Family planning in adolescents.

PURPOSE OF REVIEW: As politics continue to shape contraception and abortion care, providers have a responsibility to address the specific needs of the adolescent patient. Here we review the current literature on contraception and abortion in adolescents. RECENT FINDINGS: Shared decision-making among patients, parents, and providers is the cornerstone of successful adolescent family planning. Providers should be aware of local state regulations related to consent in minors. When provided directive and noncoercive contraception counseling at no cost, adolescents are motivated and effective decision-makers in their care. Long-acting reversible contraceptives should be offered as the first-line method of contraception in adolescents. SUMMARY: Family planning in adolescents presents unique challenges to obstetrician-gynecologists. Improved access to contraception and abortion services is significantly lowering unintended pregnancies rates in adolescents, but more data assessing the effectiveness of interventions in marginalized communities are needed.

Electives in obstetric/gynecology residencies. Evidence of flexibility.

OBJECTIVE: To describe the patterns of electives in obstetric and gynecology (OB/GYN) residencies. STUDY DESIGN: A cross-sectional survey of all 274 U.S. and Canadian residency directors assessed the type and number of electives offered by residency programs and correlated these with program characteristics. A separate survey evaluated resident satisfaction with electives at the University of Cincinnati (UC). RESULTS: Electives were offered by 53.8% of U.S. programs (95% CI: 45.2, 60.4), and 92% of electives were offered in the third year. The median length was four weeks, and surgical experience was the most common type of elective. A larger proportion of Canadian programs offered electives, which were of longer duration. The proportion of programs reporting electives did not vary with city size, program size or location. Among 29 UC residents, 62% arranged an optional elective, 92% were satisfied with the experience, and 5 residents (28%) reported that electives influenced their career choice. CONCLUSION: The prevalence of electives appears higher than listed in currently available directories, although lower than in other primary care residencies.

Clinical and metabolic findings in adolescent females with hyperandrogenism.

BACKGROUND: The purpose of this study was to characterize the population of adolescent females with laboratory evidence of hyperandrogenism and to explore clinical and laboratory features that may facilitate the diagnosis and management of this condition. We further investigated these characteristics by race, weight, and type of androgen abnormality. METHODS: A 4-year retrospective chart review was undertaken. Female patients were included if they attended Adolescent Medicine Clinic and had at least one abnormal laboratory parameter on a testing panel that included total and free testosterone, calculated percent free testosterone, and sex hormone binding globulin levels. RESULTS: Our final sample included 154 females, 70% of whom were white, 28% African-American and 2% of other ethnicities. The mean age was 16.1 years (range 11-23). The mean body mass index (BMI) was 30.4, ranging from 16.6 to 45.0, and 78% were obese (BMI>95th percentile for age). Initial reason for visit included irregular menses in 75.3%, acne or hirsutism in 7.1%, and other reason in 17.5%. Non-whites were more likely than whites to present with other reason for visit (28 vs. 13%, P<0.05). Non-white patients had a higher chronologic and gynecologic age at presentation than whites. Total testosterone was elevated in 82.6% of the non-white compared to 62.0% of the white patient group (P<0.05). There was no difference in BMI or obesity between whites and non-whites. The subgroup of adolescents with an isolated elevated testosterone was leaner, had a younger gynecologic age, and was more likely to have an abnormal glucose to insulin ratio than were those girls with other androgen abnormalities. Of those tested for other metabolic abnormalities, 55% had at least one abnormal lipid value, and 68% had an abnormal glucose to insulin ratio. CONCLUSIONS: Adolescent females with hyperandrogenism are at risk for other metabolic abnormalities. The higher gynecologic age and higher testosterone levels in our non-white patient group may reflect a delay in referral. Primary care physicians need to be sensitive to signs and symptoms of hyperandrogenism in the non-white population and in lean adolescents.