Pill, implant, ring, IUD … It is not always easy to choose your first contraception in adolescence or at the start of your sex life. Here are the advice of our gynecologist to make an informed choice.
Who says first sexual intercourse ideally says first gynecological consultation and first contraception. But we still have to opt for the one that suits us best according to our profile! So, DIU or pill? Contraceptive implant or vaginal ring? Estroprogestive, 2nd or 3rd generation or progestin micropilule pill? Advice from Dr. Brigitte Raccah-Tebeka, gynecologist-endocrinologist.
If the girl had her first sexual relations, or if she plans to have it, she can consult a gynecologist And have recourse to his first contraception. She can decide, as desired, to consult a gynecologist (which her attending physician, her mother or a friend will be able to advise her) or to go to a family planning and education center (CPEF, family planning). But she reassures herself, “The first gynecological consultation does not necessarily imply a gynecological examination Like a smear for example. It is only realized if the patient is not hostile or if her state of health requires it“, Specifies Dr. Raccah-Tebeka. On the other hand, the gynecologist will always check, during this first session, its weight, tension, the appearance of your skin, the condition of its legs (to detect possible venous problems) as well as the state of her breasts via a palpation (to detect a possible ball, a flow …).
Then there is a real exchange Between the health professional and the girl. “”This first contact is an opportunity to ask her for what she knows about contraception, if she has friends who told her about it, what are her possible medical or family history (stroke, phlebitis, pulmonary embolism in her close family). Then comes the time to explain the different contraceptive possibilities to him“, explains Dr. Raccah-Tebeka. In addition, during the first gynecological consultation, the doctor will insist on the use of condoms To inform the girl about sexually transmitted infections. Finally, “No need to take a blood test before the first prescription, unless the girl is overweight (in this case, she must control her blood sugar and cholesterol levels) or if she has family history. On the other hand, it is necessary to take up an appointment with his gynecologist and to do A blood test after 3 months under hormonal contraception To check if it is well tolerated by the body and if it does not cause side effects (chest pain, weight gain, bleeding, acne, migraines …) “.
With what contraception to start?
► A hormonal contraceptive. “”Generally, for a first contraception, it is extremely rare to offer a hormone -free method like the copper IUD or a local method“, Indicates the gynecologist at the outset. Rather, the girl will be advised to associate hormonal contraceptions. When it is taken correctly, the pill remains very effective (91% efficiency in everyday life). However, other hormonal contraceptives can be offered. The vaginal rings and patches Also have good efficiency (around 90% in practical use) and make it possible to avoid pill oversights. On the other hand, they are not reimbursed by health insurance. The pill is easy to use, is completely reversible, regulates cycles and reduces rules related to the rules. Some even have a positive effect on acne. The rules of use are then well explained as well as the attitude to be adopted in case of forgetting. But why associate it with condoms? Because although raised, the contraceptive efficiency of the pill is still not sufficient in these young girls, for whom an unwanted pregnancy would be very problematic. And if after a few months, the romantic relationship continues and if the girl uses Another contraceptionwe can invite the couple to abandon the condom. But before, a sexually transmitted infections screening must be carried out by both partners.
► The contraceptive implant Can also be considered as first -line contraception in young girls: this method remains effective for a period of 3 years and makes it possible to avoid pill oversights. On the other hand, “Cervical diaphragms and capes are local contraceptions that are not offered to young girls. Their effectiveness is not sufficient (around 85 %) for these women who have normal fertility. They will be more offered to women over 40 whose fertility has decreased“, Recommends the expert.
What is the best first contraceptive pill?
Combined or estroprogestive, progestogen, 2nd generation or other … There are so many different pills that it is difficult to see clearly. But don’t panic, the gynecologist is there to guide you according to your profile:
► If the girl presents no personal or family history, has no cholesterol, diabetes or other contraindications, we offer her A so -called 2nd generation estroprogestive pill (it contains Lévonorgestrel or Norgestrel at lower thromboembolic risk);
► If the girl has family or personal history (and therefore has a risk of pulmonary embolism, phlebitis, infarction, cardiovascular accident …), or health problems (high cholesterol levels, high blood pressure,) which contraindicate the use of estrogens, we will orient it a progestogy pillor towards a contraceptive implant Subcutaneous, a device containing only progestin hormones that do not increase this risk;
► If the girl smokes less than 5 cigarettes per day and that she has a risk factor for tobacco, there are no contraindications to use a Estroprogestative pill ;
► If the girl smokes more than 5 cigarettes per day and has another risk factor (a high cholesterol level, overweight, high blood pressure …), we will avoid contraceptions containing estrogens and we will rather prescribe a progestin or a contraceptive implant ;
► If the girl has acne skin, we will offer her a Estroprogestative pill which relieves acne. Namely, the progestogen contained in the progestogen pill, such as Levonorgestrel, with effects close to male hormones, can worsen acne.
Thanks to Dr. Brigitte Raccah-Tebeka, gynecologist-endocrinologist.
