A 14-year-old female presents to her primary care provider wanting to start “the pill”.  She has been with her boyfriend for 8 months.  They both agreed that they wanted to start a sexual relationship and have already had intercourse on two occasions where they did not use contraception.  She had never been sexually active before.  Her periods started 3 years ago and were initially irregular but she now reports a regular 27 day cycle.  She has never had any gynecological or other medical problems.

She reports that she is happy at school and she is one of three children, with a brother of 21 and sister of 19 years.  She lives with her parents in a house locally.  She has presented today with a friend from school.


  1. What issues are important in determining how this situation should be managed?
  2. How would you further investigate (diagnostics), advise and manage this patient?
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