Originally posted on AWHONN Connections .
by, Susan A Peck, RNC, MSN-APN
In 2000, as a new Women's Health Nurse Practitioner, the provision of contraception to my patients was actually pretty simple. Most every woman who wanted hormonal contraception used the pill, and there were only a handful of brand name oral contraceptives that we all knew and regularly used.
Shortly thereafter, in 2001, the contraceptive patch and the contraceptive vaginal ring were approved by the FDA. These other two options quickly became competitors to the oral contraceptive market and gave patients and clinicians more choice, and ways to avoid the sometimes daunting responsibility of daily pill intake.
In the background was the IUD - only ParaGard and Mirena were available at that time. Still holding on to the worries of the unsafe IUDs of the 1970s and 1980s, most women and clinicians were not supportive of these devices at that time - fortunately that has dramatically changed! In 2013, the Skyla IUD became available and the Liletta IUD followed in 2015. And let's not forget about the contraceptive implant, Implanon (now Nexplanon) that was approved in 2006.
Barrier methods have also always been accessible to women, such as condoms (male and female) and various spermicidal formulations, as well as the diaphragm - did you know the "old" diaphragm is no longer available, but that there is a new one, Caya?
So, when we consider all of these options, and factor in the complexity of some women's medical conditions or social practices, how can women's health clinicians consider not only which method might be most acceptable to a woman, but also which method is the safest?? There certainly is a lot to keep track of with all of today's contraceptive choices. And if a woman does not use her method correctly, what can a clinician advise?
Fortunately, the CDC has recently published two documents, the 2016 US Medical Eligibility Criteria for Contraceptive Use (MEC) and the 2016 Selected Practice Recommendations for Contraceptive Use (SPR). The references are invaluable for any clinician who is providing contraception to women. I have a copy of both at my desk in my office and even after 16 years of practice, I regularly rely on their guidance to make the best, safest recommendations about contraceptive choices for my patients.
I'd like to tell you about two recent patients, for which both references helped guide my decision making.
First, Jennifer, a 32 year old woman living with multiple sclerosis, has used oral contraceptives successfully for five years. She enjoys the regular, very light periods she has with the pill, and is a very responsible pill taker - never misses one! But, this year, when I see her for her annual exam, I learn that her MS has unfortunately taken a turn for the worse. She is currently in a wheelchair more the 50% of the time and her mobility is greatly limited. She is very hopeful that this period of immobility will be short lived - there is a new MS drug she is starting next month. So, I begin to wonder whether an oral contraceptive is the best, safest method for Jennifer. I use my 2016 MEC App on my phone and determine that due to her immobility related to MS (increased chance of hypercoagulable state) it may be time to change methods. She and I discuss all options and she decides on the Mirena IUD. Not only is she pleased with a long term method, she feels more comfortable knowing she is safe - it is one less thing she has to worry about.
My next patient is Mary, a 20 year old healthy college student who tells me that she wants to use the contraceptive implant, Nexplanon. She is going back to school out of state in two days, and would really like to have the implant inserted today. In the past, some clinicians have traditionally preferred to insert LARC methods during a woman's menstrual period to "make sure she is not pregnant". However, this is often cumbersome for scheduling and delays an opportunity to provide effective contraception. So, I use my 2016 SPR and review the section 'how to be reasonably certain a woman is not pregnant'. I determine that since Mary has consistently and correctly used condoms since her last period, it is safe to assume she is not pregnant. After receiving her informed consent, I safely place the Nexplanon and she is able to return to college with a highly effective long term method of contraception.
It is important to remember that in nearly all situations the use of a birth control method is safer than an unintended pregnancy. These CDC resources are invaluable guides for clinicians so we can be confident our contraceptive recommendations are based on the latest evidence. Both the MEC and the SPR are available free - of- charge with the option of downloading an APP for your device.
Tell your colleagues and have these references close at hand!
Susan A. Peck, RNC, MSN, APN is a practicing Women's Health Nurse Practitioner. For 20 years, Ms. Peck's career has focused on women's health care, first as a labor and delivery staff nurse and for the last 16 years as an Advanced Practice Nurse. She currently works in the Department of Obstetrics & Gynecology within Summit Medical Group, a large multi-specialty practice group in Northern New Jersey.
Ms. Peck's areas of expertise include contraception, osteoporosis, general gynecology and prenatal care. She has spoken at several national and state conferences including the AWHONN National Convention.