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Is the Pill a Smart Choice for a Conscientious Young Woman?


I'm 17, have regular periods, want to have children one day, and don't want to do anything that would risk my future health. I am sexually active but haven't yet found a life partner. Do you think I should use the Pill?


Thank you for your question. You have asked about something that is very important. It turns out that about 86 percent of young Canadian women have used the Pill for three months or longer (1). Because of many requests for balanced, accurate and timely information about oral contraceptives (the Pill) I’ve just written an overview (see “Choices for Effective Contraception”).

I gather that you haven’t used the Pill before. There are some health and family history questions you need to ask yourself before starting. Take a look at the second paragraph in the safety section of that article to be sure you don’t have any clear reasons to avoid the Pill like abnormal blood clotting, family history of breast cancer, active liver disease, migraine headaches, current smoking or being overweight.

One reason to avoid the Pill at your age (and perhaps until you are over 25) is its use may prevent the increased bone growth and strength that normally occur in the late teens and early 20s (2). A study in adolescent monkeys shows the same thing (3). However, if the Pill turns out to be your choice, there is evidence that having more food calcium will prevent the negative effect of the Pill on bone growth in young women (4). To be really sure of strong bones, at any rate and especially if using the Pill, I recommend following all the suggestions in the ABCs of Adolescent Osteoporosis Prevention.

Another reason the Pill may not be optimal at your age is that it may interfere with your development of normal ovulation. You may have regular periods, but based on a large study (5), it is unlikely that you are usually releasing an egg and making the normal amount of progesterone for about two weeks (luteal phase) each cycle. We don’t have any studies that have tracked this, but based on the way the Pill works, I am concerned that it may interfere with essential teen learning about ovulation. To help you understand if you are ovulating, ask yourself the following question (or keep the Daily Menstrual Cycle Diary to learn the answer): “Can you tell by the way you feel that your period is coming?” If you can’t tell, you are likely not regularly making an egg. If you can tell, and you get breast tenderness up under your armpit while the rest of your breast is fine, you are probably ovulating (see “Ovulatory Disturbances: They Do Matter”).

You mentioned that you haven’t yet found a permanent partner. That makes it important, given your possible exposure to sexually transmitted infections, to use something that prevents these risks. For this reason, I always recommend barrier methods. My strong suggestion, especially for young women like you, is using a barrier method, like a condom or diaphragm plus a whole applicator of contraceptive jelly or foam. This barrier-plus-vaginal-spermicide method is equally good, if used every time, at preventing pregnancy—it also decreases your risks for infection. Given that you sound conscientious, I think it would work for you.

In summary, you seem healthy, highly motivated to stay that way, but at risk for problems from the Pill that are unique to your age and relationship. I’d suggest the barrier-plus-vaginal-spermicide method at least until you are older.

Hope this is helpful for you.
All the best,

Reference List

  1. Prior JC, Kirkland S, Joseph L, Kreiger N, Murray T.M., Hanley DA et al. Oral contraceptive agent use and bone mineral density in premenopausal women: cross-sectional, population-based data from the Canadian Multicentre Osteoporosis Study. Can.Med.Assoc.J. 2001;165:1023-9.
  2. Polatti F, Perotti F, Filippa N, Gallina D, Nappi RE. Bone mass and long-term monophasic oral contraceptive treatment in young women. Contraception 1995;51:221-4.
  3. Register TC, Jayo MJ, Jerome CP. Oral contraceptive treatment inhibits the normal acquisition of bone mineral in skeletally immature young adult female monkeys. Osteoporos.Int. 1997;7:348-53.
  4. Teegarden D, Legowski P, Gunther CW, McCabe GP, Peacock M, Lyle RM. Dietary calcium intake protects women consuming oral contraceptives from spine and hip bone loss. J.Clin.Endocrinol.Metab 2005;90(9):5127-33.
  5. Vollman RF. The menstrual cycle. In: Friedman EA, editor. Major Problems in Obstetrics and Gynecology, Vol 7. 1 ed. Toronto: W.B. Saunders Company; 1977. p. 11-193.
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Wednesday, November 20, 2013 - 14:15

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