Patient Care and Monitoring

1. Obtain a thorough medical and family history and carefully evaluate each patient's risk factors prior to prescribing contraceptives.

2. Educate all women taking hormonal contraceptives to prevent pregnancy regarding self-monitoring for early warning signs that may precede adverse events. Health care professionals can easily recall the major warning signs by using the two simple pneumonics highlighted below:

ACHES—for women taking hormonal contraceptives

A = Abdominal pain. This may be an early warning sign of the presence of an abdominal thromboembolism, liver adenoma, or gallbladder disease.

C = Chest pain. The presence of chest pain may indicate pulmonary embolism, angina, or myocardial infarction.

H = Headaches. Headaches (particularly those associated with focal neurologic symptoms, such as blurred vision, speech impairment, and/or weakness) may represent strokelike symptoms. Headaches also may indicate poorly controlled blood pressure.

E = Eye problems. Blurred vision and/or ocular pain may be early warning signs for stroke and/or blood clots. In addition, visual changes may occur in patients wearing contact lenses (secondary to changes in corneal shape).

S = Severe leg pain. Patients taking hormonal contraceptives who complain of severe leg pain should be evaluated for the presence of venous thromboem-bolism.

PAINS—for women with an IUD P = Period late

A = Abdominal pain, pain with intercourse I = Infection, abnormal or odorous vaginal discharge N = Not feeling well, fever, chills S = String (missing, shorter, longer)

3. In addition to the preceding, monitor patients taking hormonal contraceptives for missed periods, signs of pregnancy, appearance of jaundice, and/or severe mood changes. Instruct patients to consult a health care professional upon noticing or experiencing any of these warning signs.1

4. Stress the importance of adherence to the patient's chosen method of contraception in order to reliably prevent pregnancy. Educate the patient on what to do in the event of missed doses with hormonal contraception.

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