Contraception is an integral and very important aspect of a general obstetric and gynecologic practice. Not only should the effectiveness of a method be considered but also what is best for each individual patient in regard to probable compliance with the method, medical history, and desire or lack of desire for future fertility. Emotional and social issues at the time of decision should also be discussed and evaluated.
Each patient should be informed of all options that are appropriate for her. Many times misconceptions about safety, fertility after use, and positive benefits of the different forms of contraception are very freely volunteered by the patient during a consultation. Many patients are pleasantly surprised by the fact that they are candidates for certain contraceptive methods that they never thought they would be eligible for because of misinformation given to them by friends. The clinician’s job is not only to inform patients of their options and the risks of certain methods but also to stress the benefits of using them. The reason a particular method is not recommended for an individual patient may also be discussed at this time.
A full history and physical examination should be completed before a method is prescribed. History should include the usual data as follows:
1. Medical history.
2. Surgical history.
3. Obstetric history: Establish whether patient could be already pregnant; desire for future fertility.
4. Gynecologic history.
5. History of sexually transmitted diseases.
6. Number of partners.
7. Previous difficulties with contraception use.
8. Frequency of intercourse.
9. Family history: Include family members with history of vascular events or female cancers. Workup for thrombophilia is indicated if family history reflects risk. Risk of vascular events are increased fivefold to tenfold in the groups that are homozygous and heterozygous for factor V leiden, prothrombin gene mutation, antithrombin III deficiency, protein S&C deficiency, and methylene tetrahydrofolate reductase (MTHFR) deficiency.
10. A full physical examination: Papanicolaou smear and cultures of the cervix should be obtained.