Contraception | Bits & Bumps

This week we discuss how to “Quick Start” contraception – on the day your patient requests it.

Take home messages:

Women are at unnecessary risk of pregnancy in the window between ASKING for contraception and STARTING contraception
There are clear protocols for starting contraception at any time in a woman’s menstrual cycle (see links below)
There are no known adverse effects on pregnancy from ordinary hormonal contraceptive methods (except IUDs)
Contraception can be started even if early pregnancy can’t be excluded, with a repeat pregnancy test in 4 weeks time.
Using this algorithm reduces unplanned pregnancies in high risk groups.

References & Resources

Quick Start Clinical Protocol – Family Planning Victoria (PDF) – Australia

Quick Start Flow Chart (PDF) – Please note this is a U.S. resource and has minor differences in timing of B-hCG retesting.

Quick Starting Contraception – RCOG UK Guidelines (LINK)

Initiating Hormonal Contraception (Quick Start) (LINK) – American Family Physician (Article by Lesnewski & Prine 2006)

This week, we discuss the benefits of Long Acting Reversible Contraceptive (LARC) methods, including IUDs and Implants.

Why are we so keen on LARC methods? Because they have a significantly higher continuation rate, higher satisfaction rate, and lower unplanned pregnancy rate than other methods (COCP, POP, DMPA). We also challenge the historical misconceptions regarding the use of IUDs in nulliparous women, and discuss how they are a safe first line option, endorsed by both RANZCOG and family planning groups in Australia.

References & Resources:

Time For A Change (PDF) Time For A Change – Increasing the Use of Long Acting Reversible Contraceptive Methods In Australia Statement by Sexual Health & Family Planning Australia October 2013

Contraception: A New Focus (PDF) Contraception: A New Focus by Dr Suzanne Pearson & Dr Sumudu Cooray, O&G Magazine p14-16 Volume 16 No 3 Spring 2014

The Choice Project (LINK)

Mirena modern-day miracle (PDF) – by Dr Edwina Morgan, O&G Magazine p21-23 Volume 16 No 3 Spring 2014

RANZCOG Guidelines for Intrauterine Contraception (LINK)

Management of Unscheduled Bleeding in Women Using Hormonal Contraception (LINK) Faculty of Sexual & Reproductive Healthcare Clinical Guidance, UK May 2009

Bleeding Pattern Changes with Progestogen-only Long-acting Reversible Contraceptives (LINK) Joint Statement, Sexual Health and Family Planning Australia

Mirena Fact Sheet (PDF)

Implanon Fact Sheet (PDF)

LARCs Fact Sheet (LINK)

Addit: Also check out this great article and awesome accompanying video from NEJM published a week after we published our podcast – Provision of No-Cost, Long-Acting Contraception and Teenage Pregnancy, N Engl J Med 2014; 371:1316-1323

Browsing Category Contraception

Quick Start Contraception – It’s Contraception, STAT!

LARC Contraception Methods – A Superior Choice