Young age at first sexual intercourse
Poor personal planning
Short relationships
Alcohol abuse
Lack of family cohesion and child monitoring
Psychotropic drug abuse
Older male partner
Binge eating
Poor school performance
Depression
10.1 Counseling
Contraceptive counseling is essential, during which it is often necessary to overcome a more or less explicit resistance to the use of contraceptives (Table 10.2).
Table 10.2
Resistance to contraceptive use
Insufficient information on how they work |
Difficulties in speaking about it with partner |
Perception of a foreign body or something that is “not natural” |
“It won’t happen to me” thinking about pregnancy or illness |
We need to ensure the appropriate timing and language when supplying information on all the available contraceptive methods, with regard to their use, their additional benefits, and any side effects.
It is necessary to arrive at a shared decision.
We need also to have partner agreement; in these cases, the compliance is longer.
The agreement of the mother (where involved) is also important.
The importance of double Dutch contraception (condom plus hormonal contraception) should be stressed in the context of the prevention of STI.
To give more information about emergency contraception.
10.2 First Prescription
It is essential to fully investigate both family and personal medical history.
Family history:
Investigate:
Cardiovascular disease: ischemic stroke, myocardial infarction (MI)
Previous venous thromboembolism (VTE) <45 years *
Hyperlipidemia
Hypertension
Autoimmune diseases
Migraine
*at least 2 first-degree family members with VTE is a contraindication to EP use; grandparents should be included in the family medical history.
Other papers have pointed out that a family history from a female patient (mother or sister), in which that patient has experienced a CHC or pregnancy-related VTE, may further increase VTE risk in her female relatives [4].
There is no indication to screen thrombophilia on the basis of a risks/benefits assessment [5].
10.3 Clinical Examination
10.3.1 Personal Pathological History
Investigate:
Current or previous illnesses *
Migraine
Autoimmune diseases (SLE, rheumatoid arthritis, thyroiditis, Sjogren syndrome, celiac disease) **
Raynaud syndrome
Drugs in use (exclusion of interactions)
Current or previous behavioral binge eating
Depression
Smoking (negotiate reduction in number of cigarettes)
Recreational drug use (alcohol, vasoactive substances)
Lifestyle (physical activity, sedentary, etc.)
*thrombophilic diathesis is an absolute contraindication for CHC use.
**in these cases it is useful to test for antiphospholipid antibodies.
10.3.2 Gynecological History
Investigate:
Clinical examination:
Always check
Blood pressure recording, Weight, Height, and BMI
Evaluate hyperandrogenic symptoms: acne, seborrhea, hirsutism
Not essential:
Gynecological examination
Pap Smear *
Breast examination
These can be carried out in a subsequent checkup
* <21 years: do not perform cytological screening independently of first sexual intercourse or risk behavior—ACOG 2012, US preventive services task force 2012, Canadian task force on preventive Health Care 2012.
All women who have been vaccinated against HPV should still follow the screening recommendations for their age groups (The American Cancer Society Guidelines for the Prevention and Early Detection of Cervical Cancer 2016).
10.4 Routine Laboratory Tests?
These are not recommended routinely as they do not contribute substantially to CHC safety. If there is a family history of metabolic diseases, autoimmune diseases, diabetes or dyslipidemias, then these can be carried out.
The expected advantages of the elimination of prescription blood tests are:
To improve access to effective contraception for the adolescent population
To separate screening procedures and contraceptive prescription
To dispel the widespread belief that contraception is hazardous for female health
Recommendations at first control after 3 months use:
To note side effects and/or problems
Verify proper use end stress instructions of use.
Check blood pressure.
Annual follow-up
Blood pressure monitoring
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