Contraceptive Selection

Contraceptive counselling is not a search for the single “best” method. It is a search for the method that best fits this patient’s medical safety, pregnancy intentions, bleeding preferences, sexual practices, capacity for daily or scheduled use, privacy needs, and access to removal or follow-up. Begin by asking what pregnancy avoidance means to the patient right now. A patient who would find pregnancy medically dangerous or deeply disruptive may prioritize the lowest possible failure rate. Another may accept a higher risk of pregnancy to avoid hormones, preserve predictable bleeding, or retain control over starting and stopping the method independently. Neither preference is wrong. Explore these practical questions early: - Does the patient want pregnancy soon, later, never, or is the answer uncertain? - Would lighter bleeding, less dysmenorrhea, predictable withdrawal bleeding, or no menstrual change be preferred? - Can the patient reliably take a pill at the same time each day, return every few months for an injection, or attend for a procedure? - Is concealability important because of family, partner, financial, or safety circumstances? - Is there any risk...