scientific program • symposia - American Society for Reproductive ...

SCIENTIFIC PROGRAM • INTERACTIVE SESSIONS
Tuesdasy, October 18, 2011 1:15 pm – 2:15 pm
Contraception Day Interactive Session
ADOLESCENT CONTRACEPTON: DEPOT MEDROXY-
PROGESTERONE ACETATE VS. IUDs. AN INTERACTIVE DEBATE.
Presented by the Contraception Special Interest Group
Jeffrey T. Jensen, M.D., M.P.H. (Chair)
Oregon Health & Science University
Andrew Kaunitz, M.D.
University of Florida College of Medicine-Jacksonville
Steven J. Sondheimer, M.D.
University of Pennsylvania School of Medicine
Needs Assessment and Description
Contraception is identified as an important and relevant
topic area of the ASRM, and there is a strong demand
for small sessions focused on interactive clinical case
discussions. Members of the Contraceptive Special Interest
Group identified the topic of adolescent pregnancy as a
top priority. A literature review and information from the
most recent National Survey of Family Growth suggest that
long-acting methods of contraception are underutilized in
adolescents. The United States has the highest rate of teen
pregnancy among more developed nations. Despite the
availability of highly effective long-acting contraceptive
methods, many health care providers have questions
about safety and side-effect profiles that limit the use of
long-acting methods in young women. The commonly used
injectable, depot medroxyprogesterone acetate (DMPA),
has been linked to poor bone health and weight gain.
Intrauterine devices (IUDs) are highly effective long-acting
options, but their use has been discouraged in adolescents
due to concerns about infection and infertility. This debate
will provide an attractive and highly interactive format to
review the data on these methods in teens.
Learning Objectives
At the conclusion of this session, participants should be able
to:
1. Discuss the data on depot medroxyprogesterone acetate
(DMPA) and bone health.
2. Compare the expected bleeding patterns between
DMPA, the copper IUD, and the levonorgestrel intrauterine
system (LNG IUS).
3. Discuss differences between the copper IUD and the LNG
IUS and counsel patients about contraceptive benefits
and bleeding patterns with this system.
4. Critique the literature on weight effects of DMPA in
adolescents.
5. Summarize the effects of IUD use on pelvic infection and
infertility.
Room 230 A/B
87
ACGME COMPETENCY
Medical Knowledge
Patient Care
TEST QUESTION:
1. A 16-year-old female presents for contraceptive
counseling. She had an abortion three weeks ago after
a failure while using oral contraceptives. She admits that
she was not always a reliable pill taker, but is reluctant
to consider other options. She does not want a device
or implant, and is worried about side effects with depot
medroxyprogesterone acetate (DMPA). After participating
in this session, in my practice I would counsel this patient
that:
A. Irreversible bone loss develops in adolescents but not in
adults.
B. Calcium supplementation and diet have no impact on
bone density in adolescents.
C. Early weight gain with DMPA predicts subsequent weight
gain.
D. DMPA is as effective as a contraceptive implant.
E. Not applicable to my area of practice.
2. A 15-year-old sexually active female comes to your
office requesting contraception. She has a history of a prior
ectopic pregnancy that was treated medically. She does
not want any type of oral daily regimen or barrier method
and requests an IUD. Physical examination is normal and her
body mass index is 30 kg/m 2 . Upon speculum examination,
you note a muco-purulent cervical discharge. After
participating in this session, in my practice I would counsel
this patient that an IUD cannot be placed at this time
because she:
A. Has a history of ectopic pregnancy.
B. Is under age 16.
C. Has muco-purulent discharge from the cervix.
D. Is obese.
E. Not applicable to my area of practice.