-See HPI.
-LMP: ___
-Cycle day#:____ of a 28-day cycle.
-Pregnancy test today: Negative.
-Different methods of contraception discussed with her including benefits, risks, and side effects.
-Counseling: No contraceptive method is perfect. Patient understands that the right method of contraception is the one that meets her unique needs and which she can consistently. and accurately use.
-Her chosen method is: _____
-Backup contraception discussed.
Contraception Pearls and Links
- Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use, 2012. on CDC.gov | on Timeofcare.com.
- The WHO publishes the medical eligibility criteria for contraceptive use. See here.
- Oral Contraceptive Pills (OCPs).
- Birth Control Questionnaire (have the patient complete it beforehand. Then have nurse scan it into the chart.)
- IUD Questions.
- Contraception Failure Rates.
- Contraception: Initiating the Pill, Patch, Ring, or Injection.
- Commonly asked questions about contraception.
- Contraceptive Options for obese women.
- Contraception options for smokers ≥35 years of age.
- Patients with a history of seizures taking seizure medications.
- The Menstrual Cycle. (To understand how all contraceptives work, you have to understand the menstrual cycle well.)
- Pregnancy and Pregnancy Testing.
- Contraception in Transplant Patients.
- Emergency Contraception.
- Mimicking Pregnancy: The Way Hormonal Contraceptives Work.
- Almost all COCs have EE (Ethinyl Estradiol) as the estrogen. They differ by the type of progestin they use and the dose. The common types of progestins used in OCPs are: Norethindrone, Levonorgestrel, Desogestrel, Norgestrel, and Norgestimate.
- The dosages for progestin – EE are usually written as P / EE, e.g., 0.15 mg / 30 mcg.
- If you type Ethynyl Estradiol in Epocrates, it will pull up different OCP combinations to choose from.
- Necessary evaluation before OCP prescription. Blood pressure (as severe HTN is a contraindication to oral contraception). Ascertaining the likelihood of pregnancy (based on the sexual history and/or phase of the menstrual cycle). A pregnancy test is not required.
- “Combination birth control pills that contain less than 50 micrograms of Ethinyl Estradiol, a kind of estrogen, are known as low-dose pills. Women who are sensitive to hormones may benefit from taking a lower-dose pill. However, low-dose pills may result in more breakthrough bleeding — bleeding or spotting between periods — than do higher-dose pills. Mayoclinic.com”
- “For all women, the best form of birth control is the one that will be used consistently. For women who wish to reduce side effects and have regular periods, pills with 30 to 35 mcg of Ethinyl estradiol may be a better choice than those with only 20 mcg.” AAFP
- Oral contraceptives are either monophasic, biphasic, or triphasic
- “Smoking increases the risks of the most dangerous side effects of estrogen-containing contraceptives.”
- “Avoid estrogen-containing contraceptives in women with hypertension or a migraine with aura. In both cases, the theoretical or proven risk of stroke outweighs the advantages.”
- Progestin-only pills are most effective in women who are exclusively breastfeeding. They are not as effective in pregnancy prevention in other circumstances. E.g. Errin (Norethindrone) 0.35 mg tab. Take 1 tab po daily.
Patches:
-Xulane (Norelgestromin / Ethinyl Estradiol transdermal). Patch: 150 mcg / 35 mcg per day. Apply 1 patch qwk x 3wk, off 1 wk.
-Ortho Evra (Norelgestromin / Ethinylestradiol transdermal). Patch: 150 mcg/35 mcg per day. Apply 1 patch qwk x 3wk, off 1 wk.
References / Further Reading
- https://www.cdc.gov/reproductivehealth/contraception/index.htm Last Accessed February 2018.
- Am Fam Physician. 2015 May 1;91(9):625-633. http://www.aafp.org/afp/2015/0501/p625.html (Provision of Contraception: Key Recommendations from the CDC)
- Am Fam Physician. 2006 Jul 1;74(1):105-112. http://www.aafp.org/afp/2006/0701/p105.html (Initiating Hormonal Contraception)
- The difference between monophasic, biphasic, and triphasic pills.
- http://www.nyc.gov/html/doh/downloads/pdf/ms/contra-guide.pdf
- http://www.uptodate.com/contents/overview-of-the-use-of-estrogen-progestin-contraceptives