UNWANTED PREGNANCIES - UNDERSTANDING CONTRACEPTIVE USE AND BENEFITS IN ADOLESCENTS AND OLDER WOMEN

The highest percentages of unintended pregnancies and the largest incr eases 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 pregnan cy. In adolescents the combined oral contraceptive agents protect fert ility indirectly and exert favorable actions on menstrual dysfunction and certain hormone-related disorders such as acne and hirsutism. To a void sexually transmitted disease, barrier protection should be used a long with oral contraceptives until mutually monogamous, stable relati onships are established. Healthy older women who are nonsmokers may al so safely use currently available contraceptives. These agents have li ttle impact on metabolic parameters linked to the development of cardi ovascular disease. In addition to providing reliable contraception, or al contraceptives offer noncontraceptive benefits to older reproductiv e-age women, including control of abnormal bleeding and a reduction in the incidence of ovarian and endometrial cancers and other gynecologi c pathology. Intrauterine devices and progestin implants are safe, eff ective, and underused in the United States. Progestin implants may hav e an additional role in patients for whom estrogen preparations are co ntraindicated. Counseling is very important before insertion because o f the high rate of nuisance side effects. The contraception selection process must consider the efficacy and acceptability of the specific,m ethod to avoid the probability of unintended pregnancy and the risk of sexually transmitted diseases.