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KEY CONCEPTS
Unintended pregnancy is a public health issue. A majority of unintended pregnancies that occur are due to inconsistent use or nonuse of contraceptives.
Contraception implies the prevention of pregnancy.
The following must be considered when selecting a contraceptive method: the effectiveness of the method, the noncontraceptive benefits and side effects of the method, attitude of the patient and of the sexual partner toward a contraceptive method, the ability to use the method correctly (which may alter the effectiveness of the method), and the ability to pay for the method.
Patient-specific factors (eg, frequency of intercourse, age, smoking status, desire for return to fertility, concomitant diseases, medications, and drug–drug interactions) must be evaluated when selecting a contraceptive method.
A variety of contraceptive methods are available. Nonhormonal methods include fertility awareness, barriers, spermicides, and the copper intrauterine device. Hormonal methods include estrogen/progestin products or progestin-only methods.
Adverse effects or difficulties in using the selected method should be monitored carefully and managed in consideration of patient-specific factors.
Some medications may alter the effects of hormonal contraceptives or vice versa; therefore, a patient's concomitant medications should be assessed for drug–drug interactions with hormonal contraceptives.
Accurate and timely counseling on the management of missed doses is critical for contraceptive effectiveness.
Counseling on the optimal use of the contraceptive method and providing strategies for minimizing sexually transmitted infections/diseases (STIs/STDs) must be provided to all patients being initiated on contraceptives and for those also using contraception on an ongoing basis.
Emergency contraception (EC) may prevent pregnancy after unprotected intercourse or when regular contraceptive methods have failed.
Mifepristone, misoprostol, and methotrexate may be used in regimens for medical abortion.
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Patient Care Process for Contraception
Collect
Patient characteristics (eg, age, sex, date of last menstrual period, pregnant, recently postpartum, breastfeeding, desire for pregnancy/return to fertility)
Patient medical history (personal and family)
Medication allergies
Social history (eg, tobacco/ethanol use, relationships, sexual history)
Current medications including over-the-counter (OTC), herbal products, dietary supplements
Previous or current use of contraceptives
Objective data: blood pressure (BP), height, weight
Assess
Pregnancy status
Effectiveness of previous contraceptive methods used (Tables 18-1 and 18-2)
Blood pressure
Weight and optimal method for use
Precautions and contraindications to various types of contraceptives utilizing the CDC Medical Eligibility for Contraceptive Use, 2016 (see Table 18-6)
Venous thromboembolism (VTE) risk factors (eg, recent surgery, plaster casting of lower extremity, cancer, prolonged immobility, recent hospitalization, recently postpartum)
Drug interactions with various forms of contraception (see Table 18-6 for a select listing of drug interactions)
Patient ability/willingness to use, adhere, or pay for various forms of contraception (Tables 18-1 and 18-2)
Plan*
Drug therapy regimen including specific contraceptive dosage forms, dose, route, frequency, and duration (see Table 18-3 for select examples)
Monitoring parameters including effectiveness and safety (eg, ACHES, abdominal pain, chest pain, headaches, eye problems, and severe leg pain) (Tables 18-4 and 18-5)
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