| Procedure |
Class |
Rationale |
| Pelvic examination (speculum and
bimanual) |
C |
- Established pregnancy, the only condition which would
restrict use of COCs, should be identified by history before method initiation. A pelvic
exam is not necessary to ensure safe use of short-term COCs1,2.
- When a pelvic exam is necessary to help evaluate the
possibility of pregnancy, then it becomes Class A.
|
| Blood pressure |
C |
Because of the short duration of
the ECP regimen, it is highly unlikely that ECPs would have adverse effects 3. |
| Breast examination |
C |
A breast exam is not necessary
to ensure the safe use of OCs or ECPs. While any hormonal treatment may in theory cause a
pre-existing lump to grow it is highly unlikely that ECPs will affect the preexisting
condition, due to the short duration of the regimen1,3. |
| Sexually transmitted disease
(STD) screening by lab tests (for asymptomatic persons) |
C |
STD screening by lab tests for
asymptomatic clients is not necessary for the safe, short-term use of COCs1. |
| Cervical cancer screening |
C |
Cervical cancer screening is
unrelated to ECP use. |
| Routine, mandatory lab tests
(e.g., cholesterol, glucose, liver function tests) |
D |
The effects of COCs on
cholesterol, blood glucose and normal liver function are slight, and of no demonstrated
clinical significance4. |
| Proper infection prevention
procedures |
C |
Proper infection prevention
procedures are not applicable to ECP use. |
| Specific counseling points for
ECP use: |
A |
- Counseling is essential for the client to make an informed
choice.
|
|
|
|
- Accurate client education regarding efficacy is necessary
to prepare the client for the possible failure of the method and subsequent pregnancy5.
|
- correct use of the method (including instructions for
vomited pills)
|
|
- In the event of ECPs failure, counseling on the absence of
known risk of ECPs on fetal development, and referral to follow-up care, are necessary.
|
- what to do in the event ECPs fail
- follow-up schedule
- information on other contraceptive methods and time of
initiation
|
|
- Lower abdominal pain, abnormally light, heavy or short
bleeding, and the absence of a menstrual period three weeks after using ECPs are signs
that a woman could be pregnant or experiencing an ectopic pregnancy. Both of these
situations require medical attention6.
|
- signs and symptoms for which to see a health provider
|
|
- Appropriate counseling about common side effects of ECPs
will prepare the client for the potential uncomfortable side effects and help her
effectively manage them.
|
- common side effects (including potential disruption of
menstrual cycle)
|
|
- ECPs commonly cause a disruption in the length of the next
menstrual cycle7. The client needs to be aware of this temporary disturbance
because the arrival of the menstrual period will signify that she is not pregnant.
|
- STD protection (when/as appropriate)
|
|
- When time permits and the situation is appropriate, the
client should be counseled on STD protection because the "unprotected" act of
intercourse was unprotected from infection as well as from pregnancy.
|
