DENVER — Starting adolescent girls immediately on oral contraceptives without waiting until the next menstrual period improves continuation to the second pack of pills and beyond, Dr. Sharon M. Edwards said in a poster presentation at the annual meeting of the Society for Adolescent Medicine.
Dr. Edwards, a pediatrician at Mount Sinai School of Medicine, New York, and her colleagues enrolled 539 girls (mean age 16 years) in a prospective nonblinded randomized controlled trial to determine if starting OCs during the initial clinic visit in girls who test negative for pregnancy, regardless of menstrual cycle, would increase adherence and reduce pregnancies. The girls had presented to two large inner-city clinics requesting OCs.
A total of 267 patients were assigned to OCs with a conventional start (CS) and 272 to the “quick-start” (QS) method. In the CS group, 89% had a past unplanned pregnancy, as had 90% of the QS group.
The investigators assessed each group at 3 and 6 months after baseline with an 87% follow-up rate. The QS method was associated with second-pack OC continuation, with an odds ratio of 1.6.
Moreover, the QS method “simplifies the whole instruction method,” Dr. Edwards said in an interview. “If their period is 2 weeks later, it requires them to really wait a long time. Maybe she'll forget to start, or maybe in that interim, she'll get pregnant, because she's not on any method.” She added that the two clinics in the study could dispense the pills immediately, rather than giving a prescription to be filled.
She conceded the pregnancy rates between groups were not different at either follow-up.
The efficacy of the QS method was echoed by Dr. Margaret Blythe, professor of pediatrics at Riley Hospital for Children in Indianapolis. “We find that kids come into the clinic and get education about it, and often it will be very confusing to them as to really when to start it,” she said in an interview. “Or they'll walk out and think, 'Well, I don't really have to get the prescription, because my next period doesn't start for another couple of weeks.' But on the other hand, if you start them that day, there's an immediacy and a need to go ahead and get the prescription filled.”
Dr. Blythe said she often gives the first pack. The patient then takes the first pill on site.
“We do the same thing with Depo-Provera, in terms of making sure when their last period was, when their last unprotected sex was—and also, whether they're in need of emergency contraception,” she added.
As to why the QS method isn't standard, “I think one of the biggest issues was fear—having an unknown pregnancy and starting a hormone method with unknown effects,” Dr. Blythe said. “But the data really support [the idea] that these hormones are safe, even if someone is pregnant.”