Selecting the Right Contraceptive
Most women (46% of sexually active women) choose the oral contraceptive pill as their contraceptive of choice, but many who do so are unaware of the other options available to them. If you need a refresher, visit http://sexualityandu.ca/professionals/contraception.aspx before proceeding.
Here are the key questions you need to ask when sizing up a patient for contraception:
1) Are there any medical contraindications to this therapy?
2) What are the side effects? Are they tolerable to the patient? Are there risks to this regimen?
3) What is the Pearl Index (effectiveness)? Is the risk of pregnancy of this method too high for this patient?
4) What does the regimen entail? Pills? Injections? Topical application?
a. Is this physically possible for this patient?
b. Is the patient likely to have good adherence to this regimen?
5) Is this a good time to reduce the risk of other diseases?
a. Last Pap?
b. Risk of PID with IUD use is greatest following insertion – consider doing cervical swabs.
c. STI testing should NOT be restricted to young or high-risk individuals
Be aware of the barriers physicians can create for women seeking contraception! Some examples include:
Requiring annual Pap smears before dispensing OCP.
Not inserting IUDs in unmarried women
Not having access to nulliparous-sized IUDs in North America
Not offering alternatives to Oral Contraceptives due to unfamiliarity with new products.
Note: the prescription of hormonal methods of birth control is often the gateway to the abandonment of barrier forms of contraception, so don't forget to advise patients of the importance of barrier methods in preventing STIs.
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