Hormonal contraception.

Increased sexual activity among adolescents demands that the health care provider have a thorough understanding of contraceptive methods and application. In this article, the principles of hormonal contraception are discussed, providing relevant information for use in advising and managing the sexually active adolescent.

PIP: An updated review on oral contraception opens with history and mechanism of action and concentrates on clinical management of users, especially adolescents. Other types of hormonal contraception are mentioned in passing. Since the introduction of Enovid in 1960, the steroid dose of pills has fallen about 10-fold, reducing side effects and especially complications to the minimum. Despite this, the public is more suspicious than ever of the danger of pills. Orals work by preventing the estrogen surge, usually blocking ovulation, and reducing endometrial development. Currently the latest low dose pills are the triphasics, which offer the lowest total dose of both estrogen and progestin to date. Some of them have such low progestin content that estrogen side effects become a problem. Guidelines for patient selection, and patient management are listed and tabulated. The ideal pill user has a mature menstrual cycle, frequent sexual activity, poor compliance with other methods, a need for maximal protection and no contraindications such as history of risk of factors for thromboembolism, cancer, migraine, sickle cell disease, or depression. Lab tests, history, and a physical exam are recommended. Instructions and danger signals are listed. Estrogenic versus androgenic pills, how to deal with breakthrough bleeding, weight gain, breast pain, and other side effects are discussed. All complaints of headache should be seriously evaluated. Use of minipills, medicated IUDs, implants, vaginal rings and injectables are briefly noted.

Contraception for the adolescent.

The primary care physician is in an excellent position to counsel adolescents about contraception. However, an adequate understanding of the biologic and psychosocial development of this particular age-group is imperative. In addition, communication skills are necessary to advise adolescents on use of contraceptives. The goal in counseling the adolescent about sexuality is to instill a sense of sexual responsibility and to provide individualized instruction in selecting the appropriate birth control method. General factors to remember in selecting the proper method include motivation, moral-ethical responsibility, frequency of intercourse, side effects of the various contraceptive methods, and patient's preference.

PIP: This article provides guidelines for counseling adolescents about sexuality and contraception. The primary care physician who plays this role should have a basic understanding of the biologic and psychosocial development of this particular age group and develop the communication skills required to discuss sexuality with teenagers and their parents. Young adults respond best to health care professionals who show interest, understand their behavior, and make an effort to communicate. Contraception counseling involves discussion of 4 areas: the patient's sexual knowledge and activity, motives for and possible complications of sexual activity, the patient's concept of sexual responsibility, and physician-patient confidentiality. Oral contraception is the method most often requested by adolescents. While this method may be appropriate for highly motivated adolescents who engage in frequent sexual intercourse, patients with sporadic sexual activity may be better advised to use a barrier method or condoms and spermicidal agents. An IUD is often an appropriate choice for a sexually active immature adolescent of low intellignece with a history of repeated pregnancies and/or abortion who has demonstrated poor compliance with other contraceptive methods. The diaphragm is best used by older, stable adolescents. Coitus interruptus, injectable contraceptives, and douching should not be recommended to adolescents. In many cases, the adolescent is under pressure to participate in sexual activity and needs support from the physician for her decision to abstain from intercourse. Overall, selection of the proper method of contraception for a given adolescent involves consideration of motivation, moral-ethical responsibility, frequency of intercourse, side effects of the various methods, and the patient's preference.

Georgetown Adolescent Psychosocial Rating Scale.

UNLABELLED: The Georgetown Adolescent Psychosocial Rating Scale (GAPRS) was developed as a clinical tool to be used in the evaluation of the psychosocial development of the adolescent. Preliminary findings have shown it to be useful in assessing normal psychosocial development and identifying deviant states. The GAPRS was developed in a clinical setting over a 5-year period as a questionnaire with the statistical ability to assess adolescent psychosocial development. The data from this study support the GAPRS as a promising new clinical tool to be used with the adolescent patient for assessing normal and deviant psychosocial maturation in an efficient and concise manner. SPECULATION: Adolescent psychosocial maturation can be measured using key questions to measure normal development and deviant states.

The Medical Bookshelf.

Books received are listed as space permits, and those of particular interest to our readers are reviewed.

Contraception for adolescents.

The two major groups of contraceptives available to adolescents are simple and prescribed methods. Of the former, spermicidal agents and condoms alone or in combination offer some protection. Of the prescribed methods, oral contraceptives and intrauterine devices offer best protection. The risk of pregnancy and the mortality and pathologic risks involved in the use of each method must be considered. The indications, contraindications and specific guidelines for prescribing contraceptives in this age group cannot be uniformly applied to all adolescents; therefore, individualization is always necessary.