Current challenges in contraception in adolescents and young women.

PURPOSE OF REVIEW: Although developing countries have made much progress in expanding the availability and use of family planning services, the need for effective contraception is large, and growing because the largest cohorts in human history are entering their reproductive years. Not only regarding developing countries but also in developed countries, where the usual contraceptive methods, such as the oral contraceptives, intrauterine devices (IUDs) and condoms, have been available for decades, there have been many new advances in contraceptive technology in the last several years. New formulations of oral contraceptives, extended and continuous use of oral contraceptives and long-acting reversible contraceptives (LARC) may have a wider role in contraception and their increased implementation could help to reduce unintended pregnancy.

RECENT FINDINGS: Today's oral contraceptive regimens are safer and more tolerable, with equal or improved efficacy as compared to early formulations. Incremental decreases in the estrogen dosage have helped to alleviate some of the unwanted estrogenic side effects of combined hormonal contraceptives. Progestogens have also been controversial in connection with findings of increased venous thromboembolism risks but they have evolved over time, and, in general, newer generations of progestins have minimal side effects. Currently available 'LARC' methods, such as IUDs, the intrauterine system, injectable contraceptives and implants require administration less than once per cycle or month. They are more cost effective than the combined oral contraceptive pill even at 1 year of use. Increasing the access and availability of new formulations of oral contraceptives and LARC methods will reduce the number of unintended pregnancies.

SUMMARY: Evidence-based guidelines about the safety of contraceptive methods among women with comorbid medical conditions can help guide providers in determining the best method of contraception for each woman, depending on whether they are in their adolescent, postpartum or perimenopause years. As most patients can safely use highly effective methods of contraception, health providers should promote their use in order to further efforts to reduce unintended pregnancy. This promotion should be done by enabling women to make an informed choice among all contraceptive options.