Division of Adolescent/Young Adult Medicine.
Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Curr Opin Pediatr. 2020 Aug;32(4):461-470. doi: 10.1097/MOP.0000000000000930.
Long-acting reversible contraception (LARC) is increasingly used by adolescents and young adults (AYAs). Subsequent to LARC insertion, AYAs are presenting to their primary care providers with LARC concerns. This article seeks to equip primary care clinicians with the tools necessary to assess and manage common LARC-associated side effects.
Side effects are common with progestin-only LARC, and can precipitate early discontinuation of an otherwise effective, low-maintenance form of contraception. Abnormal uterine bleeding, pelvic pain, acne, and weight change are often cited as progestin-only LARC side effects, yet the causes are poorly understood despite extensive research. While most side effects improve with time, therapeutic interventions are available for patients with undesirable side effects that prefer medical management. Research emphasizes the importance of proper patient counseling and clinical follow-up.
Counseling remains essential in the management of LARC-associated side effects. However, options are available to temporarily mitigate such side effects and increase LARC satisfaction. While these therapeutic options are prescribed based on expert opinion, such regimens remain inadequately studied in AYA populations.
长效可逆避孕（LARC）越来越多地被青少年和年轻人（AYAs）使用。在 LARC 插入后，AYAs 会向他们的初级保健提供者提出 LARC 相关问题。本文旨在为初级保健临床医生提供评估和管理常见 LARC 相关副作用所需的工具。
孕激素仅 LARC 常见副作用，可能导致原本有效的、低维护的避孕方法过早停止。异常子宫出血、盆腔痛、痤疮和体重变化常被认为是孕激素仅 LARC 的副作用，但尽管进行了广泛的研究，其原因仍不清楚。虽然大多数副作用会随着时间的推移而改善，但对于有不良副作用且更喜欢药物治疗的患者，可提供治疗干预措施。研究强调了适当的患者咨询和临床随访的重要性。
咨询在 LARC 相关副作用的管理中仍然至关重要。然而，有一些选择可以暂时减轻这些副作用并提高 LARC 的满意度。虽然这些治疗选择是根据专家意见开出的，但在 AYA 人群中，这些方案的研究仍不够充分。
