Restarting Birth Control in Adolescents

Initial Pill Selection and Initiation

The American Academy of Pediatrics recommends starting a monophasic combined oral contraceptive containing 30-35 μg ethinyl estradiol with levonorgestrel or norgestimate immediately, without waiting for the next menstrual period, for adolescents 1
The optimal dose for adolescents provides ovulation suppression, which is particularly important for this age group who frequently miss pills, according to the Pediatrics journal 1, 2
The formulation with the lowest copay on the patient's insurance formulary should be chosen if multiple appropriate options exist, as recommended by the Pediatrics journal 1
Standard 28-day pill packs are recommended initially, with the option to transition to extended cycles later based on patient preference or medical needs, according to the Pediatrics journal 1

The Centers for Disease Control and Prevention recommends initiating the pill on the day of the visit, regardless of where the patient is in her menstrual cycle, with same-day initiation protocol 1, 3
If there is uncertainty about pregnancy, the benefits of starting the pill exceed any risk; proceed with initiation and schedule a follow-up pregnancy test in 2-4 weeks, as recommended by the MMWR Recommendations and Reports 3
Instruct the patient to use backup contraception or avoid intercourse for the first 7 consecutive days after starting the pill, according to the Pediatrics journal 1

Combined oral contraceptives provide noncontraceptive benefits, including decreased menstrual cramping, reduced blood loss, and improvement in acne, all relevant concerns for adolescents, as recommended by the Pediatrics journal 1
The method is completely reversible with no negative effect on long-term fertility, according to the Pediatrics journal 1
Do not require a pelvic exam or extensive testing before initiation, as these are not necessary for healthy adolescents and create unnecessary barriers to contraception, as recommended by the MMWR Recommendations and Reports 3
Do not wait for the next menstrual period to start the pill; same-day initiation is recommended, according to the Pediatrics journal and MMWR Recommendations and Reports 1, 3

The patient should be advised to contact the provider if she experiences side effects, problems, or wants to change methods, with no routine follow-up visit required, as recommended by the Praxis Medical Insights 2
Blood pressure should be monitored during any routine follow-up visits, according to the Praxis Medical Insights 2, 4
If breakthrough bleeding becomes problematic, NSAIDs for 5-7 days can be offered as treatment, as recommended by the MMWR Recommendations and Reports and Praxis Medical Insights 4, 5