mostly women can safely begin takin...

mostly women can safely begin taking hormonal birth command products immediately after an office visit, at any point in the menstrual revolution of time Because hormonal contraceptives do not accelerate cervical neoplasia or interfere with cervical cytology, women who have not had a modern Papanicolaou smear can begin using hormonal contraceptives before the example is performed. After childbirth, greatest in quantity women can begin using progestin-only contraceptives immediately. Estrogen-containing courses can safely be initiated six weeks to six month postpartum for women who are breastfeeding their infants and three weeks postpartum for women who are not breastfeeding. Women can begin any appropriate contraceptive rule immediately following an early abortion. Delaying contraception may decrease adherence. Physicians can help patients improve their use of birth command by providing anticipatory guidance about the principally common side effects, giving comprehensive information about available choices, and honoring women's selections An evidence-based, flexible, patient-centered approach to initiating contraception may help to lower the high rate of unintended pregnancy in the United States. (Am Fam Physician 2006;74:105-12

While waiting to start a strange birth control method, many women become pregnant unintentionally. Tradition determines that women delay starting hormonal contraceptives until the nearest menses, until a certain number of weeks have passed after childbirth, or until a breastfeeding infant is weaned. In addition, many physicians delay prescribing contraceptives for women who have not had a latter physical examination and Papanicolaou (Pap) smear.

Unintended pregnancy attitude s significant health risks to women and their families--it is associated with higher rates of domestic violence, maternal remedy and alcohol use during pregnancy, delayed prenatal care, and gentle birth weight. (1) Almost single half of pregnancies in the United States are unintended, and about 50 percent of those, or 13 million for year, lead to abortion. (2) Although the incidence of unintended pregnancy in the United States has declined in fresh years, it remains much higher here than in other perform the operations indicated ined countries, with a widening disparity between wealthy and indigent assemblages of American women. (2) Limited access to primary health care services contributes to high rates of unintended pregnancy in women with depressed incomes. American teens, in particular, face multiple barriers in timely access to contraception. (3)

To address this moot point family physicians can make contraception safely and promptly available to their patients, with special attention to those at highest risk of unintended pregnancy. This article reviews the rationale for instant practice and the evidence supporting a more timely approach.

Office Visits Between Menses

When women beg birth control at an office visit occurring between mense many physicians delay starting hormonal contraceptives. Waiting until the nearest menses provides assurance that the woman is not already pregnant when she begins the of recent origin method. This practice probably began in order to avoid exposing a fetus to hormones, before studies had evaluated teratogenicity. Now there is a large dead body of evidence that refutes this risk; combined estrogen/progestin contraceptives do not cause birth wants (4) A more limited carcass of evidence indicates that hormonal contraceptives taken in early pregnancy cause no significant increase in the risks of miscarriage or fetal vegetation problems. (5-7) Concern that hormones can mask the symptoms of early pregnancy, thus delaying diagnosis and leading to a later abortion or later attack of prenatal care, can be addressed in consequence of appropriate use of urine pregnancy ordeals consideration of emergency contraception, and use of backup contraception during the first week of hormonal contraceptive use. (8)

The "quick start" order (Figures 1 (9) and 2 (9)) allows principally women with a negative urine pregnancy touchstone to begin using the birth dominion government pill, patch, or vaginal ring immediately after an office visit, at any point in the menstrual round of years (8) This strategy eliminates the delay between receiving a prescription and starting the modern contraceptive method, and may improve adherence. With standard delayed contraceptive initiation, about 25 percent of women given a contraceptive prescription not ever fill it, (10) and about 50 percent of women who start using birth rule pills discontinue use within undivided year. (11) In the quick start trial, (8) women who took their first birth mastery pill during an office visit had significantly higher adherence three month later than women randomized to the delayed start arrange Women who begin their recent method after the first day of their last menstrual period should use a backup classification during the first week. (12)

calm women who have had newly come unprotected intercourse can use the quick start process Women who have had unprotect intercourse within five days of their visit can be proposeed hormonal emergency contraception that day, after appropriate counseling, and can begin their strange contraceptive method the next day. (812-14)