What are the options for contraception (birth control) counseling?

From the Guidelines

Birth control counseling should prioritize a comprehensive discussion of all available contraceptive options, their effectiveness, benefits, risks, and proper usage, with a focus on the patient's reproductive goals, medical history, and personal preferences, as recommended by the most recent guidelines 1. When counseling patients, it is essential to start by assessing their reproductive goals, medical history, and personal preferences. This includes exploring patient goals, such as continued method use or method discontinuation, and providing reassurance and advice on managing bleeding irregularities while using contraception 1.

Key Considerations

• Hormonal methods, including combined oral contraceptives, patches, vaginal rings, injectable contraceptives, implants, and hormonal IUDs, should be discussed, along with their potential side effects and contraindications based on medical conditions.
• Non-hormonal options, such as copper IUDs, barrier methods, and fertility awareness methods, should also be presented, highlighting their effectiveness and potential benefits.
• Emergency contraception options, like Plan B or ella, should be explained, emphasizing their importance in preventing unintended pregnancies.
• The importance of proper use and potential barriers to using the selected method should be addressed, with providers working interactively with clients to select the most effective and appropriate contraceptive method 1.

Effective Contraceptive Methods

• Long-acting reversible contraceptives (LARCs), such as IUDs and implants, have the highest effectiveness rates (>99%) due to their ability to eliminate user error 1.
• Providers should inform clients about all contraceptive methods that can be used safely and present information on potential reversible methods of contraception using a tiered approach, starting with the most effective methods first 1.

Patient-Centered Approach

• A patient-centered approach should be used, tailoring information to ensure that clients understand the benefits, risks, and proper usage of their selected contraceptive method 1.
• Providers should establish and maintain rapport with the client, obtain clinical and social information, work interactively to select the most effective method, provide a physical assessment when warranted, and provide the contraceptive method along with instructions and follow-up plans 1.

From the FDA Drug Label

Patients should be counseled that oral contraceptives do not protect against transmission of HIV (AIDS) and other sexually transmitted diseases (STDs) such as Chlamydia, genital herpes, genital warts, gonorrhea, hepatitis B, and syphilis. Counsel patients that this product does not protect against HIV-infection (AIDS) and other sexually transmitted infections

• Birth control counseling should include information that oral contraceptives do not protect against HIV and other STDs.
• Patients should be advised to use alternative methods of protection against STDs.
• It is considered good medical practice for sexually active women using oral contraceptives to have annual history and physical examinations 2.
• Patients should be counseled on the importance of annual check-ups and the potential interactions between oral contraceptives and other medications 3.

From the Research

Birth Control Counseling

• Birth control counseling is an essential aspect of women's healthcare, as approximately 87% of US women use contraception during their lifetime 4.
• The most commonly used reversible method of contraception is oral contraceptive pills, which comprise 21.9% of all contraception in current use 4.
• Long-acting methods, such as intrauterine devices and subdermal implants, have increased in popularity, with failure rates of less than 1% per year 4.
• Hormonal contraceptives can improve medical conditions associated with hormonal changes related to the menstrual cycle, such as acne, endometriosis, and premenstrual dysphoric disorder 4.

Initiating Contraception

• Most women can safely begin taking hormonal birth control products immediately after an office visit, at any point in the menstrual cycle 5.
• Women who have not had a recent Papanicolaou smear can begin using hormonal contraceptives before the test is performed 5.
• After childbirth, most women can begin using progestin-only contraceptives immediately, while estrogen-containing methods can be initiated six weeks to six months postpartum for women who are breastfeeding 5.

Contraceptive Effectiveness and Safety

• The levonorgestrel intrauterine system and combined oral contraceptives are effective options for improving bleeding-related quality of life 6.
• The extended-cycle regimen of ethinylestradiol and levonorgestrel is effective and well-tolerated, resulting in a lower number of bleeding days and a favorable bleeding pattern compared to the conventional-cycle regimen 7.
• Long-term use of levonorgestrel-releasing intrauterine system as a maintenance treatment for endometriosis is effective and feasible, with significant pain reduction and fewer systemic side effects compared to other treatments 8.

Patient-Centered Approach

• Optimal contraceptive selection requires patient and clinician discussion of the patient's tolerance for risk of pregnancy, menstrual bleeding changes, other risks, and personal values and preferences 4.
• Physicians can help patients improve their use of birth control by providing anticipatory guidance about the most common side effects, giving comprehensive information about available choices, and honoring women's preferences 5.