Nondaily Hormonal Contraception: Considerations in Contraceptive Choice and Patient Counseling

Abstract

Despite the efficacy of OCs, missed pills are quite common and contribute to unintended pregnancy. Many women in all population categories would benefit from the convenience and reliability of nondaily hormonal contraceptives. The highest efficacy rates with typical use are associated with agents that require minimal user participation (i.e., Depo-Provera, Mirena). Compared to daily regimens, all nondaily options offer increased convenience and may contribute to improved patient adherence. However, barriers to use may exist. Patient fears regarding use of hormones can be minimized by discussing the long-term safety of hormonal contraceptives. (The data are predominantly derived from Depo-Provera and OCs because these agents have been available in the United States and in the rest of the world for much longer than the newer nondaily options.) Patient counseling and appropriate expectations regarding changes in menstrual pattern have been demonstrated to further enhance patient adherence to therapy. Finally, patient lifestyle preferences must be considered. The finding that many women are comfortable with or even prefer amenorrhea, which is associated with options such as Depo-Provera, highlights how important it is for clinicians to avoid making assumptions about a patient's contraceptive preferences. Rather, clinicians and patients should exchange information through an open dialogue. For the majority of patients, nondaily hormonal contraceptives should be considered and offered as first-line options.

Challenges in Translating Evidence to Practice

“…[32][33][34] In addition, less restrictive, evidencebased criteria for intrauterine contraception candidate selection should be developed and promoted. 35 Clinical training is also necessary, especially to alleviate concerns about perforations from postpartum insertions or expulsions from incorrect placement in postabortion insertions. 35 Clinical training is also necessary, especially to alleviate concerns about perforations from postpartum insertions or expulsions from incorrect placement in postabortion insertions.…”

Counseling and management of patients requesting subcutaneous contraceptive implants: proposal for a decisional algorithm

“…In fact, this method overcomes the problem of the oral route (forgetting a pill), or of the possible displacement of IUDs, and it requires less intervention, a benefit particularly useful to women with busy lifestyles who are also in need of a discreet contraceptive method. Moreover, it could be widely appreciated by women who prefer avoiding the discomfort of menstrual cycle, and by women who have recurring menstrual problems, such as dysmenorrhea, endometriosis, and headache [20][21][22].…”

“…In such context, the role of the HCP/gynecologist becomes crucial in providing exhaustive information on the medical and technical aspects of all the contraceptive options available and especially in addressing his/her patient's need in line with her current lifestyle and social and cultural environment. Moreover, given the extremely personal nature of the woman's sexual sphere, the dialogue on contraceptive issues is very sensitive and may facilitate the trust in the patient-doctor relationship on many aspects including the medical information provided [20].…”

Contraception and Adolescents

“…Adverse effects were similar to those of Depo-Provera and included weight gain, menstrual irregularity, headaches, and breast tenderness, although adverse effects were fewer than in trials with DMPA alone. 76,77 A general acceptance of and overall satisfaction with Lunelle by women in clinical trials suggested that this method was widely accepted, but its return into the market is not expected in the future.…”