*This post does not replace medical advice. Talk to your doctor when choosing birth control methods.

Are you having this discussion with your daughter yet? It’s probably just a matter of time. Any day now she’ll come home and tell you her friend is on the pill and she wants to go on it too! What will you say? How will you react? Are you prepared for this discussion?

I felt like I needed to get up to speed on what’s available to young women these days so I chatted with Dr. Rupinder Toor, the medical director and award-winning founder of Calgary’s Northeast Women’s Clinic.

And wow, has the birth control landscape changed since you and I were teens!

It may be that your daughter’s friend needs contraception because she’s having sex, but she could also be choosing the pill to reduce period cramps, control acne, lighten her flow, make her period more regular or get rid of it altogether!

Requests for menstrual suppression happen all the time, according to Dr. Melisa Holmes, the founder of Girlology and a practicing obg-yn in North Carolina.

“I had a patient in my office who was going to hike the Appalachian Trail this summer. She’s 15 and her mom brought her in to see if we could suppress her period while she was hiking,” says Dr. Holmes.  “So I’m like, ‘Of course! If we know well enough in advance we can give her birth control pills and manipulate her period while she’s hiking’,” she says. There you go – a modern solution to an age-old inconvenience!

There are a lot of choices out there and they all have their advantages and disadvantages. Dr. Toor breaks them down into three easy-to-understand categories:

The Top Tier

If the number one goal is to reduce unwanted pregnancy, this category is considered the gold standard. Also known as LARCS (long-acting reversible contraceptives) this includes IUDs (Mirena), Copper IUD’s, implants (Nexplanon, though it’s not available in Canada yet) and sterilization (surgery). I suppose it goes without saying that abstinence is the only method that is 100% effective. The failure rate in this category is less than 1%. IUDs result in an 80-95% reduction in menstrual blood flow.

 The Middle Tier

This category includes birth control pills (estrogen and progestin), the mini-pill (progestin only), the patch, the ring and Depo-Provera injections. These are good choices for young women who want to lighten their flow, reduce the number of periods they’re having and prevent unwanted pregnancy. The failure rate is about 9-10% for the pill, patch and ring. The pill generally results in a 50% reduction in menstrual flow, but some can eliminate periods completely.

The Bottom Tier

This is a category of birth control methods that most teen girls are using to prevent unwanted pregnancy, but it also has the highest failure rate. It includes condoms, diaphragms and the “pull-out” method. Condoms have a failure rate of 18-20%.

 

More about LARCS

I was surprised to learn that doctors in both Canada and the US now recommend long-acting reversible contraception (LARCS) as the first-line choice for contraception in women and adolescents, according to the Society of Obstetricians and Gynecologists.

That’s largely because IUDs and implants take away the “forgetfulness” factor. Once they’re inserted by a doctor, you are good to go for about 3-5 years. These contraceptives have the side-effect of lightening and, in 50% of women, completely eliminating monthly bleeding.

What is the safest option for my teen?

Like any parent, my primary concern is my daughter’s health. Do I want her exposed to synthetic hormones so early in life? What, if any, are the risks? Isn’t it un-natural for her NOT to have her period?

There aren’t definitive or easy answers to these questions. I’ve talked to two well-respected doctors in the field of girls’/women’s health and both have told me there is no scientific evidence to suggest that hormonal contraceptives are unsafe.

However, all doctors agree that girls/women should be exposed to the lowest and most effective dose possible.

“(Most) pills contain estrogen and progestin…and estrogen is the one we worry about,” says Dr. Toor. “It makes your blood ‘sticky’, leading to the risk of clots, strokes and heart attacks. The IUD doesn’t have any estrogen, so there’s no clotting risk with it.”

There are also progestin-only pills such as the mini-pill (Micronor in Canada) and a low-estrogen pill (Yasmin) if you’re concerned about hormone exposure, but you don’t think your daughter is ready yet for an IUD. Keep in mind that progestin-only pills MUST be taken at the same time every day. They are a lot less forgiving than the combination estrogen-progestin pills because the hormone stays in the body for a much shorter period of time.

Another important thing I learned is that since the birth control pill is taken orally, a woman’s whole blood system is exposed to the hormones. With an IUD, the progestin stays local and doesn’t even get out of the uterus.

“The amount of hormone you’re exposed to with an IUD is about a thousand times less than the birth control pill,” says Dr. Toor. She says more women and teens are becoming comfortable with IUDs. “The first thing they say is, ‘Oh, it’s so tiny!’ ”

It’s important to note the Copper IUD contains no hormones or medication. The copper itself acts as a spermicide, but women still have periods on a monthly basis and sometimes complain of a heavier flow and more cramps.

Dispelling period myths and urban legends

 And what about continuous contraception…the idea of taking pills non-stop so you never have to worry about a period. Doesn’t your body need a break from the pill?

Dr. Toor says she sees many patients who falsely believe you need a period so your body can get rid of toxins and clean itself every month. She says, it’s just not true – that’s what your kidneys and liver do. The purpose of the uterus is to hold and protect a baby, so if you’re not planning on getting pregnant, there’s no need to have a period.

“Medically speaking, it is perfectly fine not to have periods if you are not wanting to get pregnant,” she says.

Clearly, it’s a matter of personal choice and family values. There’s obviously a lot to think about when selecting birth control and figuring out if it’s the right choice at all. I’m hoping you can discuss all of these choices openly with your daughter and with a trusted health professional to strike a healthy balance between your daughter’s wants, needs and long-term health.

For more info, you can visit the Northeast Women’s Clinic or call 403-717-0810.