As you have no doubt experienced in your practice, most patients come in with some basic knowledge of birth control methods and many express definite preferences. However, these women may not know all of their options or may even desire options that are not medically appropriate for their situations. Given the wealth of options that today's women have, the choices have never been so
liberating—or so complex.

The following counseling guidelines can help make the contraceptive counseling process faster, easier, and more efficient. Feel free to adapt the following conversation starters, tips, checklists, and questionnaires for your practice.

Conversation Starters
While many women will proactively mention birth control, others may hesitate to bring it up. Even if they are currently using birth control, it is important to check to see whether the method they are using is appropriate for their lifestyles and needs. Here are a few ways to approach the topic, especially with new patients:

  • "What are you currently using for birth control? Even if you are not sexually active at the moment,
    it is always a good idea to think ahead about birth control and learn about the different options available to you"
  • "If you are sexually active or plan to be sexually active in the near future and haven't chosen a contraceptive option, I'd be happy to help you choose one. No one contraceptive is right for everyone. That's why it is important to find out what works best for you"
  • "Are you satisfied with your current contraceptive choice? Why or why not?"
  • "How familiar are you with the contraceptive options that are available to you?
    I can work with you to help you choose a method that is right for you"

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Lifestyle Questions
As you know, patients may sometimes be reluctant to divulge personal details. So, before asking them these questions, it may be helpful to reassure them that their answers will be confidential.
The patient's chart may have some of the answers you need, but here is a basic list of considerations to review: View | Hide

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Health and Family Planning Considerations
You may already know some of these answers, but patient preferences and habits change,
so it may be helpful to ask: View | Hide

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Medical Considerations
Again, you may have already captured some of this information on the patient's chart, but here is a helpful checklist of relevant health considerations: View | Hide

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Evaluating Her Contraceptive Options
First, consider her lifestyle and preferences. If the patient is sexually active (or plans to be sexually active in the near future), does not have multiple or high-risk partners, prefers spontaneity, or has difficulty adhering to a daily or weekly regimen, she may be a good candidate for ParaGard®.

Likewise, if she would prefer not to get quarterly shots and/or prefers a nonhormonal birth control option, ParaGard® may be an appropriate option for her.

ParaGard® may also be an appropriate choice for those patients who want to keep their option of getting pregnant open, but do not plan on becoming pregnant within the next few months.

Nonhormonal ParaGard® may be an appropriate choice for women who:

  • Do not want to take hormones
  • Want the predictability of their natural cycle
  • Want an option with no associated weight gain
  • Are breastfeeding and prefer a nonhormonal option such as ParaGard®

And there are some women who should not take hormones due to medical conditions. Consistent with World Health Organization (WHO) guidelines, ParaGard® may be safely used in women:

  • Who have medical conditions such as hypertension, breast cancer, or uncontrolled diabetes2
  • Who smoke2

However, nonhormonal ParaGard® does not need to be limited to women who cannot or choose not to use a hormonal contraceptive; for example, nulliparous women who are not at risk for PID may be appropriate candidates for ParaGard®.

To view appropriate candidates for ParaGard®, click here.

For information on ParaGard® Patients, click here.



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* This section was adapted with permission from the Association of Reproductive Health Professionals (ARHP) website. Association of Reproductive Health Professionals. Choosing a Birth Control Method. http://www.arhp.org/crc Washington, DC 1996 (Last updated 2007).

ParaGard® does not protect against HIV/AIDS or other sexually transmitted infections. ParaGard® must not be used by women who are or may be pregnant; have acute pelvic inflammatory disease (PID) or current behavior suggesting a high risk for PID; have had a postpregnancy or postabortion uterine infection in the past 3 months; have cancer of the uterus or cervix; have an infection in the cervix; have an allergy to any component; or have Wilson's disease. The most common side effects of ParaGard® are heavier and longer periods and spotting between periods; for most women, these typically subside after 2 to 3 months. If a woman misses her period, she must be promptly evaluated for pregnancy. Some possible serious complications that have been associated with intrauterine contraceptives, including ParaGard®, are PID, perforation of the uterus, and expulsion.

References:

  1. Association of Reproductive Health Professionals (ARHP) Web site. Choosing a Birth Control Method. http://www.arhp.org/Publications-and-Resources/Patient-Resources/Interactive-Tools/Choosing-a-Birth-Control-Method. Accessed November 17, 2008.
  2. World Health Organization. Medical Eligibility Criteria for Contraceptive Use. 3rd ed. Geneva, Switzerland: World Health Organization, Reproductive Health and Research; 2004.