EXERCISES: CONTRACEPTION & AFTERCARE

EXERCISE 7.1

Purpose: To role-play different aspects of contraceptive counseling and understand recent evidence-based contraceptive developments and medical criteria for use.

  1. How would you respond to these common patient concerns about contraception?
    1. I don’t like the idea of having something inside of my body.
    2. I don’t want any hormones.
    3. Won’t IUDs cause an abortion?
    4. I want to have this (IUD / implant) removed (a few months after placement).

See Teaching Points

  1. A 17-year-old G0 old patient comes to the clinic who is sexually active and currently using withdrawal and condoms.  Role play how you might initiate a conversation about their contraceptive priorities, and options based on a preference of privacy of contraceptive use (from parents) and avoiding STIs.

See Teaching Points

  1. A 28-year-old G3P3 patient presents to the clinic seeking to switch to a new method of contraception. They are currently on DMPA, which has been causing weight gain, and want something non-hormonal. A friend mentioned having pain with an IUD, so your patient is hesitant to consider that option. Role-play being both the healthcare provider and patient whose priority is avoiding weight gain and other “hormonal side effects”.
    • Using the IQFP measure, what did you do as a provider to ensure that the patient felt respected, listened to, had their preferences identified and received information?
    • As the patient, is there more the provider could have done to establish rapport, identify priorities and share information?

See Teaching Points

  1. What would you discuss with the following patients regarding their desire for contraception? (Consult MEC as a reference)
    1. A 36-year-old smoker with moderate obesity who wants the patch.
    2. A 29-year-old with migraine headaches with aura who wants the pill.
    3. A 20-year-old nulliparous patient with a history of Chlamydia at age 15 and who wants an IUD.
    4. A 28-year-old patient who has BMI > 30, has vaginitis, and wants emergency contraception as well as ongoing contraception. Pt had unprotected intercourse 3 and 5 days ago.
    5. A 25-year-old with a history of deep vein thrombosis (DVT) 2 years ago, which occurred 6 weeks after a vaginal delivery.  They are interested in the vaginal ring.
    6. A 31-year-old who takes anti-seizure medications and wants the pill.
    7. A 27-year-old who wants a combined hormonal method but doesn’t want a monthly period.

See Teaching Points

EXERCISE 7.2

Purpose: To review routine follow-up after uterine aspiration, please answer the following questions.

  1. A patient has had nausea and vomiting throughout pregnancy. How long will it take for them to feel better after the abortion? See Teaching Points
  2. Providers typically advise patients to call the office if they have certain “warning signs” following uterine aspiration. What “warning signs” would you include and why? See Teaching Points
  3. After an aspiration, how long would you advise your patient to wait before resuming exercise, heavy lifting, and vaginal intercourse? What is the rationale for your recommendations? See Teaching Points

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