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Counseling women considering combined hormonal contraception

Vanessa Cullins, MD, MPH, MBA
Section Editor
Mimi Zieman, MD
Deputy Editor
Kristen Eckler, MD, FACOG


Hormonal contraception methods are the most commonly used reversible methods in the United States; almost one-third of female contraceptors use oral contraceptive pills and many of the remainder use a hormonal injection, implant, transdermal patch, vaginal ring, or intrauterine system [1]. Most women can safely use many of the current hormonal contraceptive methods, with special consideration warranted for women with chronic medical disorders [2-5]. Nevertheless, many women and some clinicians avoid hormonal contraception because of misperceptions about the health risks and side effects [6].

This topic will review the issues related to counseling a woman who desires combined hormonal contraception. An overview of all contraceptive methods is presented separately. (See "Overview of contraception".)


Many unplanned pregnancies occur in women who are not using contraception because of barriers to access, concerns about adverse events, dissatisfaction with a method's side effects, lack of convenience, or other bothersome characteristics. Therefore, it is important for health care providers to appropriately counsel women about contraception, with attention to: the woman's values, preferences, and expectations [7-9]; both contraceptive and noncontraceptive benefits of the method; strategies for dealing with side effects; and strategies for a hassle-free switch to another method when desired by the woman. Women report that they want to be treated as equal partners during this dialogue [10].

Prior to making decisions about contraceptive methods that might work well for them, women usually want to understand the method's [7]:



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