CEU Guidance on Contraceptive Choices for Young People

Overview

• Published by: Faculty of Sexual and Reproductive Healthcare
• Amendments: March 2010, with updates in May 2019
• Purpose: To provide guidance for health professionals on contraceptive options for young people under 18, extending to those up to 25 years.
• Objective: Improve sexual health outcomes by providing clear, evidence-based guidelines.

Key Recommendations

Legal and Ethical Framework

• Discuss legal age and consent with young people; competence to consent should be assessed and documented.
• Maintain confidentiality with limits unless disclosure is justified by child protection needs.
• Staff should receive training on safeguarding children.

Contraceptive Options

• Inform young people of all contraceptive methods, emphasizing long-acting reversible contraception (LARC).
• Recommend follow-up within 3 months of starting hormonal contraception.
• Encourage return visits if problems arise.
• Emergency contraception (EC) should be offered to all ages within 72 hours of unprotected sex.

Health Concerns and Risks

• Weight Gain: No evidence of weight gain with combined hormonal contraception (CHC); possible weight gain with depot medroxyprogesterone acetate (DMPA).
• Acne: Combined oral contraception (COC) may improve acne; specific treatments for severe acne.
• Mood Changes and Depression: Hormonal contraception may cause mood changes, but not depression.
• Fertility: No delay in fertility return after stopping most contraceptive methods, except possible delay with DMPA.
• Bleeding Patterns and Dysmenorrhoea: Changes in bleeding patterns are common; CHC may improve primary dysmenorrhoea.
• Bone Health: DMPA associated with small bone mineral density loss; review every 2 years if continued use.
• Thrombosis: Slightly increased risk of venous thromboembolism (VTE) with CHC; absolute risk is small.
• Cancer: COC reduces ovarian cancer risk; slight increase in breast and cervical cancer risk.

STIs and Young People

• Encourage condom use to prevent STIs and provide education on their correct use.
• STI testing recommended 2 to 12 weeks post any unprotected sex incident.

Background

• Young people in the UK face poor sexual health outcomes compared to older populations and peers in Europe.
• High rates of unintended pregnancies and STIs.
• Importance of safe relationships, access to services, and understanding rights.

Legal and Ethical Considerations

• UK laws on sexual consent vary among regions; guidelines like Fraser Guidelines assist in determining consent competence for under-16s.
• Confidentiality is crucial; services should have child protection policies.

Contraceptive Use Trends

• Use of contraceptives is increasing among young people, with the pill and condoms most common.
• LARC methods, although less common, are gaining traction.

Implementation and Service Standards

• Encourage comprehensive consultations and information provision.
• Highlight the importance of understanding method-specific risks and benefits.

Appendices

• Useful Sources of Information: Links to UKMEC, NICE, and other guidelines.
• History Taking Suggestions: Framework for assessing young people's needs and contexts.
• Contraceptive Failure Rates: Data on typical and perfect use effectiveness.

This guidance document provides a comprehensive framework for health professionals to support young people's contraceptive choices, emphasizing informed consent, safeguarding, and addressing common health concerns.