Combined hormonal contraception

Combined estrogen and progestin contraceptives containing less than 50 μg of ethinyl estradiol are highly effective, reversible, and have a favorable risk/benefit profile for young women. The OCP has gone through a 40-year pharmacological evolution with manipulation of the doses and chemical structure of both hormones, resulting in a choice of pills today that are safe and can be tolerated by almost any adolescent. In the past 5 years, new transdermal and transvaginal delivery systems for combined hormonal contraceptives have been marketed allowing once-a-week and once-a-month dosing, respectively that improve adherence in adult women. Experience with use of the new delivery systems in adolescents is limited, however. It has been established that adverse events are likely to cause discontinuation, especially in adolescents. Therefore, education and counseling should be done at initiation and during the first months of method selection. Contraceptive counseling should include a discussion on how a method works, the potential adverse effects, dispelling myths, exploring barriers to use, and assurance of health care provider support.