Nearly 50% of pregnancies in the United States are unintended. Advising patients about family planning and appropriate methods of birth control, such as combined hormonal contraceptives, can help reduce this. Increased use of effective contraception can lessen the risk for poor maternal and infant outcomes. It can also help lower the nation's medical costs related to unintended pregnancies, which soared to $21 billion in 2010.

Strategies to prevent unintended pregnancies include assisting and educating patients on appropriate contraceptive methods and usage. Patients require advisement on topics such as initiating use of a contraceptive method, including which examinations and tests may be needed prior to doing so, what follow-up will be needed, handling missed doses, and possible adverse reactions. Comprehensive recommendations issued by the CDC (U.S. Selected Practice Recommendations for Contraceptive Use, 2013) delineate optimal use of contraceptive methods. This guide addresses clinical issues and supplies healthcare providers with information to use when advising patients on contraceptive methods.

When suggesting contraceptive methods to patients, safety and effectiveness are of utmost importance. Factors such as availability, including the aspects of accessibility and affordability, will need to be discussed. It will also be necessary to identify unique patient characteristics such as age, income, desire to prevent or delay pregnancy, and acceptability, in order to ensure consistent and correct use of a chosen contraceptive method. Regardless of contraceptive choice, all patients should receive counseling regarding the use of condoms and the risk for STDs, including HIV infection.

Additional highlights on combined hormonal contraceptives:

• They can be safely used by most women, and are reversible.
• They contain both estrogen and a progestin and are available as a transdermal contraceptive patch, a vaginal contraceptive ring, and combined oral contraceptives (various formulations).
• When it is reasonably certain that a female patient is not pregnant, they can be initiated at any time.
• Few examinations or tests are needed before initiation in healthy patients. Blood pressure, weight, and BMI should be measured. Patients with preexisting medical problems or other special conditions may require additional clinical review.
• If possible, patients should be provided a prescription for a combined oral contraceptive that is valid for up to 1 year, so that they can obtain it easily and at the needed time.
• No evidence exists regarding whether a routine follow-up visit after initiating combined hormonal contraceptives improves correct or continued use.
• Blood pressure monitoring is important, and healthcare providers can suggest for patients to seek regular testing in nonclinical settings.
• Patients should always be advised to return at any time to discuss side effects, other problems, or a desire to change the contraceptive method.

For a comprehensive list of combined hormonal and other oral contraceptives, please see PDR's Oral Contraceptives table (content revised in March 2014 using FDA-approved labeling and included as part of the 2015 PDR Nurse's Drug Handbook). Additionally, labeling information on combined hormonal contraceptives, as well as on thousands of other products, is available on PDR.net. Please update or register your PDR profile to receive alerts and other critical drug information from PDR via email. Also, look for information from PDR within your eRx workflow. Drug safety information, updates about dosing and formulary, patient support programs, and savings opportunities display on your screen as you prescribe, at no cost to you or your patients. To learn more about PDR services in your eRx/EMR/EHR workflow, email us at EHR-info@PDR.net.

Salvatore Volpe, MD, FAAP, FACP, CHCQM
Chief Medical Officer
PDR