Department of Pediatrics, Division of Child and Adolescent Health, Section of Adolescent Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York2New York-Presbyterian Hospital, Ambulatory Care Network, New York.
Department of Pediatrics, Division of Child and Adolescent Health, Section of Adolescent Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York3New York-Presbyterian Hospital, Ambulatory Care Network, Center for Community Health and Education, School-Based Health Centers, New York4Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York.
JAMA Pediatr. 2017 Jul 1;171(7):694-701. doi: 10.1001/jamapediatrics.2017.0598.
Adolescents have higher rates of unintended pregnancies than any other age group. Contraceptive implants and intrauterine devices (IUDs) are long-acting reversible contraceptives (LARCs) that are known to be highly effective in preventing pregnancy. New devices have recently been approved for use in adolescents, yet pediatricians may be less familiar with how to counsel adolescents about implants and IUDs.
LARC methods should be described in basic terms to adolescents, including hormone dose, method of insertion, and method of pregnancy prevention. Clinicians should appreciate the developmental stages of adolescents, discuss the most effective methods of contraception, and ensure confidentiality from their parents. Short-acting contraception methods (eg, oral contraceptives) can be used as a temporary bridge to provide coverage until a LARC method can be placed. The most common adverse effect of LARC is nuisance bleeding, which can be managed with short courses of oral contraceptives or nonsteroidal anti-inflammatory drugs.
LARC devices constitute first-line contraceptive methods for adolescents. All clinicians, including pediatricians, can counsel about LARC even before suggesting an oral contraceptive or another less effective contraceptive method. Effective, confidential communication with sensitive language to inform adolescents of the different types of LARC is necessary to normalize offering LARC as a contraceptive option and improve its uptake among adolescents. Special clinical populations can also be offered appropriate contraceptive options inclusive of LARC.
青少年的意外怀孕率高于其他任何年龄组。避孕植入物和宫内节育器（IUD）是长效可逆避孕药（LARC），已知其在预防怀孕方面非常有效。最近新批准了一些设备用于青少年，但儿科医生可能不太熟悉如何向青少年提供有关植入物和 IUD 的咨询。
应向青少年以基本术语描述 LARC 方法，包括激素剂量、插入方法和避孕方法。临床医生应了解青少年的发育阶段，讨论最有效的避孕方法，并确保对其父母保密。短期避孕方法（如口服避孕药）可用作临时避孕方法，以提供覆盖，直到可以放置 LARC 方法。LARC 最常见的不良反应是恼人的出血，可以通过短期口服避孕药或非甾体抗炎药来治疗。
LARC 设备是青少年的首选避孕方法。所有临床医生，包括儿科医生，都可以在建议口服避孕药或其他效果较差的避孕方法之前咨询 LARC。使用敏感的语言与青少年进行有效、保密的沟通，告知他们不同类型的 LARC，对于将 LARC 作为一种避孕选择正常化并提高其在青少年中的使用率非常必要。也可以为特殊的临床人群提供包括 LARC 在内的适当避孕选择。
