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When it comes to initiating oral contraceptive (OC) use, 70% of providers responding to the 1999 Contraceptive Technology Update survey say they prefer to start patients the Sunday after the beginning of the menstrual cycle. This compares with readers’ 1998 response, in which 78% indicated a preference for this initiation method.
"I think they like the Sunday start better than the others," says Debbie Freels, MSN, certified nurse midwife at University Physicians Clinic, Boonville, and clinical instructor of nursing at the University of Missouri-Columbia. "I actually don’t even counsel about other ways, just because it seems to be the easiest."
According to Contraceptive Technology, OCs can be started on the:
• first day of menstrual bleeding;
• first Sunday after menstrual bleeding begins;
• day of office visit, if pregnancy is excluded and there has been no unprotected sex since the last menstrual period.1
Freels, who sees many adolescents in her practice, says that educating patients on other methods has not proven as easy as the "Sunday start."
"It seems to work really well, she notes. "I get a fairly good amount of compliance, and the questions I get are always appropriate. When I get questions, it’s not that they started it incorrectly. It is about other issues, such as they forgot what to do if they missed a couple of pills."
Vomiting and diarrhea info
Do you provide written recommendations that women who continue pills after developing vomiting or diarrhea use a backup method of contraception until their next period? While the majority of survey respondents (56%) say they do offer written instructions, the gap between pro and con is narrowing: 43% say they do not. Respondents were split 68% pro and 32% con in the 1998 survey.
"They are helpful in general about 50% of the time," says Susan Skotleski-Krum, MSN, CRNP, nursing instructor at Lycoming College in Williamsport, PA, who uses written instructions with patients she sees at the college’s health center and local family planning agencies. "Patients either lose them, or when the problem arises, they don’t remember what you told them and are too embarrassed to call."
Written instructions on use of backup contraceptives is recommended as a precautionary measure at South Texas Family Planning and Health Corp. in Corpus Christi, TX, reports Grace Miyazaki, NP, family nurse practitioner. No known actual cases have been reported if patients did not comply and pregnancy occurred, she notes.
For patients who experience vomiting or diarrhea, Contraceptive Technology offers the following patient instructions:
• If you vomit within two hours of taking a pill, take another pill from a separate pill pack as soon as you feel better. Make sure you always have extra pills on hand for situations like this.
• If you have severe diarrhea or vomiting for more than 24 hours, keep taking your pills on schedule, if you can. During the time you are ill and for seven days after you feel better, use a backup contraceptive or abstain from sexual intercourse.
• If your illness caused you to miss any pills from the third week (pills 15 to 21), do not take your usual week off of hormonal pills (do not take the reminder pills in the 28-day pack). Start a new pack of pills immediately.1
1. Hatcher RA, Trussell J, Stewart F, et al. Contraceptive Technology. 17th ed. New York City: Ardent Media; 1998.