Contraception and Family Planning

Contraception questions reward one habit: screen the health history first, then teach the method's follow-up rules.

Combined hormonal methods

Combined pills, the patch, and the vaginal ring deliver estrogen plus progestin. They work primarily by suppressing ovulation. Estrogen raises clot risk, so some patients can never use these methods. Rule out estrogen for a patient age 35 or older who smokes, for migraine with aura, for any history of blood clots, stroke, or heart disease, for current breast cancer, for uncontrolled high blood pressure, and for the first three weeks after birth.

For a missed pill, the rule depends on the count. One missed pill: take it as soon as remembered and continue the pack. Two or more missed pills: take the most recent missed pill right away and use condoms for the next 7 days.

Progestin-only methods

Progestin-only methods avoid estrogen, so they suit breastfeeding patients and anyone with an estrogen contraindication. The progestin-only pill works by thickening cervical mucus, and that effect fades fast. Taking the pill more than 3 hours late means using a backup method for 48 hours.

The depot medroxyprogesterone injection is given every 12 weeks. Teach calcium, vitamin D, and weight-bearing exercise, because long-term use can lower bone density. Fertility can take a year or more to return after stopping.

Long-acting reversible contraception

The implant and the intrauterine devices are the most effective reversible methods because nothing depends on daily adherence. The implant lasts about 3 years. The hormonal IUD lightens periods over time. The copper IUD is hormone-free and can make periods heavier. Teach IUD users to check the strings after each period.

Emergency contraception

Emergency contraception is time-critical. The copper IUD is the most effective option and works up to 5 days after intercourse. Ulipristal, a prescription pill, also works up to 5 days. The over-the-counter levonorgestrel pill works best within 72 hours, and sooner is better. None of these end an established pregnancy.

Barrier methods and interactions

Condoms are the only method that reduces the risk of sexually transmitted infection. Use water-based lubricant with latex. Rifampin, some seizure medicines, and St. John's wort speed up hormone breakdown and weaken hormonal methods, so add a backup method.

Report now

Escalate immediately for severe abdominal pain, chest pain or shortness of breath, severe headache or vision changes, or one-sided calf pain and swelling. These are the ACHES warnings for a clot, stroke, or liver problem. An IUD user with fever, pelvic pain, foul discharge, or missing strings also needs prompt evaluation.