Contraception counseling helps a patient choose a birth control method that fits her health, goals and preferences. A good visit uses shared decision making, explains how well each method works and checks for medical reasons to avoid estrogen.
Key symptoms
- Wish to prevent or delay pregnancy
- Side effects from a current method, such as spotting
- Missed pills or a recent episode of unprotected sex
- Heavy, painful periods or acne that a method could help
What you find on exam
- Blood pressure, since high pressure limits estrogen use
- Weight and BMI
- Pelvic exam only when placing an IUD or if there are symptoms
- Screen for smoking, migraine with aura and history of blood clots
Tests
- Pregnancy test when pregnancy cannot be ruled out
- STI testing based on sexual history
- CDC US Medical Eligibility Criteria to check the safety of each method
- No routine Pap or labs needed to start most methods
Treatment basics
- Most effective: IUDs (levonorgestrel or copper) and the etonogestrel implant
- Pills, patch, ring or medroxyprogesterone injection
- Avoid estrogen in smokers over 35, migraine with aura or past blood clots
- Emergency contraception: levonorgestrel, ulipristal or a copper IUD
- Condoms to prevent STIs, with teach-back and follow-up
Red flags
- Leg pain, chest pain or sudden severe headache on an estrogen method
- Positive pregnancy test with pelvic pain while using an IUD
- Signs of reproductive coercion or partner violence
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.