Contraceptive Counselling: What We Heard
Conversations about contraception and reproductive goals
The Alberta Primary Care Nursing Association was luckily enough recently to provide a virtual education experience from Dr. Hoffart with the support of Bayer. In this education session Dr. Hoffart discussed the importance of engaging our patients in conversations about contraception and provided an overview of different contraceptive methods. The following post contains a brief overview of some of the key learnings from Dr. Hoffart’s talk.
40% of all pregnancies in Canada are unintended. Knowing this it is important that contraception be view as part of preventative health. It is our role as health care professionals to help patient make informed decision about contraceptive methods that best fulfill the needs of our patients. Conversation regarding contraception go beyond preventing pregnancy, it should include the patient's overall priority for their own reproductive goals – this is not limited to the desire to become pregnant or not but also refers to how they want to experience their menstrual cycles.
Contraceptive conversations take time; however, they are very important conversations to engage in with our patients. We need to explore what the patient may or may not already know about different methods of contraception is important as they may have fears of certain methods due to myths or a knowledge deficit. There are many opportunities within primary care to initiate the conversation with patient regarding contraception, these include (but are not limited to): annual wellness check, chronic disease management visits, antepartum & post-partum visits, etc. Even if a patient is currently on contraception, it is important to discuss how it is working for them and if it is meeting their reproductive needs. Whilst it is important to have this conversation it is also important to gauge the appropriateness of timing for this conversation, using your judgement for this while also greatly improve the patient's receptiveness to engaging into a contraceptive conversation.
There are two big questions you can use to guide a contraceptive conversation:
1. When do you want to become pregnant, if ever?
2. How important is it for you NOT to get pregnant now?
This helps you to determine if you should be leading the patient towards long-acting reversible contraceptive methods (LARCS) or short-acting contraceptive method (SARCs).
LARCs are the most effective form (99% efficacy) of reversible contraceptive – they are effective for greater then 1 year with most devices lasting 3 to 5 years. Easy to refer to these as ‘set it and forget it’ contraceptive method, however the insertion of these devices can be associated with mild to moderate amount of discomfort and are considered to be more invasive (for a brief period of time) then SARCs. The two main types of LARCs are an intrauterine contraception (IUC) and Nexplanon an implantable rod. IUCs can either be hormonal (Mirena or Kyleena) or non-hormonal (Copper), both works to stop the sperm from meeting the egg however, the hormonal IUC slowly releases progestin within the uterus. Nexplanon is a hormonal contraceptive method that in implanted into a patient arm, it contains progestin which is slowly released into the body which halts the ovaries from releasing an egg as well as thickens the mucous in your cervix to make it more difficult sperm from being able to pass through.
SARCs include the pill, patch, injection, ring and condoms. These types of contraceptive methods require the patient to actively participate in their effectiveness as they are effective from single use up to 3 months depending on the method. For more information about the different types of SARCs follow this link: Contraceptive methods . SARCs are ideal for patients who want to become pregnant within the next year or who are unable to tolerate the procedure of having a LARC inserted.
So, let's starting making the most out of the visits with our patients and start having early and continued discussion with our patient to make sure that their contraceptive and reproductive needs are being met.
Here are some important contraceptive resource links: