When was your last menstrual period? ____________________ Was it normal? Yes No
Which method are you using? _________________________________________________________
What regimen (continuous or cyclic) are you using? __________________________________
If taking oral contraceptives, are you using a combined product or a progesterone-only product? _______________________________________ Generic? _____________________________________ Do you know the correct name? _________________________________________________________________ What time of day do you take your pill? ________________ Have you missed any? _________________
If using Ortho Evra, did you change your patch on the usual day? ____________________ Any trouble with adherence? ___________________________________________________________________
If using NuvaRing, is the ring properly in place? ___________________________________ How many days has it been in place? ___________________________________________________________
Are you taking any other medication(s)? Drug name ___________________________________ Dose ___________________________________ Duration of use ______________________________________
Are you taking any supplements? _____________________________________________________
Do you routinely use a backup method of contraception? Yes No
If yes, what method do you use? ____________________________________________________________
pain localized in the right lower quadrant, or
symptoms not improving during a period of 12 to 24 hours.
The patient is unable to keep down any fluids (not even sips of water).
The patient has not voided in the past 8 hours.
The patient reports dizziness.
All patients need to be taught the serious warning signs associated with oral contraceptive use (see Systemic Hormonal Contraception Overview at the beginning of this chapter).
The patient with symptoms of gastroenteritis should be instructed to modify her diet for the next 24 to 48 hours.
Avoid milk and milk products.
Slowly rehydrate with sips of water (two sips of water every 5 to 10 minutes).
Begin the BRAT (bananas, rice, applesauce, toast) diet after tolerating clear liquids.
Remember that diarrhea may persist for several days after nausea and vomiting subside.
The patient should be instructed to call back if:
her symptoms do not begin to resolve within 1 to 2 days,
her symptoms increase in intensity (more vomiting/nausea), or
she begins to run a fever.
If you suspect the gastrointestinal (GI) complaints are only related to her contraception, refer to protocol on Gastrointestinal Complaints: Nausea/Vomiting and Systemic Hormonal Contraceptives, page 501.
Oral contraceptives may be prescribed to improve acne.
It may take several months to see a significant improvement.
Many oral contraceptives, not just those products with U.S. Food and Drug Administration (FDA) labeling that allows them to be marketed as such, are excellent for improving skin breakouts.
Patients should be instructed in proper skin care for mild-to-moderate acne.
Wash affected areas twice a day with a washcloth and noncreamy soap.
Consider using facial cleansers such as Cetaphil lotion or benzoyl peroxide wash 10%.
Avoid picking at lesions.
Avoid oil-based cosmetics/face creams.
Avoid moisturizers, such as Vaseline, or baby oil.
For dryness, Moisturel or Nutraderm may be helpful.
All patients need to be educated about the expected side effects of their chosen method.
All patients need to know a backup method and use of emergency contraception in the event a method error occurs or other problems alter the efficacy of their method.
Patients using POPs need to know that bleeding and spotting are common. Some patients, despite perfect use, still experience this annoying side effect.
All patients, regardless of method, need to know how to use a backup method, such as condoms. Those at particular risk for STIs need to be especially careful.
All patients using systemic hormonal contraceptives need to know they can become pregnant, even with perfect use.
Breakthrough bleeding and spotting are common problems with continuous use of systemic hormonal contraceptives, regardless of the delivery system used. All women who choose this method should be counseled at the time of method selection as to how to deal with the problem.
Most women will develop a pattern to their bleeding that may guide them in choosing an appropriate time for a withdrawal bleed.
Many experts advise women to never extend the method-free interval even as long as 7 days, as is common in a 21/7 regimen. The thought is that the longer a method is used in a continuous fashion, the greater the tendency to ovulate spontaneously given the opportunity.
A 3- to 4-day method-free interval is usually enough to cause a significant withdrawal bleed and, as stated earlier, should never be extended beyond 7 days.
It can be helpful if patients retain any “day labeling” material provided with their method. This can be used to relabel packages when the method is restarted.
One of the keys to successful use of systemic hormonal contraception is understanding the expected problems and usual course of action. Educating the patient regarding the possible nature of her pain, particularly in the case of recent method initiation with bilateral pain, may help the patient tolerate the symptoms until her body adjusts to the pill’s hormone dose.
Particular sensitivity is needed for patients with unilateral pain who may be at risk for breast problems of a more serious nature. Refer to the Chapter 15: Breast Complaints Overview for some approaches in dealing with women with additional concerns.