As your daughter transitions from being a little girl to a young lady, there are many changes that will occur. One of the most common office visits that I have at the Couri Center is helping mom and daughter figure out what method of birth control is right for her. There are many factors to consider when making this important decision. Many times, young women have painful periods with heavy bleeding, so birth control is also used to help with these symptoms. Many young women who are in a serious relationship will discuss with their mom/parents that they are considering becoming sexually active. Educating your daughter early and often on your personal beliefs is paramount to ensuring her health and safety.
Clearly, the most effective form of birth control is abstinence. It is important to talk with your teen openly about this. As a parent, we often feel like “our kids don’t listen to us” but they do hear us. In fact, 3 out of 4 girls who have had sex wish they had waited longer and felt a discussion about abstinence would have been helpful. Abstinence is more than waiting to have intercourse. It is being sure that you have the utmost respect for your body and understand that not being abstinent comes with consequences. Again we encourage an open dialogue where you as a parent have opportunities to communicate and educate appropriately.
Not all, however, will choose abstinence. If the decision is made to proceed with birth control then there are several other options to consider. The most common options for young women are birth control pills, Depo-Provera hormonal injection, IUD (intrauterine device) and the NuvaRing.
Before starting birth control it is important to understand her daily schedule. Does it allow for taking a pill daily? We also need to know past medical history: Does she have any blood clot or bleeding disorders? What are her monthly periods usually like? Are there any other medications taken daily? Does she smoke? Once those questions are answered, it may guide us in a certain direction for what form of birth control to use.
There are many choices of birth control pills also referred to as oral contraceptive pills (OCPs). They are effective when used correctly meaning the pill needs to be taken daily, at the same time or within a few hours. Generally, the pill is very well tolerated but sometimes patients may experience nausea or spotting. These symptoms usually resolve within the first 3 months of starting the OCP. Weight gain can also occur but is not as common with the pill as it is with Depo-Provera.
Depo-Provera is a contraceptive injection given in the muscle every 12 weeks. We ask that patients come in while on their period to give the injection. As mentioned above, the biggest side effect is weight gain, about 2-4 lbs. per year. Irregular bleeding is also a common side effect in the first few months. Eventually many women will stop having their cycles by the end of the 1st year. Depo-Provera can have longer-term effects as well. It can delay fertility once stopped. Women with increased duration of use have also shown to experience bone loss.
An IUD is a soft, flexible plastic device that is placed in the uterus during a routine office visit. The procedure takes less than 10 minutes and is fairly painless. Most women feel cramping while the insertion is taking place, however it is generally well tolerated. There are several types of IUDs available: Mirena™, Paragard®, and Skyla®. Skyla® was developed with the younger aged patient in mind. It is smaller so can be inserted into the uterus easier. Once an IUD is placed, it can remain in the uterus for 3-10 years depending on which IUD is chosen. During the first few months, bleeding and spotting may occur,and periods may be irregular. After the body adjusts, monthly bleeding usually decreases. Over time periods may become lighter and lighter and may even stop. Once an IUD is removed, regular cycles resume.
The NuvaRing is a small, flexible plastic ring that is inserted in the vagina once a month. The patient will insert it and then remove it 3 weeks later when it’s time to have a period. After her period, she will insert a new NuvaRing. Insertion is similar to inserting a tampon. The most common side effect is vaginal irritation.
Once a decision has been made on what type of birth control is best, it is important to stress that condoms should always also be used in young women who are sexually active. OCPs, Depo-Provera, NuvaRing and IUDs will protect against STDs.
This transition of going from a pediatrician to a gynecologist can be hard for moms and daughters alike. It is important to keep the lines of communication open. And when in doubt, bring your daughter to the Couri Center. We would be happy to help ease the transition in this time of life!
Renee Alwan Percell, PA-C