A request for contraception
Reproductive health
Clinic
The first question
What does she want from a method, and what is she eligible for?
- 01
Her priorities
Effectiveness, bleeding pattern, hormones, privacy, return to fertility, cost, protection from infection.
- 02
Eligibility
The MEC questions: migraine with aura, VTE history, smoking over 35, hypertension, breast cancer, liver disease, postpartum timing, breastfeeding.
- 03
Options that fit, most effective first
LARC when acceptable; then the rest by preference.
- 04
Start, safety-net, follow up
Quick start if pregnancy is reasonably excluded; back-up for 7 days; when to return; emergency contraception explained.
Where it is
Each opens the structure on the 3D pelvis.
History that discriminates
- Reproductive plans and timing
- Prior methods and what went wrong
- Menstrual pattern and heavy bleeding
- Migraine with aura, VTE, cardiovascular risk, smoking, hypertension
- Breast cancer, liver disease
- Postpartum and breastfeeding status
- Medications (enzyme inducers)
- Partner involvement and safety
Examination that discriminates
- Blood pressure and BMI before oestrogen-containing methods
- No pelvic examination is needed to start most methods; a bimanual before IUD insertion
Investigations
- Pregnancy test if pregnancy cannot be reasonably excluded
- Chlamydia and gonorrhoea screen at IUD insertion where indicated
- No routine bloods
Pitfalls this pathway refuses
- Requiring a pelvic examination or a Pap to start the pill
- Missing migraine with aura
- Assuming a young or nulliparous patient cannot have an IUD