The basics of OCs: Your peers share insights
The basics of OCs: Your peers share insights
Most providers use Sunday start’ for beginners
What is the leading method when it comes to initiating combined oral contraceptives (OCs)? Participants in Contraceptive Technology Update’s 2000 Contraception Survey say they prefer starting patients on pill packs the Sunday after menstrual bleeding begins.
Most patients like this regimen because they do not have menses on weekends, observes Barbara Kremer, CNM, MPH, a clinician at Planned Parenthood of Southern Arizona in Tucson. Kremer says she also instructs patients on how to shorten the pill-free interval if they so choose or begin pills on the first day of menses, which is known as the "same-day start."
About 66% of participants in the 2000 survey report a preference for the Sunday-start method, compared with nearly 70% in 1999. The remaining 34% say they like the same-day approach, an increase over 1999’s 29% figure.
"Same-day start works well for most women, especially those who are starting for the first time," notes Sharyn Ginsberg, RNP, CNM, a clinician at Kaiser Permanente Medical Group in Walnut Creek, CA. "Those who have taken OCs in the past find it difficult, but I offer them the option of Sunday start if it works better for them."
Jan Jenson, NP, a nurse practitioner at a California college student health facility, says she offers her patients the choice of whatever they want to do: a same-day start, a Sunday start, or starting on the day of the office visit. "I explain each one and the reason [behind it]," she says. "If they are confused, I only tell them what they understand well."
Do you provide written instructions telling women who continue pills after developing vomiting or diarrhea to use backup contraception until their next period? Nearly 60% of participants responding to the 2000 survey say they offer such printed material to reinforce their office counseling. That’s a slight increase from 1999, when about 56% of respondents said they distributed written instructions.
Laguna Beach (CA) Community Clinic has a standard sheet of OC use instructions, which contains that information, says Diana Lithgow, RN, FNP, family nurse practitioner. "It works well and has all the issues we are concerned about in one page," she notes. (See a similar patient handout, "The Pill," from the authors of Managing Contraception, inserted in this issue.)
Patients need reinforcing information when it comes to such written instructions, says Pamela Porter, PA-C, CRN, FNP, MSN, a clinician at Woodland (CA) Healthcare, a multispecialty clinic.
"I know patients lose them and call in for recommendations," Porter says. "It is a subject that is talked about when started on OCs and then with subsequent refills as reminders."
When should backup contraception be used? According to Contraceptive Technology, women should use such protection if they:
• suspect pills may be less effective;
• miss taking any of the hormonal pills;
• are late starting new pill packs;
• have severe vomiting or diarrhea;
• take medications, such as the anticonvulsants phenobarbital, phenytoin, topirimate, carbamazepine, and primadone, that lower the body’s ability to absorb contraceptive hormones.1
If women think they might have had sexual intercourse that was not adequately protected, they should consider emergency contraception, states Contraceptive Technology. Counsel women on emergency contraception when discussing contraceptive methods, its authors advise.
Reference
1. Hatcher RA, Trussell J, Stewart F, et al. Contraceptive Technology. 17th ed. New York City: Ardent Media; 1998.
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