Contraception

Objectives

1. With all patients, especially adolescents, young men, postpartum women, and perimenopausal women, advise about adequate contraception when opportunities arise.
2. In patients using specific contraceptives, advise of specific factors that may reduce efficacy (e.g., delayed initiation of method, illness, medications, specific lubricants).
3. In aiding decision-making to ensure adequate contraception:
   • Look for and identify risks (relative and absolute contraindications).
   • Assess (look for) sexually transmitted disease exposure.
   • Identify barriers to specific methods (e.g., cost, cultural concerns).
   • Advise of efficacy and side effects, especially short-term side effects that may result in discontinuation.
4. In patients using hormonal contraceptives, manage side effects appropriately (i.e., recommend an appropriate length of trial, discuss estrogens in medroxyprogesterone acetate [Depo–Provera]).
5. In all patients, especially those using barrier methods or when efficacy of hormonal methods is decreased, advise about post-coital contraception.
6. In a patient who has had unprotected sex or a failure of the chosen contraceptive method, inform about time limits in post-coital contraception (emergency contraceptive pill, intrauterine device).