Oral Contraceptive Pill Counseling

Go through a standard History and Physical with some additions as mentioned below:

Identifying Data

Chief Complaint

who (partners), what (type), where (live at home, try to involve parents), when (sexual active with this partner), why you want pills?

Past Medical History - HITS – hospitalizations, illnesses, surgeries, trauma

Specific Past Medical History (MATCH):
M migraines
A active liver disease
T thromboembolic disease
C cancer of the breast, uterus, colon
H hypertension

Allergies

Medications – ask about antibiotics, anticonvulsants, and antacids – all reduced oral contraceptive pill effects

Social History

Family History

Menstrual History

Obstetrical History

Pap

Sexual History

Contraceptive History

Past Gynecological Infections

Explain the following to the patient, Cousel:

Mechanism of Action of OCP:

Standard preparations contain estrogen and progesterone, and prevent ovulation by interfering with feedback of hormone signalling.

Estrogen Side-effects:

Nausea and vomiting, Sycope, Weight gain, Edema, Leg cramps, Dysmenorrhea, menorrhagia,
Uterine fibroid growth

Progesterone Side-effects:

Depression, Fatigue, Increased appetite, Weight gain, Acne, Hypertension

Contraindications to Oral Contraceptive Pills:

Current Pregnancy
Undiagnosed vaginal bleeding
Cardiovascular Disease such as strokes, heart attacks, history of clots
Age greater than 35 and smoking
Cancer that depends on estrogen for growth
Liver function, decreased
Hyperlipidemia, congenital
Wilson’s disease

Relative Contraindications to OCP:

smoker >35 yrs old, diabetes, migraines, fibroids.

Benefits of Oral Contraceptive Pill:

Prevent pregnancy
PMS and cramps are reduced
Menses become regular, lighter and shorter
Acne improvement
Cysts, ovary, and benign breast disease risk reduced
Reduces risk of reproductive tract cancers
Risks of hormonal contraceptives:
Slight weight gain is usual (5 lbs)
Increases risk of DVT especially in combination with smoking.
May stimulate estrogen-receptor positive breast cancers but does not appear to cause them.
No protection of STDs

Oral Contraceptive Pill Advice:

May have to try two or three different preparations to arrive at the best one for the patient.
Hormonal contraceptives do not provide any protection against STDs, unlike barrier methods.

Start on 1st day of next period. Place package in an obvious location to help you remember. Take at the same time each day. Use additional contraception for the first two months, as OCP contraception is not reliable until then. If you miss a day, take two pills the next. If you miss two days, take two pills for the next two days and use an alternative method until the next period. Give prescription for OCP of choice. Arrange follow up.

Available preparations: 21 day vs 28 day tablets. Other preparations include: depo injections q 3 months, implants q 5 yrs. Longer term preparations offer lower cost over the duration of action (but
greater one-time cost) and greater convenience.