EXECUTIVE SUMMARY
The Association of Reproductive Health Professionals offers two informative web-based educational options to help clinicians fine-tune their counseling skills on long-acting reversible contraception (LARC) methods.
- A new Clinical Minute“Counseling Young Women about Long-Acting Reversible Methods,” explains the difference between LARC methods and emphasizes the effectiveness of these methods. It also covers effective contraceptive counseling strategies and outlines appropriate candidates for intrauterine contraception.
- Also available is a two-part webinar “Provider Education and Training to Increase Use of Intrauterine Contraception.” The first section explains the differences between the four forms of intrauterine contraception available in the United States, outlines appropriate candidates, and describes possible side effects of each type of intrauterine contraception. The second section covers pain management strategies during and after insertion, strategies for follow-up, and skills required for proper insertion techniques.
Do you know how to counsel your young adult patients on selecting the right long-acting reversible contraception (LARC) method for their needs? The Association of Reproductive Health Professionals offers two informative web-based educational options to help clinicians fine-tune their counseling skills. Both options offer free CE credits.
A new Clinical Minute, “Counseling Young Women about Long-Acting Reversible Methods,” is available at http://bit.ly/2aoa7t6. The brief presentation explains the difference between LARC methods and emphasizes their effectiveness. It covers effective counseling strategies and outlines appropriate candidates for intrauterine contraception.
The second option, a two-part webinar titled “Provider Education and Training to Increase Use of Intrauterine Contraception,” is available at http://bit.ly/29TFq1R. The first section of the webinar explains the difference between the four forms of intrauterine contraception available in the United States, outlines the appropriate candidates for intrauterine contraception, and describes possible side effects of each type of intrauterine contraception. That section is conducted by Amna Dermish, an obstetrician/gynecologist with Planned Parenthood of Greater Texas in Austin. The second section covers pain management strategies during and after insertion, discusses strategies for follow-up of intrauterine contraceptive (IUC) users, and addresses skills required for proper insertion techniques for the four methods of intrauterine contraception. That section is led by Wendy Grube, PhD, CRNP, director of the Women’s Health Nurse Practitioner Program at the University of Pennsylvania and director of its Center for Global Women’s Health.
Approach patient counseling within a shared decision-making framework, notes Dermish. The steps of shared decision making include:
- query to identify preferences, using open-ended questions;
- provide information about side effects, effectiveness, and use of method, including written materials in the appropriate language and literacy level;
- give context about options, and allow patients to hold devices if possible;
- ensure access to method placement and removal;
- allow time for and encourage questions.
Incorporate the “One Key Question,” an initiative launched by the Oregon Foundation for Reproductive Health, at the start of counseling, advises Dermish. The initiative encourages providers to routinely ask women of reproductive age one simple question: “Would you like to become pregnant in the next year?” From there, a clinician can begin the discussion of what a woman’s reproductive health plans are for the future, what is important to her about her contraceptive method, and what methods she has used in the past, Dermish explains. Open-ended questions help clinicians better understand what concerns patients have, as well as what they already know about their contraceptive options.
Use the contraceptive effectiveness chart (which can be accessed at http://bit.ly/29K8XXD) that illustrates the different tiers of effectiveness of birth control methods so patients can get a clear picture of the top-line effectiveness of LARC methods. LARC includes the contraceptive implant and intrauterine contraception. Most women are LARC candidates, including adolescents, young women, and nulliparous women.
The U.S. Medical Eligibility Criteria for Contraceptive Use (US MEC) lists the following contraindications to use of the contraceptive implant:
- breast cancer — current or in the past;
- ischemic heart disease or stroke — current or in the past (for continuing method);
- lupus (systemic lupus erythematosus or SLE);
- migraine with aura (for continuing method);
- unexplained vaginal bleeding;
- severe cirrhosis;
- malignant liver tumor.1
The US MEC lists the following contraindications to use of intrauterine contraception:
- known or suspected pregnancy;
- puerperal sepsis;
- immediate post-septic abortion;
- unexplained vaginal bleeding;
- uterine fibroids that interfere with placement;
- uterine distortion;
- active purulent cervicitis/pelvic inflammatory disease;
- active endometrial cancer (for initiating method);
- active cervical cancer (for initiating method).1
Be prepared to discuss possible menstrual changes associated with LARC methods and how these will be managed, says Grube. Implants are associated with infrequent bleeding, amenorrhea, and prolonged bleeding. In many women, these changes improve over time. Most women using the Copper T intrauterine device (IUD) experience an increase in the duration and amount of menstrual bleeding, which often lessens by the first year of use. For women who choose a hormonal IUD, the bleeding pattern is unpredictable. Many women have spotting and irregular bleeding during the first three to six months; most women have reduced bleeding or amenorrhea by 12 months after insertion.
“In our culture, if you don’t bleed when you think you should, then that’s a problem, and if you’re bleeding when you shouldn’t, that’s a problem,” Grube observes.
By letting a patient hold an IUC or implant in her hand, and using a visual model to show where it will be placed, patients gain a better understanding of the device and how it works. Go over insertion and removal procedures so women are well-prepared, says Grube. When it comes to IUC placement, many women may be concerned about pain at time of insertion. Review options for lessening pain, from use of ibuprofen prior to insertion, to use of lidocaine.
Be prepared to spend time with patients before they choose a LARC method, because these methods represent a potential commitment of time from three to 12 years, says Grube. The patient needs to feel as if she knows everything there is to know, within reason, about this method and that she is in control of making the decision, she notes. “I truly believe that if you give women all the information that they need, they will make the right decision for themselves,” states Grube.
REFERENCE
- CDC. U.S. Medical Eligibility Criteria for Contraceptive Use. MMWR 2010; 59(RR04):1-86.
