How do you use OCs? Clinicians share tips
How do you use OCs? Clinicians share tips
A woman comes into your office and says she wants to use an oral contraceptive (OC) for birth control. After confirming that she is a good candidate for the method, when do you start her on her first pack of pills?
Almost all (93%) of respondents to the 2011 Contraceptive Technology Update Contraception Survey say they use the Quick Start method of pill initiation, up from 2010's 87% figure. Also known as the Same-Day Start, the practice entails having the woman take the first pill in her pill pack on the day of her visit as long as it is reasonably certain that she is not pregnant and not in need of emergency contraception.1
Quick Start is preferred because other combined oral contraceptive initial protocols generally have a time gap between the time of prescription and the time the patient begins taking it. Research indicates as many as 25% of women who use other protocols fail to take the pills as instructed because they conceive in the interim, fail to fill the prescription, or worry about taking the Pill.2,3
Quick Start was accepted easily by staff at the Graham County Department of Public Health in Robbinsville, NC, says Marlene Carver, NP-C, a nurse practitioner at the facility. "We had a nursing staff meeting and reviewed all the methods using Quick Start and rewrote our policies and attached them to our standing orders," says Carver. "Staff are more knowledgeable about how to use the Quick Start protocol."
Donna Gray, NP, a nurse practitioner at Wyoming County Health Department in Silver Springs, NY, says she hopes that Quick Start is decreasing unwanted pregnancies. "If someone comes in for a pregnancy test and it is negative, I can then start them on a method, and they will return for preventative care and continue on their method," notes Gray. "If a new client comes in, I have been starting them on their method at that appointment after I try and make sure they couldn't be pregnant already, and I also instruct them that even if they are pregnant, the method they start will not hurt a pregnancy."
This practice also gives patients time to bring in their information to get started on insurance to cover their method at the drug store, which saves the health department's inventory for those who need it, says Gray.
No OCs for older smokers
Clinicians continue to hold the line when it comes to prescribing combined pills to older women (40 and above) who smoke 10 cigarettes a day. Almost 98% said they would withhold OCs from such patients, moving up from 2010's 96% statistic. Readers were almost as emphatic when it comes to women smokers ages 35-39; about 90% said they would not prescribe combined pills to those who smoke 10 cigarettes a day.
The U.S. Medical Eligibility Guidelines For Contraceptive Use rank combined hormonal contraceptive use for women age 35 or older who smoke less than 15 cigarettes per day as a "3" — a condition for which the theoretical or proven risks usually outweigh the advantages of using the method. For women in the same age range who smoke 15 cigarettes or more per day, the guidelines rank combined hormonal contraceptive use as a "4" — where the condition represents an unacceptable health risk if the method is used. Use of combined hormonal contraceptives for smokers under age 35 is listed as a "2" — a condition for which the advantages of using the method generally outweigh the theoretical or proven risks.4
References
- Nelson AL, Cwiak C. Combined oral contraceptives (COCs). In: Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology: 20th revised edition. New York: Ardent Media; 2011.
- Oakley D, Sereika S, Bogue EL. Oral contraceptive pill use after an initial visit to a family planning clinic. Fam Plann Perspect1991; 23:150-154.
- Westhoff C, Kerns J, Morroni C, et al. Quick start: novel oral contraceptive initiation method. Contraception 2002; 66:141-145.
- Centers for Disease Control and Prevention. U.S. Medical Eligibility Criteria for Contraceptive Use. MMWR 2010; 59(RR04):1-6.
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