Contraception: Counseling and Selection
Evidence-Based Approach to Patient-Centered Care
Department of Obstetrics and Gynecology
Prof. Mykhailo Medvediev
gynecology.com.ua
Learning Objectives
Patient-Centered Counseling
Master shared decision-making approaches that prioritize patient preferences and reproductive autonomy
Method Selection
Understand contraceptive options, efficacy rates, and medical eligibility criteria
Special Populations
Address unique contraceptive needs of adolescents and diverse patient groups
Health Equity
Recognize and address bias in contraceptive counseling to promote reproductive justice
Source: ACOG Committee Statement No. 1, 2022; CDC US MEC 2024
Evolution of Contraceptive Counseling
Contraceptive counseling has evolved from directive, clinician-led approaches to personalized, patient-centered counseling using shared decision-making. This shift recognizes that contraceptive choice is a preference-sensitive decision highly dependent on individual values and needs.
The modern approach acknowledges patients as experts on their preferences while providers contribute medical knowledge about options and how they relate to those preferences. This framework respects patient autonomy and the diversity of preferences for contraceptive method characteristics.
Reference: Dehlendorf C, et al. Perspect Sex Reprod Health 2014;46:233
Goals of Contraceptive Care
Primary Goal
Help individuals achieve their reproductive goals through informed decisions aligned with their preferences
Not solely focused on preventing unintended pregnancy
Key Principles
  • Support informed decision-making
  • Respect patient autonomy
  • Align with individual values
  • Optimize health outcomes
  • Promote reproductive justice
Source: ACOG Committee Statement No. 1, Obstet Gynecol 2022;139:350
Contraceptive Counseling Process
The contraceptive counseling process follows a structured approach that begins with establishing rapport and ends with comprehensive education about the selected method. Each step builds on the previous one to ensure patient-centered care.
Reference: ACOG Committee Statement No. 1, 2022
Identifying Contraceptive Need
Recommended Question
"Do you want to discuss contraception or pregnancy prevention at your visit today?"
This approach directly addresses current contraceptive needs without making assumptions about pregnancy intentions
Alternative Approaches
One Key Question: "Would you like to become pregnant in the next year?"
PATH Questions: Pregnancy Attitudes, Timing, How important is prevention
Source: Wingo E, Dehlendorf C. Contraception 2024;135:110303
Medical History Assessment
Once a patient is identified as appropriate for contraceptive counseling, assess for medical conditions that could affect the safety of specific methods. Common conditions to consider include smoking status, cardiovascular conditions, history of venous thrombosis, and migraine with aura.
The WHO Medical Eligibility Criteria and US Medical Eligibility Criteria provide evidence-based recommendations for contraceptive use across a broad range of conditions. Methods are classified as categories 1-4, with categories 1 and 2 considered generally safe.
Reference: Curtis KM, et al. MMWR Recomm Rep 2016;65:1
Medical Eligibility Categories
Category 1
No restriction on use - method can be used in any circumstance
Category 2
Advantages generally outweigh risks - method can generally be used
Category 3
Risks usually outweigh advantages - use of method not usually recommended unless other methods unavailable or unacceptable
Category 4
Unacceptable health risk - method should not be used
Source: WHO Medical Eligibility Criteria, 5th edition, 2015; CDC US MEC 2024
Eliciting Patient Preferences
Opening Question
"Do you have a sense of what is important to you about your method?"
This question explicitly lets patients know their preferences will be respected and begins the process of identifying what matters most to them
Key Method Characteristics
  • How method is taken/used
  • Frequency of use
  • Contraceptive efficacy
  • Effect on menstrual bleeding
  • Other side effects
  • Noncontraceptive benefits
  • Privacy considerations
  • Effect on future fertility
Reference: Dehlendorf C, et al. Contraception 2013;88:250
Contraceptive Effectiveness
Understanding contraceptive efficacy is essential for informed decision-making. Misconceptions about both absolute and relative efficacy of different methods are common among patients.
Best practices for communicating effectiveness include using visual aids and stating natural frequencies rather than percentages. For example: "With typical use, method efficacy varies from 1 in 100 to 20 in 100 women getting pregnant in one year of use."
The risk of pregnancy with no contraception is approximately 85 percent over one year.
Source: Steiner MJ, et al. Am J Obstet Gynecol 2006;195:85
Contraceptive Efficacy Comparison
Lower percentages indicate higher effectiveness. Long-acting reversible contraception (LARC) methods have the lowest failure rates because they do not depend on user action.
Reference: Contraceptive Technology, 21st edition, 2018
Menstrual Bleeding Changes
All prescription contraceptive methods affect menstrual bleeding, and individuals have strong and varied preferences regarding these changes. The same change, such as amenorrhea, can be viewed as a benefit by some yet a negative side effect by others.
We recommend asking: "How do you feel about your method causing changes in your period, such as making it less regular, making it more or less heavy, or making it go away entirely?"
Some preferences are based on misconceptions about safety. Expressed preferences to avoid amenorrhea should be explored to determine if based on misinformation, while providing evidence-based education.
Source: Newton VL, Hoggart L. J Fam Plann Reprod Health Care 2015;41:210
Addressing Side Effect Concerns
Social Network Information
Many patients receive information about contraceptives from social networks, with negative information more commonly communicated than positive
Social Media Misinformation
Increasing mis- and disinformation available on social media about contraceptive methods requires careful counseling
Counseling Approach
Ask directly about concerns, avoid being dismissive, acknowledge "everyone is different," emphasize evidence for what is common
Reference: Yee L, Simon M. J Adolesc Health 2010;47:374
Facilitating Decision-Making
The goal is to help patients identify the most appropriate method given their preferences and contraceptive characteristics. Clinicians should be aware that preferences and planned contraceptive may change over time.
For patients with one dominant preference (such as desire for highly effective method), the process can be straightforward. For those with multiple or conflicting preferences, clinicians can help patients consider how to weigh their preferences relative to each other.
Visual aids can be helpful in this process, as can pelvic models or samples of contraceptive methods.
Source: ACOG Committee Statement No. 1, 2022
Avoiding Clinician Bias
Key Principles
Avoid expressing partiality that does not reflect the patient's own expressed preferences. Indicating bias is not consistent with preference-sensitive nature of contraceptive decision-making.
Patients who feel their clinician had a method preference are less likely to be satisfied with their method. Those who felt pressured to use a contraceptive implant are more likely to discontinue their method.
Use phrases like: "Based on what you are telling me, these methods may be a good fit"
Evidence
Priorities of clinicians around contraceptive methods vary significantly from those of patients
Patient-centered counseling improves satisfaction and continuation
Reference: Donnelly KZ, et al. Contraception 2014;90:280
Long-Acting Reversible Contraception (LARC)
LARC methods include intrauterine devices (IUDs) and contraceptive implants. These are the most effective reversible methods because their efficacy does not require any action on the part of the patient.
LARC methods are considered first-line options by the American Academy of Pediatrics, ACOG, and the North American Society for Pediatric and Adolescent Gynecology. Twelve-month continuation rates are approximately 85 percent compared with 40-50 percent for non-LARC methods.
Source: ACOG Committee Opinion No. 186, 2017; Usinger KM, et al. J Pediatr Adolesc Gynecol 2016;29:659
Intrauterine Devices (IUDs)
Copper IUD
Nonhormonal option effective for 10-12 years. Pregnancy rate <1% per year. May increase menstrual bleeding initially.
Levonorgestrel IUD
Hormonal option effective for 3-8 years depending on dose. Reduces menstrual bleeding and dysmenorrhea. Pregnancy rate <1% per year.
Both types can be removed at any time if patient wishes to become pregnant or switch methods. IUDs have highest satisfaction and continuation rates of all contraceptive methods.
Reference: Heinemann K, et al. Contraception 2015;91:280
IUD Safety and Efficacy
Safety Profile
  • Few absolute contraindications
  • Safe for adolescents and nulliparous women
  • No difference in infection rates by age
  • Expulsion rates 5-9% in adolescents vs 4-5% in older women
  • Can be used safely in most medical conditions
Contraindications
  • Distortion of uterine cavity
  • Active pelvic infection
  • Known or suspected pregnancy
  • Wilson disease (copper IUD)
  • Unexplained vaginal bleeding (for initiation)
  • Breast cancer (LNG IUD)
Source: Curtis KM, et al. MMWR Recomm Rep 2016;65:1
Contraceptive Implant
The etonogestrel contraceptive implant is a single flexible plastic rod, the size of a matchstick, placed just under the skin of the inner upper arm. It is a progestin-only method effective for up to 5 years (FDA approved for 3 years, evidence supports 5 years).
Pregnancy rate is <1% per year in typical patients, and fertility returns quickly after removal. The implant can be removed at any time if the patient wishes to become pregnant or switch to a different method.
Reference: McNicholas C, et al. Am J Obstet Gynecol 2017; Ali M, et al. Hum Reprod 2016;31:2491
Managing LARC Bleeding Patterns
01
Anticipatory Counseling
Discuss expected bleeding patterns before insertion. Most LNG IUD users establish favorable pattern within one year.
02
Reassurance and Validation
Provide easy access to clinic staff for questions. Validate symptoms and provide support.
03
Treatment Options
NSAIDs (naproxen 500mg BID x 5 days) or COCs (30-35mcg EE daily x 6 weeks) for short-term relief
04
Evaluate New Bleeding
Assess for pregnancy, STIs, and IUD location if bleeding pattern changes or worsens
Source: Henkel A, Goldthwaite LM. Curr Opin Obstet Gynecol 2020;32:408
Depot Medroxyprogesterone Acetate (DMPA)
DMPA is an injectable progestin-only contraceptive providing effective, discrete contraception for three months. Pregnancy rate is 4-7% per year with typical use. Return to fertility may take up to one year after discontinuation.
Administered intramuscularly every 12-13 weeks. Subcutaneous formulation available in prefilled syringes for home administration. Unique advantages for patients with seizure disorders as it may decrease seizure frequency.
Reference: Sundaram A, et al. Perspect Sex Reprod Health 2017;49:7
DMPA: Benefits and Considerations
Benefits
  • Effective contraception for 3 months
  • Discrete method
  • May reduce seizure frequency
  • Reduces menstrual bleeding over time
  • No estrogen-related risks
  • Can be used while breastfeeding
Considerations
  • Irregular bleeding initially
  • Possible weight gain
  • Reversible decrease in bone density
  • Delayed return to fertility (up to 1 year)
  • Requires clinic visits every 3 months
ACOG and WHO conclude there should be no limitations on duration of DMPA use. Bone density loss is reversible after discontinuation.
Source: ACOG Committee Opinion, 2014; WHO statement, 2005
Combined Oral Contraceptives (COCs)
COCs contain both estrogen and progestin. Pregnancy rate is 4-7% per year with typical use. Require daily pill-taking and timely prescription refills.
Usually taken for 21 consecutive days followed by 7 days of placebo pills or no pill. Extended or continuous regimens available for those wishing to reduce or eliminate menstrual periods.
Important to counsel about drug interactions that may decrease efficacy, including certain antiretrovirals, anticonvulsants, rifampin, and GLP-1 agonists.
Reference: Hatcher RA, et al. Contraceptive Technology, 21st edition, 2018
Noncontraceptive Benefits of Hormonal Contraception
Menstrual Benefits
Reduces dysmenorrhea, heavy menstrual bleeding, and irregular cycles. Treats premenstrual syndrome and PMDD.
Cancer Protection
Reduces risk of ovarian and endometrial cancer. Protection against ectopic pregnancy.
Other Conditions
Treats acne and hirsutism. Reduces ovarian cysts. Helps manage endometriosis symptoms.
General Health
Reduces iron deficiency anemia. Decreases benign breast disease. May reduce menstrual migraines.
Source: ACOG Practice Bulletin No. 206, 2019
Contraceptive Patch
Administration
Applied weekly for 3 weeks, followed by patch-free week. Two brands available in US with different hormone formulations.
Considerations
  • Pregnancy rate 4-7% per year
  • Convenient weekly application
  • Visible on skin
  • May cause skin irritation
  • Extended cycles possible
FDA labels include warnings about decreased efficacy in patients with larger bodies (≥90 kg) and BMI >30 kg/m². However, US MEC classifies patch as category 2 for BMI ≥30, indicating advantages generally outweigh risks.
Reference: Nelson AL, et al. Contraception 2021;103:137
Vaginal Ring
The vaginal ring is a discrete and convenient option requiring only monthly adherence. Available in one size, does not need fitting. Can be used with tampons and removed for up to 3 hours without reducing efficacy.
Two brands available: one releases 15mcg EE and 120mcg etonogestrel daily (effective 1 month), the other releases 15mcg EE and 150mg segesterone acetate daily (effective 1 year).
Inserted by patient and left in place for 3 weeks, followed by ring-free week. Extended and continuous use possible.
Reference: Contraception: Hormonal contraceptive vaginal rings, UpToDate 2024
Estrogen-Containing Contraception: Contraindications
Cardiovascular
  • Migraine with aura
  • Hypertension (≥160/100)
  • History of VTE
  • Ischemic heart disease
  • Stroke
Thrombophilia
  • Factor V Leiden
  • Prothrombin mutation
  • Protein C/S deficiency
  • Antithrombin deficiency
  • Antiphospholipid syndrome
Other Conditions
  • Breast cancer (current)
  • Severe cirrhosis
  • Hepatocellular adenoma
  • Acute viral hepatitis
  • Prolonged immobilization
Postpartum
  • <21 days postpartum
  • 21-30 days if breastfeeding
  • 30-42 days with VTE risk factors
Source: Curtis KM, et al. MMWR Recomm Rep 2016;65:1
VTE Risk: Contraception vs Pregnancy
The risk of VTE from estrogen-containing contraceptives must be balanced against the significantly higher risk during pregnancy and postpartum. Combined oral contraceptive use is associated with 15-20 VTEs per 100,000 women per year, while pregnancy carries a 3-4 fold higher risk.
Reference: Vandenbroucke JP, et al. N Engl J Med 2001;344:1527
Barrier and Nonhormonal Methods
Barrier methods include external and internal condoms, diaphragms, cervical caps, and sponges. The copper IUD is the most effective nonhormonal method with <1% failure rate.
External condoms have 2% failure rate with perfect use, 13% with typical use. They are the only method that provides protection against sexually transmitted infections in addition to pregnancy prevention.
Phexx is a nonhormonal contraceptive gel used immediately prior to sex, approximately 86% effective with typical use.
Source: Contraceptive Technology, 21st edition, 2018
Emergency Contraception Options
Levonorgestrel EC Pills
Available over-the-counter. Use within 72 hours of unprotected intercourse. Pregnancy rate 1.8-2.6%. Less effective with BMI >26.
Ulipristal Acetate
Requires prescription. Use within 120 hours. Pregnancy rate 0.6-1.8%. Less effective with BMI >35. More effective than LNG.
Copper or LNG IUD
Most effective EC option (<0.1% failure). Can be inserted up to 120 hours after intercourse. Provides ongoing contraception.
Reference: Salcedo J, et al. Contraception 2023;121:109958
Emergency Contraception: Mechanism of Action
Important Clarification
Hormonal EC does NOT interrupt an existing pregnancy and does NOT cause abortion
How EC Works
Primary mechanism: Delays or prevents ovulation
Secondary mechanism: May prevent fertilization if ovulation has already occurred
Does NOT: Interfere with implantation of fertilized egg
The FDA label for levonorgestrel EC no longer includes prevention of implantation as a mechanism. Data from systematic reviews fail to support that ulipristal acetate prevents implantation.
Reference: Gemzell-Danielsson K, et al. Gynecol Endocrinol 2014;30:685
Contraception for Adolescents
All adolescents should be able to receive contraception in their medical home. The AAP recommends that all clinicians who care for adolescents provide contraceptive care.
Adolescents have unique contraceptive needs reflecting variations in individual development, barriers to access, and lack of information. Recognition of the patient's developmental stage assists with helping navigate correct and consistent method use.
LARC methods are considered first-line options for adolescents by AAP, ACOG, and NASPAG due to high efficacy and continuation rates.
Source: Ott MA, et al. Pediatrics 2025;156
Adolescent Contraceptive Use Patterns
Among sexually active high school students in the 2021 Youth Risk Behavior Survey, only one-third reported using hormonal contraception, and only 10% used long-acting reversible contraception.
The risk of pregnancy over one year in couples using no contraception is approximately 85%. Teen pregnancy rates have declined 75% since 1991, attributed to increased access to comprehensive sex education, improved contraceptive access, and shifting social norms.
Reference: CDC Youth Risk Behavior Survey, 2021
Adolescent Concerns About Contraception
Weight Gain
Causal relationship not established for most methods. DMPA may be associated with weight gain, especially in those with BMI ≥30 at baseline.
Reduced Height
By menarche, most adolescents have achieved ≥95% of adult height. Hormonal contraception does not affect final height.
Harm to Pregnancy
Inadvertent use during early pregnancy is generally safe (except IUDs). Does not increase risk for adverse pregnancy outcomes.
Future Infertility
All reversible methods demonstrate return to baseline fecundity with cessation. Only sterilization permanently affects fertility.
Source: Ott MA, et al. Pediatrics 2025;156
Same-Day Contraceptive Start
Same-day start of contraception is recommended when possible to enhance access and simplify the process. Studies show same-day start has low overall risk of pregnancy (0.4% first-cycle pregnancy rate).
A checklist can be used to rule out luteal phase pregnancy. Patients who do not satisfy the checklist can still start contraception same-day with appropriate counseling about follow-up pregnancy testing.
Emergency contraception should be considered for all patients. If patient is candidate for EC and interested in IUD, both copper and LNG 52mg IUDs provide EC and ongoing contraception.
Reference: Curtis KM, et al. MMWR Recomm Rep 2016;65:1
Pregnancy Checklist for Same-Day Start
No menstrual period in past month
Has not had sexual intercourse since last normal menstrual period
Has been correctly and consistently using reliable contraception
Is within 7 days after start of normal menstrual period
Is within 4 weeks postpartum (if not breastfeeding)
Is within first 7 days post-abortion or miscarriage
If patient meets ANY of these criteria, pregnancy is very unlikely and contraception can be started immediately.
Source: CDC US SPR 2024
Special Populations: Key Considerations
Adolescents
Developmental stage affects method use. LARC recommended as first-line. Address concerns about weight, fertility, side effects.
Postpartum
Discuss options multiple times during prenatal care. Offer immediate postpartum LARC. Consider lactation effects and VTE risk timing.
Chronic Medical Conditions
Use WHO/CDC MEC for safety guidance. Balance contraceptive risks against pregnancy risks. Maintain patient autonomy.
Obesity
All methods can be offered. Consider efficacy of some methods may be reduced. Patch has specific BMI considerations.
Reference: ACOG Committee Statement No. 1, 2022; Curtis KM, et al. MMWR 2016
Reproductive Justice Framework
Contraceptive counseling occurs in a historical context where services have participated in coercive practices designed to limit fertility of specific populations, including women of color, poor women, and women with disabilities.
Examples include nonconsensual sterilization and targeted marketing of specific methods. This history remains in consciousness of affected communities, with over 40% of Black and Hispanic Americans believing government promotes birth control to limit minorities.
Reference: Thorburn S, Bogart LM. Health Educ Behav 2005;32:474
Addressing Bias in Contraceptive Counseling
Evidence of Ongoing Bias
Women of color more likely to report being advised to limit childbearing and being pressured to use contraception. Providers more likely to recommend IUDs to low-income Black and Hispanic women than White women in standardized scenarios.
Shared Decision-Making as Protection
Provides structure that protects against perceived or actual bias by explicitly focusing on patients' expressed preferences. Practitioners should guard against overemphasizing specific methods based on assumptions.
Quality Monitoring
Use Person-Centered Contraceptive Counseling measure to monitor quality and identify inequities by patient characteristics such as race/ethnicity, age, and language.
Reference: Dehlendorf C, et al. Am J Obstet Gynecol 2010;203:319.e1
Myths About Contraception
Myth: All Unintended Pregnancies Are Unwelcome
Reality: Women have varying perspectives about unintended pregnancy. Some embrace unpredictability of fertility and consider unintended pregnancies welcome surprises.
Myth: Unintended Pregnancies Are Unhealthy
Reality: Literature on association between pregnancy intention and poor outcomes is not as robust as previously thought, especially in developed countries.
Myth: Efficacy Is Always Most Important
Reality: Patients report average of 11 characteristics as important. While 89% rate effectiveness as extremely important, 80% rate ease of use and 74% rate few side effects as extremely important.
Reference: Aiken AR, et al. Perspect Sex Reprod Health 2016;48:147
Contraceptive Initiation Counseling
Contraceptive initiation counseling should include anticipatory guidance and strategies to manage side effects and optimize method use. Key components include:
  • Whom to contact with questions (provide easy-to-read visit summary)
  • Need for condoms to prevent STIs
  • Availability and indications for emergency contraception
  • How to use method correctly and consistently
  • What to do if doses missed (for short-acting methods)
  • Expected side effects and how to manage them
  • How to access refills and follow-up care
  • Acceptability of method switching at any time
Source: ACOG Committee Statement No. 1, 2022
Overcoming Barriers to Access
Cost Barriers
Affordable Care Act requires coverage of FDA-approved contraceptive methods without out-of-pocket costs. Identify local resources for low/no-cost contraception.
Access Barriers
Offer same-day appointments, after-hours and weekend appointments. Provide wide range of methods including same-day LARC. Prescribe without prerequisite exams.
Confidentiality
Lack of or perceived lack of confidential care is major barrier. Explicitly inform patients of their right to confidential services when available.
Reference: Secura GM, et al. N Engl J Med 2014;371:1316
STI Prevention Counseling
Counsel patients choosing nonbarrier contraceptive methods that these methods alone do not prevent sexually transmitted infections. Consistent and correct condom use in addition to their contraceptive is recommended to prevent STIs including HIV.
Other STI prevention strategies include vaccines (HPV, hepatitis B, hepatitis A) and antimicrobial prophylaxis such as HIV pre-exposure prophylaxis and doxycycline for bacterial STI prevention.
Routine STI and HIV screening are advised for sexually active individuals based on CDC recommendations.
Reference: Workowski KA, Bolan GA. MMWR Recomm Rep 2015;64:1
Follow-Up Care
01
Initial Follow-Up
Schedule appointment 2-4 months after initiating method to address questions, reinforce proper use, provide additional guidance
02
Ongoing Care
Meet whenever patient has STI symptoms or requires review of side effects. Prioritize timely visits for LARC removal requests
03
Annual Visit
All patients should have annual visit for health maintenance and preventive care including STI screening per CDC recommendations
04
Refills
Provide 12-month supply of pills, rings, or patches annually when possible. Refills need not align with follow-up appointments
Source: Curtis KM, et al. MMWR Recomm Rep 2016;65:1
Managing Side Effects
Anticipatory Counseling
Discuss potential side effects before initiation. Anticipatory counseling associated with both method satisfaction and continuation.
Revisit side effect discussion once method chosen and at follow-up visits.
Common Side Effects
  • Irregular bleeding (especially with progestin-only methods)
  • Headaches
  • Breast tenderness
  • Nausea (usually resolves)
  • Mood changes
  • Weight changes
Easy access to clinic staff helps ensure consistent use. Reassurance, validation, and short-term treatment may promote continuation.
Reference: Backman T, et al. Obstet Gynecol 2002;99:608
Patient Education Resources
Bedsider.org
Free website with method descriptions, comparison tools, and automated reminders for appointments and refills
Planned Parenthood
Comprehensive reproductive health resources for patients and clinicians
ACOG Patient FAQs
Evidence-based answers to frequently asked questions about contraception
Center for Young Women's Health
Boston Children's Hospital website addressing reproductive health needs of teens and young adults
Source: Multiple patient education resources, 2024
Clinician Resources
CDC Medical Eligibility Criteria
US MEC 2024 provides evidence-based recommendations for contraceptive use across broad range of conditions. Available online with mobile app.
CDC Selected Practice Recommendations
US SPR 2024 provides guidance on contraceptive initiation, follow-up, and management of side effects.
WHO Guidelines
WHO Medical Eligibility Criteria and Selected Practice Recommendations provide international evidence-based guidance.
ACOG LARC Program
Comprehensive resources on long-acting reversible contraception including training materials and patient education.
Source: CDC, WHO, ACOG resources, 2024
Key Takeaways: Counseling Approach
Patient-Centered
Use shared decision-making that prioritizes patient preferences and values over clinician bias or directive counseling
Evidence-Based
Follow WHO and CDC medical eligibility criteria. Provide accurate information about efficacy, side effects, and safety
Equity-Focused
Recognize historical context and ongoing bias. Monitor counseling quality and address disparities
Comprehensive
Discuss all options including LARC, emergency contraception, and STI prevention. Address barriers to access
Reference: ACOG Committee Statement No. 1, Obstet Gynecol 2022;139:350
Summary: Clinical Recommendations
Assessment
  • Identify contraceptive need with open-ended questions
  • Document medical history and contraindications
  • Elicit informed preferences for method characteristics
  • Use visual aids to support education
Selection
  • Facilitate decision-making through shared process
  • Avoid clinician bias
  • Support patient autonomy
  • Offer same-day start when possible
Initiation
  • Provide comprehensive counseling on method use
  • Discuss side effect management
  • Address STI prevention
  • Ensure access to emergency contraception
Follow-Up
  • Schedule 2-4 month follow-up
  • Provide easy access for questions
  • Support method switching
  • Annual preventive care visits
Source: ACOG, AAP, CDC Guidelines 2022-2024
Conclusion
Quality contraceptive counseling requires a patient-centered approach using shared decision-making that respects individual preferences, values, and reproductive goals. Clinicians should provide evidence-based information about all contraceptive options while avoiding bias and directive counseling.
By following WHO and CDC medical eligibility criteria, addressing barriers to access, and promoting reproductive justice, we can help patients make informed decisions that align with their needs and optimize their reproductive health outcomes.
The evolution toward personalized, equity-focused contraceptive care represents both an ethical imperative and an evidence-based approach to improving patient satisfaction, method continuation, and long-term health care engagement.
Department of Obstetrics and Gynecology
Prof. Mykhailo Medvediev
gynecology.com.ua
References: ACOG Committee Statement No. 1, 2022; CDC US MEC 2024; WHO MEC 2015; Curtis KM, et al. MMWR 2016; Dehlendorf C, et al. Contraception 2017