How can I effectively counsel patients on contraception options, including long-acting reversible contraceptives?

To effectively counsel patients on contraception options, including long-acting reversible contraceptives (LARC), it is essential to ensure patient involvement and informed decision-making ¹.

• Provide Comprehensive Information: Offer information on all contraceptive methods, including LARC, to enable an informed choice ¹,². This information should be both verbal and written, tailored to the individual's needs, and presented in easily understandable language and formats ¹,². Key details to cover include:
  • Contraceptive efficacy ¹,².
  • Duration of use ¹.
  • How each method works ².
  • Risks and possible side effects ¹,².
  • Non-contraceptive benefits ¹.
  • The procedure for initiation and removal or discontinuation ¹.
  • When to seek help while using the method ¹.
  • Possible drug interactions ².
  • Health risks and benefits of the methods ².
  • Information on return to fertility after discontinuing the methods ².
• Conduct a Thorough Assessment: Before initiating any contraceptive method, a medical history should be taken, including relevant family, menstrual, contraceptive, and sexual history ¹,². Pregnancy must be excluded ¹,². Assess the patient's suitability for different methods by identifying factors such as comorbidities, allergies, lifestyle, reproductive history, drug treatments, and age ². Utilise nationally agreed guidance like the UK Medical Eligibility Criteria (UKMEC) to ensure safe use of methods ¹,².
• Ensure Sensitivity and Accessibility: Counselling should be sensitive to cultural differences and religious beliefs ¹. For patients who are not English speaking, or have sensory impairments or learning disabilities, ensure access to trained interpreters or advocates ¹.
• Address Special Considerations:
  • Young People: Be aware of the law regarding advice and contraception for young people, considering child protection issues and Fraser guidelines for those under 16 years ¹,³. All methods can be considered, but avoid regular hormonal contraception in sexually active girls who have not started menstruating ².
  • Patients on Teratogenic Drugs: Advise the use of highly effective contraception, such as LARC methods (progestogen-only implant, copper intrauterine device, levonorgestrel intrauterine device), to reduce pregnancy risk ².
  • Patients on Liver Enzyme-Inducing Drugs: Advise on potential interactions with hormonal contraception and offer reliable methods unaffected by enzyme-inducers (Cu-IUD, LNG-IUD, progestogen-only injectable) ².
  • Post-Pregnancy/Abortion: Discuss contraception options with pregnant women for postnatal use, providing information on effective methods tailored to their needs ³. For young women post-abortion, discuss contraception as soon as possible, dispelling myths about fertility immediately after ³.
  • Patients with Learning/Physical Disabilities: Support them in making their own decisions about contraception ¹. If unable to understand, establish a care plan with carers and involved parties ¹.
• Promote Safer Sex: Always promote safer sex, assess the risk for sexually transmitted infections (STIs), advise testing when appropriate, and provide information about local STI services ¹.
• Provide Interim Contraception: If required, supply an interim method of contraception at the first appointment ¹.