Controversies in contraception.
OBJECTIVE
New research is constantly being published regarding hormonal contraceptives and bone health, migraine headaches, thrombosis risk, hypertension, weight gain, and obesity, as well as emergency contraception. At times, these studies can be clarifying, but they can also raise new controversies and questions. It is important for providers to be aware of the emerging issues regarding contraceptive care for adolescent patients.


RESULTS
Research suggests that Depo-Provera (depot medroxyprogesterone acetate; Pfizer, New York City, New York, USA) and, perhaps, low-dose oral contraceptive pills can have adverse effects on adolescent bone health, although the data demonstrating reversibility of bone loss after discontinuation of these contraceptives are reassuring. Additionally, estrogen-containing contraceptives pose risks for patients, including the onset of or exacerbation of migraine headaches, venous thromboembolism, and hypertension. Depo-Provera has been implicated in weight gain, especially in girls who are already overweight. Obesity may decrease the efficacy of some hormonal contraceptives. Finally, the mechanism of action of emergency contraception is still unknown, although studies continue to suggest that it has primarily preovulatory, not postovulatory, effects.


CONCLUSIONS
Adolescent health providers need to be aware of the new research and controversies in contraceptive care in order to counsel and care for patients effectively.
Pitts
Sarah A B
SA
Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA. sarah.pitts@childrens.harvard.edu
Emans
S J
SJ
D000293:Adolescent; D003267:Contraception / Q000009:adverse effects* / Q000379:methods*; D003271:Contraceptive Agents, Female / Q000009:adverse effects* / Q000494:pharmacology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D017258:Medroxyprogesterone Acetate / Q000009:adverse effects; D008881:Migraine Disorders / Q000139:chemically induced; D009765:Obesity / Q000139:chemically induced; D010024:Osteoporosis / Q000139:chemically induced; D054556:Venous Thromboembolism / Q000139:chemically induced; D015430:Weight Gain / Q000187:drug effects
D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate