Family planning and emergency contraception

Last updated: September 22, 2022

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Family planning is the ability of individuals and couples to control their number of children and the spacing between births, which may involve measures of family planning services and reproductive medicine, including contraception, infertility counseling, STI counseling, and infertility treatment. A reproductive life plan (RLP) is the set of goals individuals or couples develop with regard to the wish and timing to have children based on their personal values, priorities, and resources. Family planning counseling can assist individuals and couples with developing and following their RLP. Preconception counseling is provided to individuals and couples planning to conceive in the near future and typically involves risk assessment, the promotion of a healthy lifestyle, and physical assessment. Emergency contraception is a means of preventing unwanted pregnancy in the event of unprotected intercourse or contraception failure. Measures include intrauterine devices (effective if used within 5 days of intercourse) and oral medications (antiprogestins, progestins, combined regimens; effective if used within 3 days of intercourse).

General principles [1][2][3]

Reproductive life plan (RLP) counseling [5]

Infertility counseling [9][10][11]

  • Definition: evaluation for couples who have not conceived after one year of unprotected vaginal intercourse and counseling for individuals and couples who are sterile or are not physically able to conceive (e.g., individuals with reproductive organs disorders, e.g., Mullerian agenesis)
  • Goals

General principles [13][14][15]

  • Definition: : a form of medical counseling provided to couples of reproductive age who are planning to conceive
  • Goals
    • Identify and address any modifiable factors that may negatively affect pregnancy and childbirth
    • Educate couples about risks and how to mitigate them.
  • Key components

Patient medical history [13]

The administration of MMR vaccine, varicella vaccine, human papillomavirus vaccine, and zoster vaccine is contraindicated during pregnancy.

Genetic carrier screening

  • Preconception counseling should also cover carrier screening.
  • Patients may choose whether to decline some or all of the recommended genetic testing (e.g., for cultural or religious reasons).
  • If an individual is found to be a carrier, their reproductive partner should also be offered testing for the condition in question (especially autosomal recessive disorders).
  • Further genetic counseling should be offered if both partners are found to be carriers of a genetic condition (for more information, see “Genetic counseling” and “Pedigree analysis”).

Lifestyle modifications

Management of exposures [14][18]

  • Exposure to harmful agents
    • Advise patients to assess workplace and household for potentially harmful agents (e.g., heavy metals, solvents, chemicals).
    • Educate the patient about the avoidance of harmful agents and refer them to occupational medicine programs as needed.
  • Exposure to violence
    • Screen for family violence at each visit.
    • If ongoing abuse is identified, providers should:
      • Provide community resources to the patient
      • Report the case as appropriate

Physical assessment

Emergency contraception (EC) refers to measures taken to prevent pregnancy within 5 days of unprotected intercourse or contraception failure (e.g., condom breakage, missed oral contraceptives).

Approach

  • EC is indicated for individuals who have had unprotected intercourse or contraception failure and who do not wish to conceive. [20]
  • Type of emergency contraceptives are based on the following:
  • EC should be initiated as soon as possible to maximize efficacy.
Overview of emergency contraception methods [21]
Method Efficacy [20] Timing after unprotected intercourse
Intrauterine devices (IUDs) Copper IUD
  • Within 5 days
Progestin IUD
  • ≥ 99%
Oral emergency contraception medication Antiprogestins (ulipristal acetate)
  • Approx. 99%
Progestins (levonorgestrel)
  • Approx. 98%
  • Within 3 days
Combined oral contraceptives pills (Yuzpe regimen)
  • Approx. 86%

Intrauterine devices for emergency contraception [21]

General

  • Does not disrupt embryo implantation or already established pregnancies
  • Indications
    • Individuals who meet standard criteria for an IUD
    • Individuals who desire long-acting contraception
    • Individuals who have a BMI ≥ 30

Types

Adverse effects

Oral emergency contraception medication [20][21][24]

General

Types

Adverse effects

  1. Johnson K, Posner SF, Biermann J, et al. Recommendations to improve preconception health and health care--United States. A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care.. MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports. 2006; 55 (RR-6): p.1-23.
  2. Callegari LS, Aiken ARA, Dehlendorf C, Cason P, Borrero S. Addressing potential pitfalls of reproductive life planning with patient-centered counseling. Am J Obstet Gynecol. 2017; 216 (2): p.129-134. doi: 10.1016/j.ajog.2016.10.004 . | Open in Read by QxMD
  3. Louis JM, Bryant A, Ramos D, Stuebe A, Blackwell SC. Interpregnancy Care. Am J Obstet Gynecol. 2019; 220 (1): p.B2-B18. doi: 10.1016/j.ajog.2018.11.1098 . | Open in Read by QxMD
  4. Report of a WHO technical consultation on birth spacing. https://www.who.int/publications/i/item/WHO-RHR-07.1. Updated: June 15, 2005. Accessed: August 9, 2022.
  5. Lindsay TJ, Vitrikas KR. Evaluation and treatment of infertility.. Am Fam Physician. 2015; 91 (5): p.308-14.
  6. Koser K. Fertility Counseling With Couples: A Theoretical Approach. The Family Journal. 2019; 28 (1): p.25-32. doi: 10.1177/1066480719887498 . | Open in Read by QxMD
  7. Carson SA, Kallen AN. Diagnosis and Management of Infertility. JAMA. 2021; 326 (1): p.65. doi: 10.1001/jama.2021.4788 . | Open in Read by QxMD
  8. Practice Committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Reproductive Endocrinology and Infertility. Electronic address: asrm@asrm.org.. Optimizing natural fertility: a committee opinion.. Fertil Steril. 2022; 117 (1): p.53-63. doi: 10.1016/j.fertnstert.2021.10.007 . | Open in Read by QxMD
  9. Lu MC. Recommendations for preconception care.. Am Fam Physician. 2007; 76 (3): p.397-400.
  10. ACOG. ACOG Committee Opinion No. 762. Obstetrics & Gynecology. 2019; 133 (1): p.e78-e89. doi: 10.1097/aog.0000000000003013 . | Open in Read by QxMD
  11. Recommendations to Improve Preconception Health and Health Care. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm. Updated: April 21, 2006. Accessed: May 13, 2022.
  12. Alexander EK, Pearce EN, Brent GA, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017; 27 (3): p.315-389. doi: 10.1089/thy.2016.0457 . | Open in Read by QxMD
  13. American Diabetes Association. 14. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2019. Diabetes Care. 2018; 42 (Supplement 1): p.S165-S172. doi: 10.2337/dc19-s014 . | Open in Read by QxMD
  14. Farahi N, Zolotor A. Recommendations for preconception counseling and care.. Am Fam Physician. 2013; 88 (8): p.499-506.
  15. Daalderop LA, Wieland BV, Tomsin K, et al. Periodontal Disease and Pregnancy Outcomes: Overview of Systematic Reviews. JDR Clinical & Translational Research. 2017; 3 (1): p.10-27. doi: 10.1177/2380084417731097 . | Open in Read by QxMD
  16. Medicine Io, Children Bo, Youth Bo, Families a, Policy BoHS, Program CoaCRotHOoFPTX. A Review of the HHS Family Planning Program. National Academies Press ; 2009
  17. Family planning/contraception methods. https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception. Updated: November 9, 2020. Accessed: May 24, 2022.
  18. Gavin L, Pazol K, Ahrens K. Update: Providing Quality Family Planning Services — Recommendations from CDC and the U.S. Office of Population Affairs, 2017. MMWR Morb Mortal Wkly Rep. 2017; 66 (50): p.1383-1385. doi: 10.15585/mmwr.mm6650a4 . | Open in Read by QxMD
  19. Family Planning. https://www.healthypeople.gov/2020/topics-objectives/topic/family-planning. Updated: January 1, 2020. Accessed: May 24, 2022.
  20. American College of Obstetricians and Gynecologists. Emergency Contraception. Obstetrics & Gynecology. 2015; 126 (3): p.e1-e11. doi: 10.1097/aog.0000000000001047 . | Open in Read by QxMD
  21. Bosworth MC, Olusola PL, Low SB. An update on emergency contraception.. Am Fam Physician. 2014; 89 (7): p.545-50.
  22. Gemzell-Danielsson K, Berger C, P.G.L. L. Emergency contraception — mechanisms of action. Contraception. 2013; 87 (3): p.300-308. doi: 10.1016/j.contraception.2012.08.021 . | Open in Read by QxMD
  23. Turok DK, Gero A, Simmons RG, et al. Levonorgestrel vs. Copper Intrauterine Devices for Emergency Contraception. N Engl J Med. 2021; 384 (4): p.335-344. doi: 10.1056/nejmoa2022141 . | Open in Read by QxMD
  24. American College of Obstetricians and Gynecologists. Access to Emergency Contraception. Obstetrics & Gynecology. 2017; 130 (1): p.251-252. doi: 10.1097/aog.0000000000002155 . | Open in Read by QxMD
  25. Kapp N, Abitbol JL, Mathé H, et al. Effect of body weight and BMI on the efficacy of levonorgestrel emergency contraception. Contraception. 2015; 91 (2): p.97-104. doi: 10.1016/j.contraception.2014.11.001 . | Open in Read by QxMD
  26. Snow SE, Melillo SN, Jarvis CI. Ulipristal Acetate for Emergency Contraception. Ann Pharmacother. 2011; 45 (6): p.780-786. doi: 10.1345/aph.1p704 . | Open in Read by QxMD

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