Counseling Outline

• Anytime you can be reasonably sure the client is not pregnant (see Client Assessment chapter)
• Days 1–7 of the menstrual cycle
• Postpartum:
• after 6 months if using LAM
• after 6 weeks if breastfeeding but not using LAM
• after 3 weeks if not breastfeeding
• Postabortion (immediately or within 7 days)

• Women of any reproductive age or parity who want highly effective protection against pregnancy
• Breastfeeding mothers 6 months or more postpartum (6 weeks or more if not using LAM)
• Postpartum women who are not breastfeeding (may begin after third week postpartum)
• Postabortion clients (may begin immediately)
• Women with anemia
• Women with moderate to severe menstrual cramping
• Women with irregular menstrual cycles
• Women with histories of ectopic pregnancy

• Highly effective
• Rapidly effective
• Pelvic examination not required prior to use
• Do not interfere with intercourse
• Few side effects
• Can be provided by trained nonmedical staff

Noncontraceptive Benefits

• Decrease menstrual flow (lighter, shorter periods)
• Decrease menstrual cramps
• May improve anemia
• Protect against ovarian and endometrial cancer
• Decrease benign breast disease (cysts/lumps) and ovarian cysts
• Prevent ectopic pregnancy
• Protect against some causes of PID

• Some nausea, dizziness, mild breast tenderness or headaches as well as spotting or light bleeding (usually disappear within 2 or 3 cycles/injections)
• Effectiveness may be lowered when certain drugs are taken (see table Interactions with Other Drugs in this chapter)
• Can delay return to fertility
• Serious side effects rare (stroke, blood clots in lungs or brain and malignant liver tumors) in women using COCs
• Resupply must be available
• Do not protect against STDs including, HBV and HIV/AIDS

• Monophasic: All 21 active pills contain same amount of E/P
• Biphasic: 21 active pills contain 2 different E/P combinations (e.g., 10/11)
• Triphasic: 21 active pills contain 3 different E/P combinations (e.g., 6/5/10)

• Women who want a combined (estrogen/progestin) contraceptive but do not want injections

• Highly effective when taken daily (0.1–8 pregnancies per 100 women during the first year of use)
• Rapidly effective (<24 hours)
• Convenient and easy to use
• Client can stop use

Noncontraceptive Benefits

• More regular menstrual cycles
• Immediate return to fertility

• User-dependent (require continued motivation and daily use)
• Forgetfulness increases failure
• Women starting COCs after day 7 of the menstrual cycle should use a backup method or abstain from sex for 4 days.

• Cyclofem^®/Cyclo-Provera^®/Lunelle^®: 25 mg depot-medroxyprogesterone acetate and 5 mg estradiol cypionate injected IM once a month
• Mesigyna^®: 50 mg norethindrone enanthate and 5 mg estradiol valerate injected IM once a month

• Highly effective (0.1–0.4 pregnancies per 100 women during the first year of use)
• No supplies needed by client
• More rapid return to fertility than with progestin-only injectable contraceptives

• Cause changes in menstrual bleeding pattern (irregular bleeding/spotting initially) in some women
• User-dependent (client must return for injection every 30 days)