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KEY CONCEPTS
Unintended pregnancy is a public health issue. A majority of unintended pregnancies occur due to inconsistent use or nonuse of contraceptives.
Contraception implies the prevention of pregnancy, however, some hormonal contraceptives may also provide noncontraceptive benefits.
When 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.
Patient-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.
A 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.
Adverse effects or difficulties in using the selected method should be monitored carefully and managed in regard to patient-specific factors.
Some medications may alter the effects of hormonal contraceptives or vice versa; therefore, concomitant medications should be assessed for medication 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 also for those using contraception on an ongoing basis.
Emergency contraception (EC) may prevent pregnancy after unprotected intercourse or when regular contraceptive methods have failed.
Mifepristone and misoprostol 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 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...