Information from the patient’s menstrual and obstetric history should be used to determine which contraceptive method is best for her. The patient’s history is also used to plan appropriate patient teaching.

An assessment for family planning involves collecting a reproductive history, including:

In some cases, the health of the patient’s sexual partner influences which contraception method is used. For example, if the
patient’s sexual partner is infected with HIV, ideally, she should practice abstinence. If this isn’t an option for your patient, encourage her to use a condom to prevent conception as well as infection transmission.

Here are the advantages of abstinence:

Here are the disadvantages of abstinence:

For most natural family planning methods, the woman’s fertile days must be calculated so that she can abstain from
intercourse on those days. Various methods are used to determine the woman’s fertile period. The effectiveness of these methods depends on the patient’s and partner’s willingness to refrain from sex on the female partner’s fertile days. Failure rates vary from 10% to 20%.

Teach the woman to keep a diary of her menstrual cycle to determine when ovulation is most likely to occur. She should do this for 6 consecutive cycles. To calculate her safe periods, tell her to subtract 18 from the shortest cycle and 11 from the longest cycle that she has documented. For instance, if she had 6 menstrual cycles that lasted 26 to 30 days, her fertile period would be from the 8th day (26 minus 18) to the 19th day (30 minus 11). To ensure that pregnancy doesn’t occur, she and her partner should abstain from intercourse during days 8 to 19 of her menstrual cycle. During those fertile days, she and her partner may also choose to use contraceptive foam. (See Using the calendar method.)

Here are the advantages of the rhythm method:

Here are the disadvantages of the rhythm method:

To use the BBT method of contraception, a woman must take her temperature every morning before sitting up, getting out of bed, or beginning her morning activity. (See Teaching a patient how to take BBT, pages 68 and 69.) By recording this daily temperature, she can see a slight dip and then an increase in body temperature. The increase in temperature indicates that she has
ovulated. She should refrain from intercourse for the next 3 days. Three days is significant because this is the lifespan of a discharged ovum. Because sperm can survive in the female reproductive tract for 4 days, the BBT method of contraception is typically combined with the calendar method so that the couple can abstain from intercourse a few days before ovulation as well.

One problem with this method is that many things can affect BBT. The woman may forget and take her temperature after rising out of bed or she may have a slight illness. These situations cause a rise in temperature. If the woman changes her daily routine, the change in activity could also affect her body temperature, which may lead her to mistakenly interpret a fertile day as a safe day and vice versa.

Here are the advantages of the BBT method:

Here are the disadvantages of the BBT method:

During the peak of ovulation, the cervical mucus becomes slippery and stretches at least 2.5 cm (1 in.) before the strand breaks. Breast tenderness and anterior tilt of the cervix also occur with ovulation. The fertile period consists of all the days that the cervical mucus is copious and the 3 days after the peak date. During these days, the woman and her partner should abstain from intercourse to avoid conception.

Cervical mucus must be assessed every day for changes in consistency and amounts to be sure that those changes signify ovulation. Assessing cervical mucus after intercourse is unreliable because seminal fluid has a watery, postovulatory consistency, which can be confused with ovulatory mucus.

Here are the advantages of the cervical mucus method:

Here are the disadvantages of the cervical mucus method:

Here are the advantages of the symptothermal method:

Here are the disadvantages of the symptothermal method:

Here are the advantages of the ovulation awareness method:

Here are the disadvantages of the ovulation awareness method:

Here are the advantages of the coitus interruptus method:

Here are the disadvantages of the coitus interruptus method:

Certain patient populations may not be appropriate for natural family planning methods. These may include adolescents, women who are not in monogamous relationships, women with irregular menses, and women whose partners are not interested in active participation in natural family planning.

There are two types of combined oral contraceptives:

Monophasic oral contraceptives provide fixed doses of estrogen and progesterone throughout a 21-day cycle. These preparations provide a steady dose of estrogen but an increased amount of progestin during the last 11 days of the menstrual cycle.

Triphasic oral contraceptives maintain a cycle more like a woman’s natural menstrual cycle because they vary the amount of estrogen and progestin throughout the cycle. Triphasic oral contraceptives have a lower incidence of breakthrough bleeding than monophasic oral contraceptives.

A mini pill is a progestin-only oral contraceptive (Micronor and Ovrette) available for women who can’t take estrogen-based
pills because of a history of thrombophlebitis. This type of pill is taken every day—even when the woman has her menses. Progestins in the pill inhibit the development of the endometrium, thus preventing implantation. Progestin-only pills may also be used by women who are breast-feeding.

The mini pill must be taken at exactly the same time each day. If a dose is missed, another form of contraception, such as a barrier or chemical method, should be used for the remainder of the menstrual cycle.

Monophasic and triphasic oral contraceptives are dispensed in either 21- or 28-day packs. The first pill is usually taken on the first Sunday following the start of a woman’s menses, but it’s possible to start oral contraceptives on any day. For a woman who has recently given birth, oral contraceptives can be started on the first Sunday 2 weeks after delivery. Patients should be advised to use an additional form of contraception for the first week after starting an oral contraceptive because the drug doesn’t take full effect for 7 days. (See Teaching tips on oral contraceptives.)

Birth control pills that are prescribed in a 21-day dispenser allow the woman to take a pill every day for 3 weeks. She should expect to start her menstrual flow about 4 days after she takes a cycle of pills. The 28-day pills are packaged with 21 days of birth control pills and 7 days of placebos. The woman starts the new pack of pills when she finishes the last pack, eliminating the risk of forgetting to start a new pack.

A newer oral contraceptive on the market is a combination of levonorgestrel and ethinyl estradiol in which one tablet is taken daily for 12 weeks (brand name Seasonale). This pill extends the time between periods, allowing a woman to have a period four times a year as opposed to monthly.

Here are the advantages of oral contraceptives:

Here are the disadvantages of oral contraceptives:

Here are the advantages of the MAP: