By Dr. Amy Glaser
A mother of a 14-year-old recently called to make an appointment for a pelvic exam for her daughter. The girl told her she was having sexual relations with her boyfriend and the mom wanted her to begin birth control. But the mother’s voice was hesitant. She seemed sorry that the time had already come. She was also conflicted about whether she was doing the right thing. She feared she might be encouraging her daughter to have sex.
When it comes to their sexually-active teen, many parents do not want to stick their head in the sand. They want to be proactive to ensure that once their children begin having sex, it is safe. Many may wish to avoid repeating their own adolescent experience of anxious days visiting free clinics, hiding birth control pills or living with the fear of pregnancy. But the opposite approach may also seem risky. Willingness to provide birth control may seem to make light of sexual activity or even encourage it.
Sensing the mother’s concerns, I reassured her that studies demonstrate that offering birth control does not increase the likelihood of sex. Her daughter’s willingness to reveal her sexual activity is also a significant plus. Her mother can discuss the risks and rewards of sex openly. This includes the role of sex in a meaningful relationship as well as the risks of sexually transmitted diseases. Adolescents, who feel ready for sex but don’t have this kind of relationship with their parents, are potentially in a more risky situation. Particularly if the desire for sex overwhelms their good judgment in seeking adequate protection.
Despite her fears, this mother is better off than the mother who denies or refuses to face the possibility of her daughter being sexually active. Unfortunately, this mother’s relationship with her daughter remains uncommon in my adolescent practice.
Today, a far broader array of birth control methods, including greater variety among birth control pills, is available than ever before. But what is the best option for an adolescent?
“Most teens choose birth control methods according to what their friends choose,” said Dr. Dena Harris, a gynecologist in Soho who frequently counsels teens about safe sex and preventing pregnancy.
But she emphasized that birth control for teens should encompass two important issues: 1) preventing pregnancy; and 2) safe sex. This means that teens should choose a birth control method and then use a condom for additional protection.
Birth control pills remain relatively effective, and the current options generally have less estrogen and more lipid-friendly progesterones than earlier generation pills. Moreover, the newer lower dose pills have fewer side effects of weight gain and breast swelling. The most common side effect is breakthrough bleeding, but this adverse effect usually diminishes after three to six cycles.
One advantage of both newer and older generation birth control pills is that they alter the cervical mucous, which increases protection against pelvic infections. However, a broader array of birth control pills may make individualization of therapy important. For example, pills with higher doses of estrogen may be necessary for girls who weigh more than 150 pounds. For athletes or those with symptoms of dysmenorrhea (painful periods), a new pill with a high dose of progesterone may be an option. These stop menstrual bleeds. This pill is taken daily for three months and then stopped to allow a normal menstrual cycle before being restarted.
Styles in birth control are changing, according to Dr. Harris. One popular option among teens is the patch. This is a 11/2 inch flesh-colored square that adheres to the body and delivers hormones through the skin. It is most commonly placed on the hip, buttock or thigh. Over a one-month cycle, a new patch is applied once weekly for three weeks and then one week passes with no patch. It’s a good method for anyone who tends to be lax about using precaution. If it falls off, it can simply be re-adhered. Again, this birth control method, like other birth control methods, should be used with condoms.
Another method gaining popularity is the Nuvareen ring. This is a flexible circle that is placed posteriorly in the vagina and worn for three weeks of every cycle followed by one week with no ring. It has similar side effects to the other methods, and it is also an appropriate method when compliance is an issue. However, it does require the patient to be comfortable with vaginal insertion.
One potential advantage of the patch and the ring over the pills is a lower failure rate. The annual failure rate of the pill in actual practice, which includes the inevitable missed pills, is three percent to five percent. All birth control methods fail, however. The patch can fall off. The ring may not be properly placed or may be ejected.
What to do? All women should be aware of the last resort, which is the “morning after” pill (also known as “Plan B”). The morning- after pill is simply a pill containing adequate progesterone to induce shedding of the uterine lining before a potentially fertilized egg can become implanted and start to develop. The morning-after pill can be effective in preventing pregnancy if taken within 72 hours of intercourse.
Parents can help their children by keeping the lines of communication open. The head-in-the-sand approach regarding teenage sexuality is not very helpful and not very effective in protecting children from adverse outcomes related to sexual activity.
Amy Glaser MD has a private adolescent practice in Soho at 430 West Broadway, 212-941-1520 or aglasermd@aol.com.
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