Contraception: Hormonal and Non-Hormonal Options

Contraceptive counselling is not simply a comparison of failure rates. The safest choice depends on whether the patient can use estrogen, whether breastfeeding or the postpartum state changes eligibility, how soon pregnancy is desired, and which bleeding pattern the patient can accept. The nurse's first screen is practical: assess pregnancy possibility, postpartum interval, breastfeeding, blood pressure, migraine with aura, smoking, personal or family thrombotic risk, liver disease, breast cancer, current medications, and the patient's reproductive goals. These findings determine whether estrogen is unsafe, whether a long-acting method fits the patient's priorities, and whether a method needs referral for insertion or prescribing. Method effects also need to be separated from warning signs. Irregular bleeding after starting a progestin method or heavier menses with a copper IUD may be expected. New severe headache, visual change, unilateral leg swelling, chest pain, or shortness of breath while using combined hormonal contraception is not an expected adjustment effect; it requires immediate assessment.