Oral contraception for the adolescent.

Sexual activity among unmarried women aged 15-19 living in metropolitan areas rose 66% in the 1970s. Additionally, teenage pregnancies average 1.2 million yearly. However, based largely upon a 25% increase in contraceptive use, the pregnancy rate among teenagers declined 15% between 1973 and 1978. The data on the use of various contraceptive methods by women aged 15-19 show the Pill to be the first choice (1,539,000). Oral contraceptives are safest for young women, with rare risks of serious cardiovascular complications and no deaths reported from cardiovascular disease for women under 18. In contrast, the mortality risk associated with childbirth for this age group is 11.1 deaths per 100,000 live births. Noncontraceptive health benefits associated with oral contraceptive use, such as a 50% decrease in the risk of developing pelvic inflammatory disease, resulting in a protective effect on future fertility, is an excellent rationale for prescribing the Pill for young women who are sexually active. The pill of choice should be one with low doses of both estrogen and progestin yet doses high enough to minimize break-through bleeding, for such bleeding is the most frequent cause of discontinuation. Adolescents require careful screening for contraindications to Pill use prior to initial prescription plus frequent follow-up and monitoring so as to minimize side effects and maximize compliance and continuation of use.