Which of the following are benefits of using long-acting reversible contraceptives (LARCs)? Select all that apply.

Adolescentsrequire tailored contraceptive counseling due to high rates of unintended pregnancy, variable adherence, limited knowledge, and developmental factors. They often face barriers such as lack of access, confidentiality concerns, and misinformation. The adolescent pregnancy rate remains significantly higher than other age groups, with unintended pregnancy rates exceeding 80% in some populations. Normal menstrual cycles may be irregular in early adolescence, complicating fertility awareness methods. Cognitive and emotional maturity also influences decision-making and consistency in contraceptive use. Long-acting reversible contraceptives (LARCs) are recommended due to their high efficacy and low maintenance.

Rationale for correct answers

2.Adolescents have the highest rates of unintended pregnancy due to inconsistent contraceptive use, limited access, and developmental factors. Tailored counseling improves method selection, adherence, and understanding, reducing risk.

Rationale for incorrect answers

1.Postmenopausal women are not at risk of pregnancy due to cessation of ovulation. Their counseling focuses on hormone replacement therapy and other health concerns, not contraception.

3.Women over 50 years typically have declining fertility due to reduced ovarian reserve and anovulatory cycles. While contraception may be needed until menopause is confirmed, their risk of unintended pregnancy is much lower than adolescents.

4.Nulliparous women may have specific considerations for method selection (e.g., IUD insertion technique), but they do not inherently have higher unintended pregnancy risk. Counseling may be individualized but not necessarily tailored due to elevated risk.

Take home points

• Adolescents have the highest unintended pregnancy risk
• Tailored counseling improves contraceptive adherence and understanding
• Postmenopausal and older women have low fertility risk
• Nulliparity affects method choice, not pregnancy risk

Depot medroxyprogesterone acetate (DMPA)is a progestin-only injectable contraceptiveadministered every 12 weeks. It works by inhibiting ovulation, thickening cervical mucus, and altering the endometrium. A common and important side effect is delayed return to fertility, with ovulation resuming on average 9–10 months after the last injection. DMPA also causes menstrual irregularities, including amenorrhea. It may reduce bone mineral density with long-term use; normal bone mineral density (BMD) values are ≥1.0 g/cm². DMPA does not increase thromboembolic risk and is safe for women with estrogen contraindications. Other side effects include weight gain and mood changes.

Rationale for correct answers

2.DMPA is associated with a delayed return to fertility, often taking 9–10 months after the last injection for ovulation to resume. This is a well-documented and important counseling point for users considering future pregnancy.

Rationale for incorrect answers

1.DMPA does not cause a significant increase in libido. In fact, some users report decreased libido or mood changes. Libido effects vary and are not a consistent or prominent side effect.

3.While DMPA does not increase the risk of venous thromboembolism, this is not a side effect but rather a safety advantage. It is suitable for women with contraindications to estrogen, but the question asks for a side effect.

4.DMPA often causes unpredictable menstrual cycles, especially in the first year. Many users experience irregular bleeding or amenorrhea. Predictable cycles are not a feature of DMPA use.

Take home points

• DMPA delays return to fertility after discontinuation
• Menstrual irregularities are common with DMPA
• DMPA is safe for women with estrogen contraindications
• Bone density loss is a concern with long-term use