EXERCISES: CONTRACEPTION & AFTERCARE

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 patient 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. Won’t an IUD (or EC pills) cause an abortion?
   4. I want to have this (IUD / implant) removed (a few months after placement).

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2. A 17-year-old G0 patient who is sexually active and currently using withdrawal and condoms comes to the clinic. Role-play how you might initiate a conversation about their contraceptive priorities and options based on preferences of privacy of contraceptive use (from parents) and avoiding STIs.

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3. A 28-year-old G3P3 patient presents to the clinic seeking to switch to a new method of contraception. They are currently using DMPA, which has been causing 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 weight gain and other hormonal side effects.
   • Using the person-centered contraceptive counseling measure, what did you do as a provider to ensure that the patient felt respected, listened to, had their preferences identified and received information?
   • As the patient, is there more the provider could have done to establish rapport, identify priorities and share information?

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4. What would you discuss with the following patients regarding their desire for contraception? (Consult MEC as a reference)
   1. A 36-year-old smoker with BMI > 30 who wants the patch.
   2. A 29-year-old with migraine headaches with aura who wants the pill.
   3. A 20-year-old nulliparous patient with a history of chlamydia at age 15 and who wants an IUD.
   4. A 28-year-old patient who has BMI > 30, has vaginitis, and wants emergency contraception as well as ongoing contraception. Pt had unprotected intercourse 3 and 5 days ago.
   5. A 25-year-old with a history of deep vein thrombosis (DVT) 2 years ago (6 weeks postpartum). 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 makes sperm.
   7. A 31-year-old who takes anti-seizure medications and wants the pill.
   8. A 27-year-old who wants a combined hormonal method but doesn’t want a monthly period.

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EXERCISE 7.2

Purpose: To review routine follow-up after uterine aspiration, please answer the following questions.

1. A patient has had nausea and vomiting throughout pregnancy. How long will it take for them to feel better after the abortion?

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2. Providers typically advise patients to call the office if they have certain “warning signs” following uterine aspiration. What “warning signs” would you include and why?

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3. After an aspiration, how long would you advise your patient to wait before resuming exercise, heavy lifting, and vaginal intercourse? What is the rationale for your recommendations?

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