From the Guidelines
A contraception review involves several key steps to ensure appropriate and effective birth control management, including gathering a comprehensive medical history, assessing current contraceptive needs, reviewing current methods, performing physical examinations, and discussing suitable options. The most recent and highest quality study, 1, provides guidance on managing bleeding irregularities while using contraception, emphasizing the importance of exploring patient goals and providing reassurance.
Key Steps in Contraception Review
- Gather a comprehensive medical history, including age, smoking status, personal or family history of cardiovascular disease, migraines, breast cancer, and previous contraceptive experiences, as recommended by 1 and 1.
- Assess current contraceptive needs by discussing relationship status, frequency of sexual activity, and future pregnancy plans.
- Review any current contraceptive methods, focusing on satisfaction, side effects, and adherence challenges.
- Perform appropriate physical examinations, including blood pressure measurement, BMI calculation, and breast examination, as suggested by 1.
- Discuss all suitable contraceptive options, ranging from long-acting reversible contraceptives (LARCs) like IUDs and implants to short-acting methods like combined oral contraceptives, patches, rings, and barrier methods.
Follow-Up and Ongoing Care
- Create a follow-up plan to assess method satisfaction and address any emerging concerns, as recommended by 1 and 1.
- At follow-up visits, assess the woman’s satisfaction with her contraceptive method, any changes in health status, and blood pressure, as suggested by 1.
- Consider assessing weight changes and counseling women who are concerned about weight changes perceived to be associated with their contraceptive method.
Prioritizing Patient Needs
- The patient's goals, preferences, and medical history should be prioritized when selecting a contraceptive method, as emphasized by 1.
- Provide detailed information about effectiveness rates, proper use, potential side effects, and non-contraceptive benefits of each method.
- Ensure that contraceptive choices align with the individual's health profile, lifestyle needs, and reproductive goals while maximizing effectiveness and minimizing risks.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Contraception Review Steps
To conduct a contraception review, the following steps are involved:
- Identify the patient's medical history, including any comorbidities and previous experiences with contraception 2
- Discuss the patient's social circumstances, gender identity, and personal values and preferences regarding contraception 2, 3
- Evaluate the patient's risk of pregnancy and desired level of contraceptive effectiveness 3
- Consider the patient's tolerance for potential side effects, such as changes in menstrual bleeding or nausea 2, 3
- Review the various contraception options, including oral contraceptive pills, intrauterine devices, subdermal implants, and emergency contraception 2, 3, 4
- Assess the patient's risk of venous thromboembolism (VTE) and consider the potential impact of hormonal contraception on this risk 5, 6
Contraception Options
The following contraception options are available:
- Oral contraceptive pills, which are the most commonly used reversible method of contraception 3
- Intrauterine devices, which have a high effectiveness and can be used for an extended period 2, 4
- Subdermal implants, which provide long-acting, highly effective reversible contraception 4
- Emergency contraception, which can be used within 120 hours after unprotected intercourse 2
- Progestin-only hormonal contraception, which is not associated with a significant increase in VTE risk 5, 6
Patient-Clinician Discussion
A patient-clinician discussion is essential to determine the best contraception option for each individual patient. This discussion should include: