What information should be obtained from a patient's medical history before prescribing contraceptive medications?

Key Information to Obtain Before Prescribing Contraceptive Medications

Before prescribing contraceptive medications, a thorough medical history assessment is essential to identify potential contraindications and determine the most appropriate method for each patient.

Medical History Components

Reproductive and Menstrual History

• Menstrual history including last menstrual period, frequency, length, and amount of bleeding 1
• Gynecological and obstetrical history 1
• Previous contraceptive use and experiences (methods used, side effects, compliance issues) 1
• Pregnancy intentions or reproductive life plan 1
• Recent pregnancy outcomes (delivery, miscarriage, abortion) 1

Medical Conditions

• History of thrombophlebitis or thromboembolic disorders (absolute contraindication for estrogen-containing methods) 2
• Cardiovascular disease history, including stroke or coronary artery disease 1
• Hypertension status and blood pressure measurements 1
• Diabetes status and control 1
• Liver disease or history of jaundice 2
• Migraine history, especially with aura 1
• Breast cancer history (current or past) 2
• Autoimmune conditions like systemic lupus erythematosus 1
• Undiagnosed abnormal genital bleeding 2

Risk Factors

• Age (particularly important for women over 35) 1
• Smoking status and quantity (cigarettes per day) 1
• Body mass index (BMI) 1
• Family history of deep vein thrombosis or thrombophilia 3
• Personal or family history of breast cancer 2

Medication Use

• Current medications that might interact with hormonal contraceptives 1
• Particularly medications for epilepsy, HIV, or Hepatitis C treatment 1, 4
• Use of herbal supplements or over-the-counter medications 1

Lifestyle and Behavioral Factors

• Sexual history and practices 1
• STI risk factors and history 1
• Alcohol and substance use 1
• Ability to adhere to daily medication regimens 1

Physical Assessment

Essential Measurements

• Blood pressure (Class A examination - essential before initiating combined hormonal contraceptives) 1
• Weight and BMI calculation (helpful for monitoring over time) 1

Non-Essential Examinations

• Clinical breast examination (Class C - not essential for contraceptive provision) 1
• Pelvic examination (Class C - not essential for contraceptive provision) 1
• Laboratory tests such as glucose, lipids, liver enzymes, and hemoglobin (Class C - not essential) 1

Special Considerations

Postpartum Women

• Timing since delivery affects eligibility for various methods 1
• Different recommendations for breastfeeding versus non-breastfeeding women 1
• Increased risk of thromboembolism in early postpartum period 1

Women with Specific Medical Conditions

• Women with well-controlled hypertension may use progestin-only methods 1, 4
• Women with history of venous thromboembolism should avoid estrogen-containing methods 4, 5
• Women with rheumatic diseases, particularly with antiphospholipid antibodies, need special consideration 5
• Women with sickle cell disease may benefit from specific contraceptive options 4

Common Pitfalls to Avoid

• Requiring unnecessary examinations or tests (like Pap smears, breast exams, or STI testing) before providing contraception can create barriers to access 1
• Failing to assess for drug interactions, particularly with anticonvulsants, antiretrovirals, and certain antibiotics 1
• Not considering non-contraceptive benefits of various methods when making recommendations 4
• Overlooking the increased risk of thrombosis in women with multiple risk factors (smoking, age >35, hypertension) 3, 6

By obtaining this comprehensive information before prescribing contraceptive medications, providers can help ensure safe and effective contraceptive use while minimizing potential risks.