CHAPTER 7 EXERCISES: CONTRACEPTION

EXERCISE 7.1

Purpose: To role-play different aspects of contraceptive counseling and understand recent evidence-based contraceptive developments and medical criteria for use.

1. How would you respond to these common concerns about contraception?
   1. “I don’t like the idea of having something inside of my body.”
   2. “I don’t want any hormones.”
   3. “I want to have this (IUD / implant) removed (a few months after placement).”
   4. “I am concerned about pain with an IUD; can you explain pain management options?”

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2. A 17-year-old who is sexually active and currently using withdrawal. Role-play how you might initiate a conversation about their contraceptive priorities and options based on preferences of privacy of contraceptive use (from family) and avoiding STIs.

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3. A 28-year-old person presents to the health center seeking to switch to a new method of contraception. They are currently on DMPA, which has been causing 2-4 lb / 0.9-1.8 kg of weight gain, and want something non-hormonal. A friend mentioned having pain with an IUD, so your patient is hesitant to consider that option. Role-play being the healthcare provider and/or patient whose priority is avoiding potential weight gain and other hormonal side effects.
   1. Using the person-centered contraceptive counseling measure, what did you do as a provider to ensure that the person felt respected, listened to, had their preferences identified and received information?
   2. As the patient, is there more the provider could have done to establish rapport, identify priorities and share information?

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4. You are about to see a 22-year-old G0 person with a mild motor and cognitive disability. They arrive in the health center in a wheelchair with a parent. During intake, the parent states that they would like to discuss contraception that will assist them with periods. How would you approach this?

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5. What would you discuss with the following people regarding their desire for contraception? (Consult MEC as a reference)
   1. A 36-year-old patient who smokes tobacco with weight > 198 lb / 90 kg (BMI > 30) wants the patch.
   2. A 29-year-old with migraine headaches with aura wants to use the pill.
   3. A 20-year-old person with a history of chlamydia at age 15 who wants an IUD.
   4. A 35 year-old with chronic kidney disease (nephrotic syndrome; not on dialysis).
   5. A 25-year-old with a history of deep vein thrombosis (DVT) 2 years ago, which occurred 6 weeks after a vaginal delivery. They are interested in the vaginal ring.
   6. A 25-year-old transgender man who became amenorrheic on testosterone, wants to prevent pregnancy with a partner that produces sperm.
   7. A 31-year-old who takes anticonvulsant medications and wants to use the pill.
   8. A 27-year-old who wants a combined hormonal method, but does not want a monthly period.

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