Contraception Counselling

Author – Mohona Sengupta  Editor – James Mackintosh

Last updated 10/10/23

Table of Contents

Introduction

Contraception is a critical aspect of reproductive health care. With a variety of methods available, it is important for healthcare providers to effectively counsel patients about the options available and help them choose a method that is suitable for their individual needs. In this article, we will discuss the key considerations for counselling patients about contraception.

 

It is important to explore the patient’s preferences during the consultation as well ask them general questions to better understand what method of contraception is best for them. Some examples of questions to ask are:

 

1. What do you know about contraception?

2. What are the different methods of contraception?

3. Have you used contraception before, and if so, what worked well and what did not?

4. Is there anything that concerns you regarding contraception?

5. Why do you want to take contraception?

 

Furthermore, there are some questions which you, as the healthcare professional may want to ask the patient to better understand which contraceptive method would suit them.

 

1. Are you currently sexually active and looking to prevent pregnancy?

2. Do you have any medical conditions or allergies? (this may impact choice of contraception)

3. Are there any religious or cultural considerations that we need to take into account?

 

The patient may have concerns and misconceptions about contraception, and it is important for healthcare providers to address these in a compassionate manner, avoiding medical jargon as much as possible. Some of the most common concerns include:

 

– The potential side effects of each method being considered

– The effectiveness rate of each method being considered

– The advantages and disadvantages of each method being considered

– The contraindications of each method being considere

Types of Contraception

There are many different methods of contraception available. Some of the most commonly used ones include:

 

1. Hormonal methods: this includes birth control pills, patches, injections, and vaginal rings.

2. Barrier methods: this includes condoms, diaphragms and cervical caps.

3. Long-acting methods: this includes intrauterine devices.

4. Natural family planning: this involves monitoring fertility signs such as basal body temperature and observation methods to determine the fertile window.

5. Sterilisation: this includes female sterilisation (tubal ligation) and male sterilisation (vasectomy).

The combined pill contains two hormones: oestrogen and progesterone. It works to prevent conception by stopping your ovaries from making an egg every month, thickening the mucus around your cervix and making the lining of your womb thinner which makes it less likely for an embryo to grow in the womb.

 

The progesterone-only pill thickens the mucus in the cervix and thins the lining of the womb.

 

If used correctly, it can be 99% effective.

 

Pros:

  • It is a non-invasive method.
  • Your periods may become more regular, lighter and less painful so it is a good option if you suffer from heavy vaginal bleeding or significant pain during periods.
  • It can reduce the risk of ovarian, uterine and colon cancer.

Cons:

  • You may experience side effects soon after you begin taking the pill including headache, nausea and breast tenderness.
  • You won’t get any protection from STIs.
  • You need to remember to take it daily.

Contraindications:

  • Smoker over the age of 35.
  • Hypertension >160/110 mmHg.
  • History of IHD, VTE, valvular disease, current breast cancer, diabetes with complications, severe cirrhosis.

This involves the use of a physical block that prevents sperm from reaching the egg. Male and female condoms are 95-98% effective and diaphragms and caps, which fit inside the vagina and cover the cervix can be up to 92-96% effective.

Pros:

The level of protection can vary depending on if they are used correctly.

Female and male condoms protect against most STIs.

Cons:

Diaphragms and caps need to be left in for six hours after sex.

If the barrier breaks or isn’t fitted correctly no protection is given from STIs or pregnancy.

Contraindications:

patients with an allergy to latex.

Patients with vaginal or penile irritation.

Repeated urinary tract infections.

Physical abnormalities.

Non-hormone releasing copper is used to stop the sperm and egg surviving in the uterus and fallopian tubes.

 

If fitted correctly, they can be 99% effective.

 

Pros:

  • They are inserted into the uterus therefore are long-lasting.
  • They are low maintenance and allow you to keep spontaneity during sexual activity.

 

Cons:

  • They have to be inserted by a specialist doctor.
  • You may experience some immediate side effects including cramping and headaches.
  • They do not protect against STIs.

 

Contraindications:

  • STI at the time of insertion.
  • A congenital uterine abnormality that concerns insertion.
  • Abnormal uterine bleeding, suspicion of uterine malignancy or acute pelvic inflammatory disease.

 

This identifies a patient’s fertile window, ranging from using a calendar to urinary hormone testing. This approach involves learning over time the days in your cycle where protection, such as condoms are required to avoid getting pregnant.

 

Pros:

  • A natural method which doesn’t involve hormones or insertion of any products.
  • Allows a women know her body and menstrual cycle.

Cons:

  • Can be time consuming to track ovulation period each month.
  • Effectiveness can vary as very dependent on patient’s calculations.
  • No protection against STIs.

Contraindications:

No absolute contraindications.

A procedure to permanently prevent pregnancy that involves blocking the fallopian tubes to prevent eggs reaching sperm or in males, involves cutting or sealing the tubes that carry sperm from the testicles. They can be up to 99% effective.

 

Pros:

  • It is highly effective at preventing pregnancy and is considered an indefinite method of contraception.

Cons:

  • It requires a minor surgical procedure.
  • It cannot be easily reversed.
  • It does not protect against STIs.

Contraindications:

  • No absolute contraindications.

After having provided the relevant information regarding the different methods of contraception, the patient is better informed to choose a method that works for them. It is important to note that a healthcare professional’s discretion is needed in these scenarios, taking into account the patient’s medical history, current medical problems, allergies and past contraceptive efficacy.

References

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