Contraceptive counseling

The choice of the contraceptive method takes into account the contraindications of the method as well as the patient's personnel history, the type of demand, the needs and the fears. In fact, observance requires proper information and reassurance on side effects, particularly on menstruation disorders to avoid drop out.

Instructions need to be clear and given in the language that the patient can understand. It helps to have written material to give to the patient. Until now, we have limited evidence about what works to help users choose an appropriate contraceptive method⁽¹⁾. Therefore, despite the high effectiveness, hormonal contraceptives report difficulty in adherence regimen and low rates for long-term continuation. However, there is a definite increase in contraceptive uptake in women provided with educational leaflets and counselling sessions with a shift toward use of more reliable contraceptive methods⁽²⁾. Hormonal contraceptives afford much better efficacy in preventing pregnancy when used with full compliance. Unfortunately, also minor effects do contribute to the high discontinuation rates seen⁽³⁾.

One of the best means to improve outcomes is through high-quality gynecologist-woman communication ⁽⁴⁾. Besides, despite the efficacy of HCs, the missed pill is common and contribute to unwanted pregnancy.

For these women nondaily HC-options may be considered: levonorgestrel-5 year intrauterine system, medroxyprogesterone quarterly injection, Lunelle monthly injection, monthly vaginal ring and weekly transdermal patch. Long-acting progestogen-only methods,such as injectable and implantable may be planned for women who need to avoid estrogens.

Furthermore, the accuracy of contraceptive counselling is a priority to avoid hazardous prescription as well as to select the method, correspondent to woman's expectation.
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In fact, almost half of the users who discontinued a contraceptive method were unsatisfied with it⁽⁵⁾. Extended or continuous regimens may be appreciated by women who have an intense lifestyle and prefer to avoid menstruation and in those who have recurrent menstrual problems as dysmenorrhea, endometriosis or headache^(6,7,8,9).

Today, many teenagers are sexually active at earlier ages than in former times,before they are cognitively able to develop a responsible sexual behaviour. Therefore, considering the frequency of their sexual intercourses and the short period of sexual partnerships,effective contraceptive counselling for adolescents should be a priority^(10,11).

During the vulnerable period of adolescence, decision relating to contraception may occur and dual method (hormonal contraceptive plus condom) may be advisable⁽¹²⁾. When possible, the involvement of the mother can support the girl's decision and to give more information regarding eventual previous illness or genetic anomalies, particularly if related to coagulation system (Leiden factor mutation, deficit of protein C,S, factorVII or VIII..) .