year IMPLANON™ is not radio-opaque

Slide 20 :

Implanon ™ Mechanism of action Prevents ovulation Alters cervical mucous Efficacy – Highly effective .38 pregnancies/100 women years No data in women over 130% of ideal body weight

Slide 21 :

Implanon™ applicator

Slide 22 :

Implanon ™ Easy to insert >85% less than 1 minute Easy to remove One rod Different material than Norplant - doesn’t stimulate fibrosis 1.7% experience difficulty with removal

Slide 23 :

Implanon ™Side Effects Bleeding Very common 44% at 3 mo, 16% at 36 mo Irregular and unpredictable Variable throughout duration of use Total days of bleeding equal to non-users ~25% amenorrhea Most common cause of discontinuation

Slide 24 :

Implanon ™ Side Effects Weight gain 3.7 lbs/2 years Emotional lability Acne Headache Depression

Slide 25 :

Implanon ™Acceptability Discontinuation rates 12 months 22% 24 months 32% 36 months 39% One fourth of discontinuations were because patients desired pregnancy Thorough pre-insertion counseling decreases discontinuation rates

Slide 26 :

Implanon ™Summary Advantages Highly effective Reasonably high acceptability and continuation Disadvantages You must be trained by a certified trainer It’s expensive Bleeding is common

Slide 27 :

Nuvaring ® Combination of ethinyl estradiol and etonogestrel One size fits all 2 x 1/8 inches – roughly equivalent to 60mm diaphragm No specific placement requirements - just get it in the vagina!

Slide 28 :

Nuvaring ® Efficacy Perfect use 99% Typical use 92% Continuation – 1 year 68% Usage 3weeks in/ 1 week out Consider continuous use Out <3 hours OK

Slide 29 :

Nuvaring ® Side effects – similar to combination OCPs but less frequent/severe Bleeding 2-6% Acceptability (Novak 2003) Baseline 66% preferred OCPs 3 months 81% preferred ring 97% would recommend to a friend Sex 85% of women, 71% of men never felt it Of those that felt it, 94% didn’t mind

Slide 30 :

Nuvaring ® Advantages Better compliance, continuation than OCPs Excellent cycle control, minimal abnormal bleeding Easy to use continuously – avoid menses Discrete!

Slide 31 :

Intrauterine contraceptive devicesIUCDs We know they are the best choice for most women What about teens?

Slide 32 :

Slide 33 :

IUCDsThe expanded patient profile Package labeling not updated in 20 years FDA approved new labeling in 2005 for Paragard Evidence based Changes can be considered appropriate for Mirena too

Slide 34 :

Out with the old…

Slide 35 :

Out with the old…

Slide 36 :

IUCDs and Teens Concerns STDs/PID Future infertility Insertion/Expulsion Discontinuation Non-compliance with regular health care

Slide 37 :

STIs/PID We still suffer from the Dalkon Shield debacle Attributable risk Increases 6-fold in first 3 weeks post insertion Decreases to baseline after 3 weeks (Mohllajee, 2006) Limited data suggest that no difference in severity of PID with an IUCD in place (Grimes 2000) No studies of PID risk in IUD users vs non-users with an STI Mirena may decrease risk of PID

Slide 38 :

Infertility GC/Chlamydia infections cause PID/infertility, NOT IUCDs Case-control of 1895 women with infertility, with and without tubal occlusion, and currently pregnant women (Hubacher 2001) IUD use OR 0.9(0.5-1.6) Chlamydia OR 2.4(1.7-3.2)

Slide 39 :

Infertility Multiple studies IUCD discontinued for desired pregnancy Similar pregnancy rates to non users No difference in ectopic rate after IUCD use

Slide 40 :

Insertion/expulsion/continuation Not a lot of data Insertion – may be more painful/difficult Premedication/ripening may help Expulsion Two older studies reported 17-20% More recent studies range from 2-10% Continuation Similar to older, parous women

Slide 41 :

Non-compliance with regular health care Paternalism at it’s finest…

Slide 42 :

IUCDs Advantages All the same reasons they are a great choice for most women! Highly effective, discreet, long term method High continuation and satisfaction rates Disadvantages Slight increase in infection post insertion Provider insertion

Slide 43 :

Summary Teens are a high risk group for unintended pregnancy Most contracept, just not well Use of highly effective, less user dependent methods could have a dramatic impact on teen pregnancy rates

Slide 44 :

Now what would you recommend? Carrie is a 17 yo G1P0 undergoing a D&C for a 9 week anembryonic pregnancy. Two lifetime partners, current x 4 months. Uses condom “most of the time”. What contraceptive would you recommend? Nothing – discuss abstinence Pills Patch/Ring Implanon Depo-Provera IUD Condoms

Slide 45 :

Another teen Alissa is a 18 yo G3P2TAb1 who presents for an annual exam and refill on her OCPs. She recently had a medical abortion “because she ran out of pills”. Any more information? Issues? What would you recommend?

Slide 46 :

And one more… Tiffany is a 14 yo G0 who is brought in by her mother because she is concerned

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	SlidesOnline 1 Years ago. Category: other

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Weight gain, acne, bleeding, future infertility. If many are contracepting…Emotional lability; Acne more Weight gain, acne, bleeding, future infertility. If many are contracepting…Emotional lability; Acne; Headache; Depression. Implanon ™ Acceptability ... less

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