Further Options to Assess for Pregnancy
A woman can start a hormonal contraceptive method or, in most cases, an IUD any time it is reasonably certain that she is not pregnant. This includes a certain number of days after the start of monthly bleeding, depending on the method. At other times in a woman’s monthly cycle, the checklist on p. 372 often can be used to be reasonably certain she is not pregnant. A woman who answers “no” to all questions in the pregnancy checklist may or may not be pregnant. In most situations, such a woman will need to use a backup method* and wait either until her next monthly bleeding to start her method of choice or until it becomes clear that she is pregnant. In some cases, however, some providers may want to assess for pregnancy by other means. To do so, providers can follow one of the sets of instructions below, as appropriate for their situation and training. These options are especially useful when there are likely explanations—other than pregnancy—that a woman has not had monthly bleeding for several months. Such reasons include:
yy She has given birth more than 6 months ago and is still breastfeeding. yy She continues to have no monthly bleeding after recently stopping a progestin-only injectable. yy She has a chronic health condition that stops monthly bleeding.
Assessing for Pregnancy If a pregnancy test is available:
yy Give her a urine pregnancy test or refer her to a facility with such tests. If the pregnancy test is negative, give her the contraceptive method she wants. If a pregnancy test is not available but a provider can conduct a bimanual pelvic examination: yy Take a history from the woman, including when she had her last monthly bleeding and whether she has signs or symptoms of pregnancy (see symptoms on next page). yy Conduct a bimanual pelvic examination to determine the size of her uterus so that you can make a comparison later. yy Give her a backup method to use and teach her how to use it consistently and correctly. Ask her to return in about 4 weeks or when she has monthly bleeding, whichever comes first.
*
370
Backup methods include abstinence, male and female condoms, spermicides, and withdrawal. Tell her that spermicides and withdrawal are the least effective contraceptive methods. If possible, give her condoms.
Family Planning: A Global Handbook for Providers
