Why We Shouldn’t Prescribe Hormonal Contraception to 12 Year Olds

http://blogs.scientificamerican.com/context-and-variation/2012/04/27/why-we-shouldnt-prescribe-hormonal-contraception-to-12-year-olds/

Variation in adolescent menstrual cycles, doctor-patient relationships, and why we shouldn’t prescribe hormonal contraceptives to twelve year olds

The United States has the highest rate of unintended teen pregnancy among industrialized nations. So I can understand why there are so many papers, and such a great effort, to get young girls on hormonal contraception (Clark et al. 2004; Clark 2001; Gerschultz et al. 2007; Gupta et al. 2008; Krishnamoorthy et al. 2008; Ott et al. 2002; Roye 1998; Roye and Seals 2001; Sayegh et al. 2006; Zibners et al. 1999).

But I’ve noticed two things: first, that hormonal contraception is used imperfectly in this population, with some estimates that 10-15% of adolescents on hormonal contraception still get pregnant (Gupta et al. 2008). Second, discontinuation rates for hormonal contraception in young girls are high, with many girls complaining about side effects, particularly breakthrough bleeding (Clark et al. 2004; Gupta et al. 2008; Zibners et al. 1999). I have to admit some concern over the fact that many of the papers I read that mentioned these discontinuation rates and side effects were almost condescending in their tone. The implication was that the side effects weren’t a big deal.

One of the ways clinicians and sexual health educators are trying to improve hormonal contraceptive use in adolescents is to emphasize their off-label use as a “regulator” – that is, the pill can regulate your cycle, regulate your mood, regulate your skin. The idea is to emphasize the positive effects of hormonal contraception to combat the side effects young girls both worry about, and actually experience. This also tends to produce campaigns and commercials with images of idealized young women that young girls would want to model themselves after – skinny, confident, and of course very feminine.

This is not my favorite idea. The pill should not regulate the cycles of adolescent girls who experience moderate variation in their cycles, which, as it turns out, is what characterizes the normal adolescent menstrual cycle. (This is independent from debilitating, pathological experiences of the menstrual cycle or menstrual bleeding, which occur in a very small percentage of women.)



*** i don't know how i feel about this -- there were girls who were definitely sexually active by 13 in my family. hell, i was
we were - still are -- white middle class folks -- children at that young age would have been disastrous and 1 young lady made a marriage too young to a male unsuited for fatherhood.