Contraceptive care for Canadian Youth

Question 1

What percentage of Canadian youth are sexually active by 17 years?

Answer 1

more than 50%

Question 2

What is the method of first choice for contraception?

Answer 2

LARCs

• First tier: long-acting reversible contraceptives (LARCs)
  
  • Copper IUD, hormone-releasing intrauterine systems (IUSs), subdermal progestin-releasing implants
• Second tier: hormonal contraceptives
  
  • daily: COC and POP
  • Weekly: transdermal patch
  • Monthly: vaginal ring
  • Quarterly: DMPA (depot medroxyprogesterone acetate injectable contraceptive)
• Third-tier contraceptives: used at time of intercourse
  
  • male & female condoms
  • diaphragm
  • cap
  • sponge
  • spermicide
  • withdrawal
  • Emergency contraception (“near the moment” method)
• using a first or second-tier method with a third-tier method, or using two third-tier methods together, decrease contraceptive failure substantially
• condom use should always be encouraged to reduce risk for STIs

Question 3

What are contraindications to contraception?

Answer 3

1. BMD
   - DMPA is associated with decreased bone mineralization. There is a rebound increase in BMD after DMPA is discontinued.
   - pills containing 30-35 mcg ethinyl estradiol should be prescribed (lower doses associated with poorer bone mineralization)
2. Thromboembolic events and stroke
   - absolute contraindication is migraine with aura
3. Body weight
   - little evidence to suggest consistent association between contraceptive use and weight gain
   - DMPA reported to have weight gain
   - patch has reduced effectiveness > 90kg

Question 4

Which contraception has reduced effectiveness in overweight individuals?

Answer 4

• transdermal patch has reduced effectiveness in women > 90kg
  
  • these women should be offered alternate contraceptive method or counselled regarding use of back up

Question 5

How do you start contraception?

Explain quick start method.

Answer 5

1. Quick start
   - test for pregnancy in patients who are not in first 7 days after start menstrual period
   - start contraception that day if test i negative.
   - back up with condoms advised for minimum 7 days (14 days if she received uliprsital for EC) because ovulation may still occur in first several days following contraception initiation
   - 2nd pregnancy test 21 days later
2. Year long prescription
3. no pelvic exam needed
4. Counsel on condom use
5. Inform youth about emergency contraception options.