Outcomes of adolescents using levonorgestrel implants vs oral contraceptives or other contraceptive methods
L. M. Dinerman, M. D. Wilson, A. K. Duggan and A. Joffe
Department of Pediatrics, Sinai Hospital of Baltimore, Md, USA.
OBJECTIVE: To compare outcomes among adolescents who use levonorgestrel
implants, oral contraceptives, or other methods of birth control. DESIGN:
Prospective, longitudinal study of 166 females who were followed up for 6
months. Fifty-four used implants, 64 used oral contraceptives, and 48 used
condoms alone or with spermicide, or no contraceptive. Outcomes were
measured by patient interview and medical chart review. SETTING:
Inner-city, hospital-based adolescent and teenaged mother and baby clinic
between April 1, 1992, and May 31, 1993. PARTICIPANTS: Sexually active 12-
to 18-year-old females at least 1 year postmenarche who had no
contraindications to use of hormonal contraceptives. MAIN OUTCOME MEASURES:
Sexual activity, pregnancy rates, condom use, incidence of sexually
transmitted disease, patient satisfaction continuation rates, and side
effects. RESULTS: Despite similar reports of sexual activity, one subject
who used the implant (2%) vs 13 subjects who used oral contraceptives
(20%), and eight subjects who used other methods (17%) became pregnant (chi
2, P < .50). Condom use did not differ among groups (chi 2, P > .60).
Overall, 30% of subjects contracted a new sexually transmitted disease;
rates did not differ by method (chi 2, P = .92). Implant users were more
likely than oral contraceptive users to continue their method (87% vs 50%;
chi 2, P < .001) despite similar satisfaction scores (one-way analysis
of variance, P = .52). Implant users were more likely to experience
irregular menses, mood swings, acne, and hair loss (chi 2, P < .05).
CONCLUSIONS: In this population, the levonorgestrel implant is an effective
method of pregnancy prevention and is associated with high satisfaction and
continuation rates at 6 months. Implant users are not at greater risk than
others for sexually transmitted disease. Health care providers should
continue to stress the use of barrier methods to all sexually active
adolescents.
