Contraceptive use in the chronically ill adolescent female. Part II

Exploring clinician confidence in the management of adolescent menstrual and reproductive health problems

PURPOSE

A high incidence of menstrual problems is reported in adolescent girls, with significant attendant morbidity. The majority are likely to be seen and managed by doctors other than specialist gynaecologists. This study aimed to survey the practice of doctors other than gynaecologists, to establish their chosen therapeutic options and confidence levels and to explore knowledge, using clinically challenging scenarios.

METHODS

A questionnaire designed to fulfil the above aims was distributed to a wide range of clinicians across paediatric disciplines and primary care.

RESULTS

The questionnaire was returned by 306 clinicians. General practitioners and paediatric endocrinologists were more confident in management and were more likely to self-manage patients (p < 0.01). The oral contraceptive pill was the most frequently chosen first-line therapy by all clinicians, followed by transdermal oestrogen/progesterone, etonorgestrel implant, progesterone-only pills, levonorgestrel-intrauterine system and depot medroxyprogesterone acetate injections. General, community and subspecialist paediatricians were more likely to choose suboptimal management strategies for each of five clinical scenarios.

CONCLUSIONS

Low confidence levels, suboptimal therapy choices and high referral rates are common among general paediatricians, community paediatricians and subspecialists for adolescents with menstrual and reproductive health concerns. Targeted education for these clinician groups, towards optimizing management for these patients, would enhance care.

Contraception for patients with psychiatric or medical disorders

The increased risk that pregnancy carries for women with medical disorders must be weighed against the risks of reversible contraception. In the absence of prospective randomized trials of various contraceptive methods and their effect on a given disease process, the clinician must use information regarding the risk of pregnancy in a woman with medical problems, the well-documented failure rates of various methods, and the probability that the patient will use the method (or any other method) effectively. The possible effects of contraceptive methods on cardiovascular, endocrinologic, neurologic, and other medical disorders are discussed as are appropriate contraceptive options and considerations for these women.

Hormonal contraception

Increased sexual activity among adolescents demands that the health care provider have a thorough understanding of contraceptive methods and application. In this article, the principles of hormonal contraception are discussed, providing relevant information for use in advising and managing the sexually active adolescent.