• Inform young people that confidentiality is to be expected from all members of the healthcare team, but confidentiality might be broken if maltreatment, exploitation, or coercion is suspected.
• In England and Wales, it is lawful to provide contraceptive advice and treatment to girls less than 16 years of age without parental consent, provided that the Fraser guidelines have been met. Similar criteria apply in Scotland. The Fraser criteria are:
• The young person understands the advice given to her by the health professional.
• The young person cannot be persuaded to inform her parents, or to allow the healthcare professional to inform them.
• It is likely that the young person will continue to have sexual intercourse, with or without the use of contraception.
• The young person's physical or mental health may suffer as a result of withholding contraceptive advice or treatment.
• It is in the best interests of the young person for the clinician to provide contraceptive advice or treatment, or both, without parental consent.
• Consider child protection issues.
• Document assessments made of vulnerabilities.

In depth

• Provided that there are no medical contraindications, any method of contraception can be used, and a girl should choose her own method. However:
• Before menarche: condoms are preferred for sexually active premenarchal girls (as a contraceptive, and to prevent sexually transmitted infection); hormonal methods are not advised.
• Bone mineral density: a progestogen-only injectable may be used if the girl chooses this over other contraceptive methods.
• Prevention of sexually transmitted infections: when a hormonal or intrauterine contraceptive method is chosen, condoms should also be used to prevent sexually transmitted infections.
• Give advice about prevention of sexually transmitted infections.
• The correct and consistent use of condoms should be advised to reduce the risk of sexually transmitted infections.
• Young people should be advised to get tested for sexually transmitted infections 2 and 12 weeks after unprotected sexual intercourse.
• Reassure girls and young women that:
• Combined oral contraceptives (COCs) may improve acne vulgaris. Co-cyprindiol is indicated to treat severe acne which has not responded to oral antibiotics, but the higher risk of venous thromboembolism should be noted.
• Any increase in risk of cancer associated with hormonal contraception is very small and not clinically relevant when weighed against the risk of pregnancy should contraception not be used.
• The risk of venous thromboembolism is increased with use of COCs, but the absolute risk is very low.
• There is no evidence of weight gain with use of COCs or the patch.
• It is unclear whether hormonal contraception has an adverse effect on mood.
• Altered bleeding patterns can occur with hormonal contraception, but dysmenorrhoea may improve with use of combined hormonal contraception.

In depth