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KEY CONCEPTS

KEY CONCEPTS

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

  • image Contraception implies the prevention of pregnancy.

  • image 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.

  • image 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.

  • image 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.

  • image Adverse effects or difficulties in using the selected method should be monitored carefully and managed in consideration of patient-specific factors.

  • image 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.

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

  • image 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.

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

  • image Mifepristone, misoprostol, and methotrexate 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 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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