#158: Plan A, B and C: Counseling Adolescents on Contraception

November 5, 2025 | By Sam Masur

Audio

General pediatricians should feel empowered to initiate and manage contraception for their adolescent and young adult (AYA) patients. This episode will help listeners tailor counseling to each patient’s priorities, weigh the benefits and drawbacks of different methods, and address emergency contraception.

Contraception Pearls

1. Pediatricians should be able to prescribe contraception to patients
2. Prioritize what matters to your patients when deciding on contraception. There are other factors outside of efficacy when it comes to making the right choice 
3. Talk to ALL patients about birth control (not just patients assigned female at birth!) 

Contraception Notes 

Confidential time with young people encourages autonomy 

Multiple organizations (including the American Academy of Pediatrics (AAP) and the Society for Adolescent Health and Medicine)  support the need for clinicians to provide confidential care for adolescents (Maslyanskaya, 2019). Confidential time with clinicians can build rapport and give space to  AYAs to communicate their needs! Dr. Wilkinson encourages confidential time with young people before adolescents to normalize the practice for families. These confidential conversations should be tailored for the developmental stage of the patient. 

Ask AYAs if they have a trusted adult they can involve as a support person. It can be helpful if it is a parent or a guardian, but patients may have other supportive adults in their life! 

Tip: Set the ground rules with AYA early in confidential conversations. You may say, “Your privacy is important to me and what we talk about can stay between us. But if you share something where I am concerned about your safety or  am worried about your well being, I will need to share this with your parents. If that happens, I will let you know and we can decide together how to approach that with your parents.”

Start contraceptive counseling with what matters to the patient

Starting with efficacy may miss an opportunity to center your patient’s needs. The AAP supports giving AYA their choice of contraception when there are no medical contraindications (Ott, 2025). Here is a questions that AYA may have when thinking about birth control methods: 

• Does this method impact menstrual cycles?
• How much control does the user have over the method? Example: Is it something the user can start or stop on their own?
• Is the method something a partner can feel or know about?
• Does the method impact fertility?
• Does the method require a procedure?

Basics about contraception 

There are several types of birth control. In hormonal birth control, progesterone is primarily responsible for inhibiting follicular development, preventing ovulation and altering the endometrial lining. Estrogen inhibits follicular development to a lesser effect. Progesterone can make cervical mucosa inhospitable to sperm (Cooper, 2024). The pill, patch and ring have combined hormonal options. The injection, implant and intrauterine devices (IUD) are progesterone only. The copper IUD is a non hormonal option that causes a localized cytotoxic inflammatory response which impairs sperm mobility and viability within the uterus (Lanzola, 2025). Condoms are a barrier method and provide additional protection against STIs. There are other methods not discussed in today’s podcast. 

Oral contraception can reduce risk of endometrial, ovarian and colorectal cancer but there is evidence that breast and cervical cancers are increased in women who use oral contraceptives (National Cancer Institute, 2018). 

There are patient handouts that can help to answer questions about the methods. Common resources include Bedsiders, Planned Parenthood, Reproductive Health Access Project, the American College of Obstetrics and Gynecology. 

Take a good medical history so you can understand the risks involved with the selected method. The Centers for Disease Control and Prevention’s US Medical Eligibility Criteria for Contraceptive Use has a chart, app and full document to help support your decision making. Dr. Wilkinson points out that hypertension and migraines with aura are two important medical problems to consider for the general AYA. 

Tip: Starting new habits are hard! Strategize with patients about ways to increase adherence. 

Tip: Dr. Wilkinson recommends starting OCPs at the lower end of estrogen (10 mcg – 20 mcg)

Quick facts about quick start 

This is for the pill, patch, ring, injection and implant. 

• Is the first day of their period less than 7 days ago?
  • Yes? Start the method today.
    • Back up method is needed for 7 days *
  • No? Have they had unprotected sex since their last menstrual period?
    • Yes: Perform a pregnancy test. If negative and the patient wants to start the new method today, (1) offer emergency contraception if they last had unprotected sex less than 5 days ago (2) start the method today with a back up method of the next 7 days and (3) repeat pregnancy test in 2 – 4 weeks 
    • No: Start method today with a back up method for the next 7 days. 

* For further details and an example quick start algorithm, visit the Reproductive Health Access Project. 

Note: The episode incorrectly states that 5 days is needed to capture a pregnancy test, but 5 days is used to determine eligibility for emergency contraception. A pregnancy test should be repeated 2 weeks after the last unprotected intercourse. 

How clinicians respond to misinformation impacts the clinician – patient relationship 

Young people may rely on their networks (personal and virtual) to inform their birth control choices. Validate their concerns and respond to misinformation with facts. 

Concern: Birth control causes weight gain! 

What we know: There is no casual link between most hormonal birth control and weight gain. The injection can lead to water retention and average weight gain for individuals who use this method is 5 – 6 lbs (ACOG, 2024; Sims, 2021). 

Concern: Birth control can impact future fertility! 

What we know: It is important to understand a person’s indication for hormonal birth control. Birth control can be used to prevent pregnancy and suppress menstruation and does not impair future fertility (ACOG, 2022; Girum, 2018).  If hormonal birth control is being used to manage reproductive health concerns, it is not about the hormonal birth control but rather the underlying health concerns that impact fertility. 

Concern: That amount of estrogen is dangerous! 

What we know: There are individuals who have increased risk of thromboembolism with excess estrogen. The MEC can help clinicians understand and quantify risk level for patients.

Emergency contraception is an important part of counseling 

There are multiple forms of emergency contraception including 1.5 mg levonorgestrel (examples: Plan B One-Step®, Julie®), 30 mg ulipristal acetate (UPA; example: ella®), the copper IUD, and the 52 mg levonorgestrel IUD. The progesterone and selective progesterone receptor modulator delay ovulation and copper is toxic to sperm. When deciding on an oral emergency contraceptive pill, UPA may be more effective than levonorgestrel for higher BMIs (ACOG, 2015). Emergency contraception should be used as soon as possible, but is effective up to 5 days after unprotected intercourse. 

Note: UPA works better than levonorgestrel for those with a higher BMI, but evidence is limited for effectiveness in those who weigh over 200 lbs. 

Our counseling practices can reinforce health equity and reproductive justice 

Again, prioritize your patient’s needs over efficacy. LARC first counseling can be perceived by our patients as coercive. Learn more about reprojective justice in our past episode about sexual health. Prescribing a year’s worth of contraception can improve adherence (Foster, 2006). Know resources in your community! Adolescent Medicine, OBGYNs, Title X clinics (clinic finder tool). 

Goal

Listeners will be about to counsel adolescents and young adults about their contraceptive options. 

Learning Objectives

After listening to this episode listeners will…  

1. Recognize the importance of centering patient’s needs when it comes to contraception 
2. Be familiar with the different types of contraceptive methods and their respective benefits and drawbacks 
3. Counsel patients on the indication and types of emergency contraception 

Disclosures

Dr Wilkinson receives project funding as Principal Investigator from Cooper Surgical, Organon, and Bayer. The Cribsiders report no relevant financial disclosures.  

Citation

Nwora C, Wilkinson T, Chiu C, Berk J, Masur S. “#158: Plan A, B, C: Counseling Adolescents and Young Adults on Contraception”. The Cribsiders Pediatric Podcast. https:/www.thecribsiders.com/ 5th November, 2025.