Contraception for Teens

Discussions about contraception with your teen can be an overwhelming conversation for both of you. Children and teens who have unanswered questions about sex and birth control may not feel comfortable asking a parent. Often times, teens then rely on friends or go online for answers, which may lead to false information. 

Talking openly with your teen about their changing body and sex can be stressful but it’s important. As a parent, you are in the best position to answer questions and talk about your values together as a family.  As you are discussing sex with your teen, take the opportunity to gauge what they know about healthy relationships and consent as well as how to prevent pregnancy and STIs.

Getting help from your pediatrician

Enlisting your pediatrician or family doctor to be a part of the birth control conversation can be helpful if your teen is having difficulty talking to you. At the appointment, your doctor will ask you and your child many questions about their health. They will also perform a physical exam. Your doctor will need to know if your teen smokes, is or could be pregnant or is breastfeeding. It’s also important for your doctor to know if your teen has any serious health conditions such as diabetes, heart disease or high blood pressure or a history of blood clots (or if a close family member has a history of blood clots), STIs or cancers.

The doctor will speak with your teen privately for at least part of the visit. It’s important for your teen to actively participate in their own health care, and this gives them a time and space to discuss topics that they may not be as comfortable discussing in front of their parents. You will then be brought back into the exam room to finish the discussion and decide on a plan. Your child’s doctor can provide or prescribe a suitable form of contraception during that appointment or provide a referral to an appropriate facility in your community, if needed.

Can my teen obtain contraception without parental consent?

  • Each state has its own laws regarding contraception. In Michigan, a minor (a child under the age of 18) can consent to the following:
  • Emergency care
  • Sexual health (birth control, pregnancy testing, testing and treatment for STIs)
  • Mental health
  • Treatment for substance abuse

Doctors will notify parents if there is suspicion of abuse, the teen is a risk to themselves or someone else, or they are under the age of 12 and have been sexually active. Minors do need parent/guardian consent for an abortion, unless a court-approved waiver is obtained.

How effective is contraception?

There are many different types of birth control and each has its own pregnancy risks:

  • For patients who use intrauterine devices (IUDs), subdermal (under the skin) implants, or sterilization (tying tubes), there is a risk of about less than 1 person out of 100 getting pregnant per year.
  • For patients who use the pill, ring, patch, or injection (the shot), there is a risk of 6–9 people out of 100 getting pregnant per year.
  • For patients who use a condom, diaphragm, withdrawal method, or natural planning, there is a risk of 12 – 24 people out of 100 getting pregnant per year.

What are long-acting reversible contraceptives (LARCs)?

LARCs are the most effective forms of reversible birth control, including intrauterine devices (IUDs) and subdermal implants. LARCs are safe for almost all women, while some of the shorter-acting birth control options like pills have restrictions on who is safe to receive them. LARCs can be removed at a doctor’s office at any time.

LARCs are usually the first option a doctor will discuss with you and your teen. Because teens are at a higher risk of forgetting to take their pill, a LARC is a reliable long-term option. However, LARCs do not provide protection against STIs so it’s still important to use condoms during sex.

Types of contraception (ranked by effectiveness)

Intrauterine device (IUD)

Less than 1/100 women using this method will get pregnant within the first year.

An IUD is a small, flexible, T-shaped device that’s inserted into the uterus. There are two types:

  • Copper T IUD (Paraguard): Does not contain hormones and does not need to be replaced for 10 years.
  • Levonorgestrel IUD (Mirena, Skyla): Contains a hormone; does not need to be replaced for 3–5 years, depending on the brand.

Pros:

  • Provides safe and very effective long-term birth control
  • Teens don't have to remember to do anything every day, week, or month to stay protected from unintended pregnancy
  • Options for both hormonal and non-hormonal types of IUD
  • May have less cramping and lighter periods with the Levonorgestrel IUD; many teens stop having periods over time

Cons:

Have to go through the procedure of having it placed inside the uterus. This may consist of mild to moderate discomfort and cramping. This may be the teen’s first pelvic exam, which can lead to the stress of the procedure.

  • May have pain or cramping for a short time after insertion
  • May have irregular bleeding or spotting with the Levonorgestrel IUD; this usually improves with time
  • May have increased menstrual cramping, spotting, and heavier bleeding that usually decreases over time with the Copper T IUD
  • Does not protect against STIs

Contraceptive subdermal implant (Implanon and Nexplanon)

Less than 1/100 women using this method will get pregnant within the first year.

A subdermal implant is a thin, flexible plastic rod (about the size of a matchstick) that is placed under the skin of the upper arm. It contains a hormone that can help prevent pregnancy for at least three years.

Pros:

  • Provides safe and very effective long-term birth control
  • Teens don't have to remember to do anything every day, week or month
  • Does not need to be replaced for three years
  • Contains a progestin hormone that prevents the ovary from releasing an egg

Cons:

  • May have irregular bleeding
  • Less common side effects include weight gain, headaches and acne

Progestin injection (Depo-Provera) 

6/100 women using this method will get pregnant within the first year. 

A progestin injection is a shot that contains a hormone that prevents the ovaries from releasing an egg. It also makes cervical mucous thicker, making it more difficult for sperm to get through. It lasts for three months.

Pros:

  • Long-lasting protection; only requires visits to the doctor every three months for another shot
  • Protects against endometrial cancer (cancer of the lining of the uterus) and iron-deficiency anemia
  • May have less cramping, lighter periods or no periods

Cons:

  • Important to keep schedule of being given every 12-13 weeks
  • May have weight gain
  • May have irregular bleeding or light spotting, which may improve over time
  • Once the hormone is discontinued, fertility may take up to two years to return to normal
  • Could interfere with normal increases in bone density but this is usually restored after it is discontinued
  • May increase the risk of blood clots
  • Does not protect against STIs

Contraceptive vaginal ring (NuvaRing)

9/100 women using this method will get pregnant within the first year. 

A vaginal ring is a small, flexible piece of plastic in the shape of a ring that is placed in the vagina once a month. It has hormones that prevent the ovaries from releasing an egg. The ring is in place for three weeks and then removed for one week (during that week the woman gets her period). It is also safe to place a new ring immediately if the woman does not want to have a period that month.

Pros:

  • May have lighter periods
  • May have less cramps
  • Acne may improve

Cons:

  • Can be hard for some teens to remember to replace the ring each month
  • May have headaches, nausea, vaginal discharge or breast tenderness
  •  May increase the risk of blood clots
  • Does not protect against STIs

Contraceptive patch 

9/100 women using this method will get pregnant within the first year.

The patch is a thin, beige piece of plastic that looks like a square bandage. It contains hormones (progestin and estrogen) that are absorbed through the skin and prevent the ovaries from releasing an egg. It needs to be replaced once a week for three weeks and then removed for one week (during that week the woman gets her period). It is also safe to place a new patch immediately if the woman does not want to have a period that month.

Pros:

  • Easy to remove and apply a new one
  • May have lighter periods
  • May have less cramps
  • Acne may improve

Cons:

  • Can be hard for some teens to remember to change the patch each week
  • May increase the risk of blood clots
  • It is visible to other people if not hidden under clothes, which may bother some teens
  • May have headaches, nausea, skin irritation or breast tenderness
  • Does not protect against STIs

Birth control pills

9/100 women using this method will get pregnant within the first year.

There are two types of birth control pills: 1) the combination pill, which contains estrogen and progesterone, the two female sex hormones that control the menstrual cycle and 2) the progestin-only pill, which contains only progesterone and is rarely prescribed for teens.

Pros:

  • May have lighter periods
  • May have less cramps
  • Acne may improve
  • Reduces the risk of ovarian and endometrial cancers and iron-deficiency anemia

Cons:

  • Serious side effects, though rare, include blood clots, stroke, hypertension and migraine headaches
  • May have headaches, nausea or breast tenderness
  • Must be taken consistently every day around the same time, which can be hard to remember for some teens
  • Does not protect against STIs

Tips to Remember to Take Your Pills:

  • Set a daily alarm on your cell phone
  • Put your pills by your toothbrush so you remember to take it at the same time you brush your teeth
  • Use a weekly pill case to organize all of your medications
  • Use a medication reminder app on your cell phone
  • Keep your pills in your purse or backpack so, no matter where you are, you’re able to take them on time every day

Male condom 

18/100 women using this method will get pregnant within the first year.

A male condom is a thin sheath of rubber that slips over the penis. Condoms provide a barrier that prevents pregnancy and STIs by keeping semen from entering the vagina. 

Pros:

  • Available without a prescription
  • Easy to use
  • Inexpensive
  • One of the only methods that protects against STIs
  • Can be used in combination with another method for STI protection and additional pregnancy prevention

Cons:

  • Needs to be used correctly each time
  • Can break or slip off during sex
  • Some people are allergic to latex (they can use polyurethane or polyisoprene condoms

Female condom (vaginal pouch) 

21/100 women using this method will get pregnant within the first year. 

A female condom is a pouch with two flexible rings, one fitting inside the vagina and the other on the outside. When it is inserted into the vagina, the closed end (the inner ring) shields the cervix, the sheath lines, and the vaginal walls while the ringed, open end hangs outside the vagina to cover the labia.

Pros:

  • Available without a prescription
  • Can be used in combination with another method for STI protection and additional pregnancy prevention

Cons:

  • Can be difficult to insert
  • May slip during intercourse
  • More expensive than the male condom

Emergency contraception

Sometimes condoms break or teens may not use their method of contraception properly. In these cases, emergency contraception is an option. Plan B One-Step® and other similar store-brand pills that contain progestin hormones are available over the counter, even for teens, and doctors can prescribe other types. Emergency contraception can work for up to five days after sex but the sooner it is used, the better it works.

Other methods of contraception

There are some birth control methods that are less effective and thus for teens due to their high failure rate. These methods also don’t protect against STIs so another method (i.e. condom) will need to be used.

Withdrawal

  • In this method, the penis is taken out of the vagina before ejaculation.
  • 22 out of 100 women using this method will get pregnant within the first year and this can be much higher for teens. Even if done correctly, the penis releases fluids containing thousands of sperm into the vagina before ejaculation.

Fertility awareness

  • In this method, a woman has to track her periods, take her temperature each morning, and inspect the color and texture of her cervical mucus every day. She also does not have sex for about a week around the time of ovulation each month. This requires a level of diligence that is very difficult even for some adults. 
  • 24 out of 100 women using this method will get pregnant within the first year and this can be much higher for teens.

Spermicide

  • This is a gel, cream, or foam that a woman inserts deep into her vagina before having sex.
  • 28 out of 100 women using this method will get pregnant within the first year, which is a high-failure rate. It can also be messy and difficult to use.

Contraception and the risk of STIs

  • The majority of birth control methods DO NOT protect against STIs. It is important to know that sometimes you may have an STI without having any symptoms. The male and female condoms are the only options that were discussed above that DO protect against STIs.
  • STIs are caused by many different bacteria and viruses and you can get an STI by having sex (oral, vaginal, rectal) with someone who already has an STI. Women who have sex with women and men who have sex with men are also at risk for STIs.
  • Some STIs can be treated and completely cured but, if you continues to have unprotected sex, you are at risk of getting that STI or another one again. Ask your doctor about treatment for you and your partner because otherwise you might just keep giving the infection back and forth between each other.

If you decide to have sex, you will have a lower chance of contracting an STI if:

  • You and your partner have been tested for STIs (and treated if necessary). Testing consists of a blood and urine sample.
  •  You and your partner have sex ONLY with each other
  • You always use a condom (male or female condom)

Ways to test for an STI:

  • HIV screening – this blood test should be done for everyone ages 13–64
  • Urine screening – every year, sexually active teens and young adults should have a urine screening for chlamydia and gonorrhea (two of the most common STIs)
  • Blood test – this is the best way to screen for syphilis

How common are STIs?

  • In 2017, 5,041 people age 15–24 years old had chlamydia in Michigan
  • In 2017, 1,189 people age 15–24 years old had gonorrhea in Michigan
  • In 2017, 3.3 out of 100,000 people age 15–19 had syphilis in the United States

Additional resources:

Written by Jacqueline Fisher, MD; reviewed by Sara Laule, MD

Updated July 2020