Dr. Álvaro Monterrosa Castro, MD
TOadolescence – from the Latin adolescere – means to grow up. It is the transition period between childhood and adulthood. The World Health Organization establishes that adolescence is the stage of life that occurs between 10 and 19 years of age. It is divided into early adolescence (10-14 years) and late adolescence (15-19 years). It is of great importance to promote the healthy development of adolescents.
There are many aspects that life offers and that are tried or attempted for the first time during adolescence, and one of them is sexual relations. However, when these young women usually become sexually active, they do so without adequate information. Without the necessary prevention from a contraceptive point of view and even without comprehensive maturity as individuals (16,187,188,189,190).
(Read Also: Oral Contraceptives in Women Over 35 Years)
Why family planning for adolescents?
By the 90s, more than 3,500,000 Colombians were young people between 15 and 19 years of age. Of which 50% have started sexual relations and 13% have started motherhood. According to the 1994 census, carried out by DANE. Colombia has 7,391,781 young people between 10 and 19 years of age. 1 in 5 Colombians is a teenager. 49.2% female and 50.8% male.
70% live in cities and 30% in rural areas. Every year 70 out of every 1,000 teenagers become mothers. 12% of urban adolescents and 16% of rural adolescents. They require contraceptive services, because they have already had a child and are still adolescents. It is utopian to think that the teenager who has experienced an unwanted pregnancy has learned her lesson (187,190).
Every day the beginning of intercourse is at a younger age. In the youth centers of Profamilia, Colombia. The average age of adolescents who come seeking advice on contraception or to take a pregnancy test is 17 years of age. And usually more than 6 months of intercourse, the vast majority of the time without planning (191).
In these same centers it has been observed that 80% of adolescents, with active coital life, do not use effective contraceptive methods. It is the rhythm method or coitus interruptus that is most used. When we know the low contraceptive effectiveness they have (190,191).
Secondary education includes basic teaching of reproductive physiology:
But such illustration is usually inadequate or insufficient. In Profamilia, 68% of adolescents who request pregnancy tests have already completed 9th grade. And their knowledge about reproduction is usually different from what is minimally accepted. (190,191).
Adolescents know the existence of contraceptive methods, but they lack the comprehensive knowledge to use them. Incorrect information provided generates unfounded fears. Educational strategies are necessary that effectively convey knowledge, forming a comprehensive vision of sexuality. Where the adolescent is motivated to exercise his sexuality with responsibility towards his partner, society and himself. Avoiding consequences that could compromise your future life (187,189).
The ideal and most effective method of contraception among adolescents is coital abstinence. Abstinence is something good, possible, natural and healthy. To achieve an adequate level of acceptance of this concept, sexual education, starting from childhood and from within the family, is basic and fundamental. (187,188,192).
When the contraceptive counseling consultation is late – postpartum or postabortion for example -. Or when intercourse is part of adolescents’ lives. Oral contraceptives may be recommended. Keep in mind that parenteral methods may not be suitable for adolescents due to the potential risk of persistent amenorrhea.
Microdose oral contraceptives are the ones to use. The lower hormonal concentration reduces the adverse effects and reduces the risks but continues the beneficial contraceptive and non-contraceptive effects.
Do not use in early adolescence with poor development of secondary sexual characteristics. Nor in young people with irregular cycles secondary to immaturity of the hypothalamic axis.
Avoid when coital relations are very occasional. It has not been proven that oral contraceptives cause fertility delay..
They are considered harmless in adolescence, especially late adolescence. There is no time limit for its use, but we do not recommend more than three continuous years. Since an increase in the risk of breast cancer has been described when they are used for long periods during adolescence (73,146,149).
If episodes of amenorrhea occur, a non-hormonal method should be used. Adolescents must have control and monitoring by health personnel. To clear up doubts in the user that will emerge as a product of poorly founded myths in the population.
It seems to be the most accurate indication for the use of oral contraceptives in adolescence. It is in those with previous pregnancies, or in those without previous pregnancies, who are normally regulated. And they have a high probability of pregnancy due to frequent and stable intercourse. (187, 188, 189, 190, 191, 192).
Dr. Álvaro Monterrosa Castro, MD
