Helping Patients Choose Contraception

Not all birth control is created equal. When assisting patients in choosing the most appropriate contraceptive method, it is very important to obtain a complete medical history. Age and sexual history are also factors to be considered.

In older women (≥35 years old), who may be a little more responsible, birth control pills may be a viable option, but you will want to make sure the patient does not smoke, has normal blood pressure, and has no risk factors for blood clots or stroke. She should also not have breast cancer (known or suspected), severely impaired liver function, or elevated lipids (ie, cholesterol or triglycerides). Depending on her age and the number of children she has delivered, the older female may benefit from permanent sterilization, or an intrauterine device (IUD) if she is in a monogamous relationship.

Younger women (<35 years old) have other factors to consider when choosing contraception, even though most of them are healthy. For example, many younger patients find Depo Provera convenient, because it is given as an injection every 3 months. With this method, they do not have to remember to take their birth control daily. When prescribing Depo Provera, it is important to know if the patient smokes, consumes alcohol chronically, or has a history of anorexia. A family history of osteoporosis is another risk factor, because Depo Provera has been shown to decrease bone mineral density with extended use, especially when patients have additional risk factors.

Younger patients are often a little more promiscuous. The use of an IUD is therefore usually not recommended, because of the risk for ascending infection from the strings if the woman contracts chlamydia or gonorrhea. Obtain - ing a complete sexual history, including number of partners and condom use, is very important.

Young women do well physically with birth control pills, but many are not dependable about taking them on schedule, which puts them at risk for an unwanted pregnancy. Before prescribing the pill, you should try to ascertain how responsible the patient is in this regard, and review her medical history and medication use. Certain drugs, such as anticonvulsants and antimicrobials, can lead to increased metabolism of oral contraceptives