Choice of Contraceptives Important Considerations

When helping a patient decide on a contraceptive, the most important goal is to find an option that the patient is comfortable with and that the clinician feels will be beneficial for the patient. It is imperative to explain the side effects, safety concerns, and noncontraceptive benefits of each alternative to the patient so that she may make an informed decision. Fertility goals vary for each patient. It must be determined if the goal is to postpone contraception, space out the next pregnancy, or avoid further pregnancy altogether. Also, a clinician must understand the patient's desire to have or not have a regular bleeding pattern, because many contraceptives will affect menses.

As discussed later in this chapter, contraindications exist for various forms of contraception. Patients must be evaluated completely by a health care professional to rule out any medical contraindications to certain contraceptives. The physical examination also will allow health care professionals to determine if there are other medical concerns, such as hypertension, diabetes, or liver disease, that need to be considered when selecting an appropriate contraceptive agent. Clinicians also should review family history for potential risks with certain forms of birth control.

Sexual behavior of the female must be determined to understand the risk for STDs. Women who are not in a monogamous relationship must consider their risk of STDs as a factor in their contraceptive decision. Some barrier methods protect against STDs, but hormonal contraceptives do not prevent STDs if used alone.

Personal preference plays a large role when determining the best contraceptive option. For instance, if a woman is not interested in using a method that interrupts sexual activity, then a diaphragm would be an inappropriate choice. Preference of the sexual partner may be important as well. Certain agents such as male condoms require the male partner to play an active role in contraception.

Cost is also another related issue for patients. Insurance may not cover all forms of contraception, and patients may have to bear the entire cost for certain options.

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