Initiating Hormonal Contraception
Am Fam Physician. 2021 Mar 1;103(5):291-300.
Author disclosure: No relevant financial affiliations.
Most patients can safely begin using hormonal contraception at any point in their menstrual cycle. An evidence-based, flexible, patient-centered approach to initiating contraception promotes health and enhances patients' reproductive autonomy. A recent Papanicolaou test is not necessary before prescribing hormonal contraception. Most patients can begin using progestin-only contraceptives immediately after childbirth. Patients can begin any appropriate contraceptive method immediately after an abortion or early pregnancy loss, except for an intrauterine device following septic abortion. Delaying contraception to wait for the next menses or for an appointment creates unnecessary barriers for patients. Clinicians can facilitate the use of hormonal contraception by providing anticipatory guidance about common side effects (e.g., spotting, other menstrual cycle changes), giving comprehensive information about available contraceptive choices, honoring patients' preferences, and eliminating office-related barriers. Prescribing or dispensing a one-year supply of contraceptives lowers costs and improves adherence. Counseling via telemedicine or a patient portal eliminates unnecessary office visits.
Although the rate of unintended pregnancy in the United States has decreased to less than 50% in recent years, it remains much higher than in other industrialized countries, with widening disparities by race, income, and education level.1 Younger people, in particular, may face multiple barriers to timely access to primary care and hormonal contraception.2,3 To address this problem, family physicians should make hormonal contraception easily and safely available.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
Hormonal contraception can be started at any point during the menstrual cycle.6,7 | C | Consensus opinion from clinical guidelines |
Papanicolaou testing should not be required before prescribing hormonal contraception.4,18 | C | Consensus opinion from clinical guidelines |
A one-year supply of contraceptives should be dispensed or prescribed to reduce patient costs, improve adherence, and increase convenience.21 | C | Decision model based on 24,309 veterans |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
Hormonal contraception can be started at any point during the menstrual cycle.6,7 | C | Consensus opinion from clinical guidelines |
Papanicolaou testing should not be required before prescribing hormonal contraception.4,18 | C | Consensus opinion from clinical guidelines |
A one-year supply of contraceptives should be dispensed or prescribed to reduce patient costs, improve adherence, and increase convenience.21 | C | Decision model based on 24,309 veterans |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
BEST PRACTICES IN GYNECOLOGY
Recommendations from the Choosing Wisely Campaign
| Recommendation | Sponsoring organization |
|---|---|
Do not require a pelvic examination or other physical examination to prescribe oral contraceptive medications. | American Academy of Family Physicians |
Source: For more information on the Choosing Wisely Campaign, see https://www.choosingwisely.org. For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see https://www.aafp.org/afp/recommendations/search.htm.
BEST PRACTICES IN GYNECOLOGY
Recommendations from the Choosing Wisely Campaign
| Recommendation | Sponsoring organization |
|---|---|
Do not require a pelvic examination or other physical examination to prescribe oral contraceptive medications. | American Academy of Family Physicians |
Source: For more information on the Choosing Wisely Campaign, see https://www.choosingwisely.org. For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see https://www.aafp.org/afp/recommendations/search.htm.
Office Visits Between Menses
When a patient requests contraception during an office visit that occurs between menses, some clinicians delay starting hormonal contraceptives until
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