The highest percentages of unintended pregnancies and the largest increases in births reported in the United States in recent years were in adolescents and in women more than 35 years of age. Increasing numbers of these women will require
contraception to avoid unintended pregnancy. In adolescents the
combined oral contraceptive agents protect fertility indirectly and exert favorable actions on menstrual dysfunction and certain
hormone-related disorders such as
acne and
hirsutism. To avoid
sexually transmitted disease, barrier protection should be used along with
oral contraceptives until mutually monogamous, stable relationships are established. Healthy older women who are nonsmokers may also safely use currently available
contraceptives. These agents have little impact on metabolic parameters linked to the development of
cardiovascular disease. In addition to providing reliable
contraception,
oral contraceptives offer noncontraceptive benefits to older reproductive-age women, including control of abnormal
bleeding and a reduction in the incidence of ovarian and
endometrial cancers and other gynecologic pathology.
Intrauterine devices and
progestin implants are safe, effective, and underused in the United States.
Progestin implants may have an additional role in patients for whom
estrogen preparations are contraindicated. Counseling is very important before insertion because of the high rate of nuisance side effects. The
contraception selection process must consider the efficacy and acceptability of the specific method to avoid the probability of unintended pregnancy and the risk of
sexually transmitted diseases.