Lesson
Person-Centered Selection and U.S. MEC
Contraceptive selection begins with the patient's goals, then uses medical eligibility to identify safe options without coercion.
- Reproductive autonomy
- U.S. MEC
- Effectiveness
- Bleeding preferences
- STI prevention
Ask what the patient wants from the method
Remove options with unacceptable risk
Support the patient's preference among safe methods
Start with the person
Ask about pregnancy goals, desired duration, control, privacy, bleeding, sexual health, prior experiences, daily tasks, procedures, cost, and tolerance for uncertainty. Effectiveness is one attribute, not the only value.
Read U.S. MEC correctly
Category 1 means no restriction, 2 means advantages generally outweigh risk, 3 means risks usually outweigh advantages, and 4 means unacceptable risk. Categories apply to a specific condition and method.
Add STI prevention
IUDs, implants, pills, patches, rings, and injections do not prevent STIs. Offer condoms and appropriate testing, vaccination, doxycycline postexposure prophylaxis or PrEP assessment when clinically relevant.
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Lesson
Combined Pills, Patches, and Rings
Combined hormonal methods share estrogen and progestin pharmacology but differ in schedule, exposure, adherence demands, and product instructions.
- Ethinyl estradiol
- Progestin
- Ovulation suppression
- Patch
- Vaginal ring
Reduce FSH-driven follicular development
Prevent ovulation and sperm passage
Match schedule and product instructions to real use
Suppress the reproductive axis
Estrogen and progestin feedback suppress follicular development and the LH surge. Progestin also thickens cervical mucus and changes the endometrium. These methods prevent pregnancy before implantation.
Compare delivery systems
Pills require daily use. Patches and rings extend the user-action interval but have product-specific replacement, hormone-free, detachment, and delayed-use instructions.
Use the regimen purposefully
Cyclic and extended regimens can be effective. Scheduled bleeding is withdrawal bleeding and is not medically required for every user. Selection should consider adherence, bleeding preference, and estrogen eligibility.
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Lesson
Combined-Method Eligibility and Vascular Risk
Estrogen eligibility depends on the interaction between vascular, neurologic, postpartum, cancer, and medication risks, not on age alone.
- Blood pressure
- Smoking
- Migraine aura
- VTE
- Postpartum risk
Quantify current cardiovascular risk
Separate ordinary headache from focal neurologic aura
Avoid category 4 and carefully evaluate category 3
Assess before prescribing
Measure blood pressure and review smoking, migraine subtype, thrombosis, thrombophilia, cardiovascular disease, postpartum status, breast cancer, liver disease, diabetes complications, and interacting medications.
Recognize category 4 patterns
Migraine with aura and several high-risk thrombotic patterns make combined methods unacceptable. Smoking 15 or more cigarettes daily at age 35 or older is category 4, while fewer cigarettes at that age is category 3.
Reassess changing health
New focal neurologic symptoms, severe hypertension, thrombosis, major surgery with immobilization, or a new interacting drug can change continued eligibility. Urgent symptoms require clinical evaluation, not routine method counseling alone.
Quick check
Lesson
Progestin-Only Pills and DMPA
Progestin-only methods avoid estrogen but still differ substantially in schedule, bleeding, return to fertility, bone effects, and missed-dose rules.
- Norethindrone POP
- Norgestrel POP
- Drospirenone POP
- DMPA
- Testosterone
Use the correct missed-pill window
Plan reinjection, bone counseling, and return to fertility
Do not assume amenorrhea prevents pregnancy
Separate pill instructions
Norethindrone, norgestrel, and drospirenone progestin-only pills do not share one missed-pill window. Counsel from the exact label and CDC method-specific guidance.
Counsel on DMPA
DMPA is given on a repeating injection schedule and subcutaneous self-administration should be available. Discuss bleeding, bone-density effects, weight concerns, and a potentially delayed return to ovulation after stopping.
Do not rely on testosterone
Testosterone may suppress bleeding but might not prevent ovulation or pregnancy. People with pregnancy potential who do not desire pregnancy should be offered contraceptive care without assuming gender identity determines method choice.
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Lesson
Levonorgestrel and Copper IUDs
IUDs provide highly effective reversible contraception, but copper and levonorgestrel produce different bleeding effects and additional benefits.
- LNG IUD
- Copper IUD
- Bleeding
- Placement
- Pain plan
Highly effective contraception with less bleeding over time
Long acting and effective for emergency use, with more bleeding possible
Use person-centered analgesia and avoid routine misoprostol
Compare the devices
Levonorgestrel IUDs thicken cervical mucus and suppress the endometrium, often reducing bleeding and pain. Copper impairs sperm function without hormones but can increase menstrual bleeding and cramps.
Remove access myths
Adolescents and nulliparous patients can use IUDs when eligible. Routine prophylactic misoprostol is not recommended, although it can be useful after a recent failed placement. Lidocaine approaches may reduce pain.
Counsel after placement
Explain expected bleeding, strings, expulsion, perforation rarity, pregnancy warning symptoms, infection assessment, product duration, and the right to removal at any time. IUDs do not cause future infertility.
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Lesson
Etonogestrel Implant and Bleeding Management
The implant combines very high effectiveness with rapid reversibility, while unpredictable bleeding is the most common reason patients seek management or removal.
- Etonogestrel
- Ovulation suppression
- Irregular bleeding
- Evaluation
- Removal autonomy
Suppress ovulation and thicken cervical mucus
Exclude another cause when the pattern requires it
Remove at any time and offer another method if desired
Set expectations
Spotting, light bleeding, prolonged bleeding, or amenorrhea can occur and are usually not harmful. The future pattern cannot be predicted reliably from the first weeks.
Evaluate when indicated
A new heavy or otherwise concerning pattern can prompt pregnancy testing, infection assessment, medication review, or evaluation for another gynecologic cause. Treatment is optional and follows patient goals.
Honor removal requests
Remove the implant whenever the patient wants it removed. Offer another method if desired, but do not require an arbitrary waiting period or treatment trial.
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Lesson
Emergency Contraception
Emergency contraception is time-sensitive prevention after intercourse, not termination of an established pregnancy.
- Copper IUD
- Ulipristal
- Levonorgestrel
- Five-day window
- Hormonal restart
Place within the eligible five-day window
Wait five days before hormonal contraception
Restart regular hormones immediately with backup
Compare effectiveness
The copper IUD is the most effective option and can be placed within five days of the first unprotected act, or within five days of estimated ovulation. It can remain for ongoing contraception.
Choose an emergency pill
Ulipristal 30 mg and levonorgestrel 1.5 mg should be used as soon as possible within five days. Ulipristal is generally more effective on days three through five, and levonorgestrel effectiveness may be lower with obesity.
Restart correctly
After ulipristal, wait five days before hormonal contraception, then use backup for seven days. After levonorgestrel, regular hormonal contraception can start immediately with the method-specific backup period.
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Lesson
Quick Start, Backup, and Missed Methods
Access improves when methods start promptly and the patient leaves with a clear plan for backup, missed use, vomiting, device problems, and pregnancy testing.
- Pregnancy checklist
- Quick start
- Backup
- Missed pills
- Delayed replacement
Use the CDC checklist and testing when useful
Do not require the next menstrual period routinely
Give a method-specific date and action sequence
Be reasonably certain
Use the CDC pregnancy checklist and clinical judgment. A urine test can be added but has timing limitations. Most methods can start without waiting for the next menses when pregnancy is reasonably excluded.
State the backup interval
Backup depends on method and timing of initiation. Give a concrete date or number of days and include what to do after recent unprotected intercourse.
Verify before correcting
Missed pills, late injections, delayed patch or ring replacement, vomiting, and device expulsion each have different rules. Identify the exact product and timing before recommending backup or emergency contraception.
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Lesson
Interactions and Longitudinal Follow-Up
Contraceptive effectiveness and safety can change when medicines induce enzymes, estrogen changes lamotrigine exposure, or a new health condition alters eligibility.
- CYP induction
- Rifampin
- Antiseizure drugs
- Lamotrigine
- Reassessment
Rifampin and selected inducers can reduce efficacy
Estrogen can lower exposure and hormone-free intervals can raise it
Choose an interaction-resistant plan and coordinate care
Find enzyme inducers
Rifampin and selected antiseizure, antiretroviral, and herbal products can reduce systemic hormone exposure. Use U.S. MEC and a current interaction resource to select a method or backup strategy.
Manage lamotrigine deliberately
Estrogen can increase lamotrigine clearance, lowering concentrations during active hormones and allowing concentrations to rebound during hormone-free intervals. Coordinate initiation, discontinuation, and schedule changes.
Follow the patient
Assess satisfaction, correct use, bleeding, relevant blood pressure, new medications, pregnancy goals, and warning symptoms. The patient can switch or stop a method even when no medical emergency exists.
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Lesson
Integrated Counseling and Method Transitions
High-quality contraception care turns one choice into a supported sequence of initiation, expected effects, problem solving, and voluntary transition.
- Teach-back
- Bleeding
- Warning symptoms
- Transition
- Reproductive planning
Confirm start, backup, missed use, and warning symptoms
Assess bleeding, adherence, new conditions, and new medicines
Preserve autonomy and continuous reproductive care
Use teach-back
Ask the patient to explain when to start, how to use the method, when backup ends, what to do after missed use, and which symptoms require urgent care.
Normalize without dismissing
Expected bleeding changes can be reassuring, but pregnancy, infection, anemia, structural disease, or a major pattern change still deserves assessment when clinically indicated.
Plan transitions
Coordinate overlap or backup when switching methods, account for return-to-fertility timing, and provide preconception care when pregnancy becomes the goal.
Quick check
Module test
Check the connections.
Each attempt draws 10 questions from the complete 100 question bank.
Each attempt draws a fresh set and rearranges the answer choices.