EVIDENCE-BASED CONTRACEPTIVE GUIDANCE

The rapidly growing body of evidence surrounding provision of person/patient centered contraceptive care is helpful to guide counseling. This section provides brief updates, with links to more in-depth resources. Keep in mind that the goal is to center people and their preferences and to remove barriers to access for those desiring contraception, rather than have everyone leave the visit with a contraceptive method (Matulich 2014, Brandi 2018).

Simplified Screening (CDC SPR 2024)

Most methods can be safely initiated with few clinical requirements. Prior to initiating a new method, the clinician should:

• Review health history to identify potential contraindications
• Suggested history and exam components for specific methods:
  • Blood pressure (self-report acceptable): combined hormonal methods
  • Pelvic exam: IUD and some diaphragms (Milex®; not Caya®)
  • STI screening: IUD (same visit; only if risks & not yet screened; Sufrin 2015)
  • Cigarette smoking history (self-report): combined hormonal methods (more data is needed on vaping/electronic cigarette use)
  • Weight (self-report at baseline): may be helpful to discuss concerns about weight change as a potential side effect and possibility of decreased efficacy or increased VTE risk.
• Not required to initiate contraception:
  • Heart, lung, breast or well-person exam, pap test, hemoglobin or “routine” labs
  • Pregnancy test if reasonably certain person is not pregnant
  • Pelvic exams – only needed for IUDs and some diaphragms
• Consult the Medical Eligibility Criteria (MEC): (See MEC Chart)
  • If multiple MEC category 2 risks or desires MEC category 3 method:
    • Use shared-decision making to discuss risks
    • Consider whether multiple risks are compounding (e.g., both increase VTE risk and therefore should be avoided) vs. separate (e.g, one increases VTE risk and other increases cholestasis risk)

How to Access and Use the Medical Eligibility Criteria (MEC) App & Chart

• The MEC is intended to determine safe use of methods among persons with certain characteristics (e.g., age or postpartum status) and medical conditions (e.g., diabetes). Use these recommendations during contraceptive counseling. Find categories in MEC Chart.
• Phone Application:
  • Download: “CDC MEC” in iOS or Android Store
  • MEC: Search for information by condition or method
  • SPR (Selected Practice Recommendations): “how to” for clinicians, including:
    • How to initiate and administer each contraceptive option, follow-up interval etc.
    • Testosterone use and risk for pregnancy

How to be Reasonably Certain a Patient is Not Pregnant (CDC SPR 2024)

• Urine pregnancy testing (UPT) is not needed for everyone
• If a person has no symptoms or signs of pregnancy and meet any one of the following criteria, UPT is not necessary (otherwise UPT is recommended):
  • is ≤7 days after the start of normal menses
  • has not had sexual intercourse since the start of last normal menses
  • has been correctly and consistently using a reliable method of contraception
  • is ≤7 days after spontaneous or induced abortion
  • is within 4 weeks postpartum
  • is fully or nearly fully breastfeeding (≥85%of feeds are breastfeeds), amenorrheic, and <6 months postpartum

Quick Start – Initiation of Contraception (CDC/OPA QFP 2024 / Interactive Version)

• All contraceptive methods can be started the day of a visit regardless of the person’s last period and last intercourse, however it is important to give accurate counseling regarding follow up if there is a risk of pregnancy.
• If unable to “Quick Start” due to possible pregnancy and desire to wait for certainty, offer a bridge method until they return to start their desired method.