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KEY CONCEPTS

KEY CONCEPTS

  • imageUnintended pregnancy is a public health issue. A majority of unintended pregnancies occur due to inconsistent use or nonuse of contraceptives.

  • imageContraception implies the prevention of pregnancy, however, some hormonal contraceptives may also provide noncontraceptive benefits.

  • imageWhen selecting a contraceptive method consider the following: the effectiveness of the method, its noncontraceptive benefits and adverse medication effects, attitude of the patient and sexual partner toward a contraceptive method, the ability to use it correctly (which may alter its effectiveness), and the ability to pay for the method.

  • imagePatient-specific factors (eg, frequency of intercourse, age, smoking status, desire for return to fertility, concomitant diseases, medications, contraceptive method preference, and medication interactions) must be evaluated when selecting a contraceptive method.

  • imageA variety of contraceptive methods are available. Nonhormonal methods include fertility awareness, barriers, spermicides, and the copper intrauterine device. Hormonal methods include progestin-only or combination of estrogen/progestin products.

  • imageAdverse effects or difficulties in using the selected method should be monitored carefully and managed in regard to patient-specific factors.

  • imageSome medications may alter the effects of hormonal contraceptives or vice versa; therefore, concomitant medications should be assessed for medication interactions with hormonal contraceptives.

  • imageAccurate and timely counseling on the management of missed doses is critical for contraceptive effectiveness.

  • imageCounseling 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 also for those using contraception on an ongoing basis.

  • imageEmergency contraception (EC) may prevent pregnancy after unprotected intercourse or when regular contraceptive methods have failed.

  • imageMifepristone and misoprostol may be used in regimens for medical abortion.

PATIENT CARE PROCESS

Patient Care Process for Contraception

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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 19-1 and 19-2)

  • BP

  • 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 19-6)

  • Venous thromboembolism (VTE) risk factors (eg, recent surgery, plaster casting of lower extremity, cancer, prolonged immobility, recent hospitalization, recently postpartum)

  • Medication interactions with various forms of contraception (see Table 19-6 for a select listing of medication interactions)

  • Patient ability/willingness to use, adhere, or pay for various forms of contraception (Tables 19-1 and 19-2)

Plan*

  • Medication therapy regimen including specific contraceptive dosage forms, dose, route, frequency, and duration (see Table 19-3 for select examples)

  • Monitoring parameters including effectiveness and safety (eg, ACHES [abdominal pain, chest pain, headaches, eye problems, and severe leg pain]) (Tables 19-4 and 19-5)

Implement...

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