Making informed choices about family planning and contraception

For reproductive-age women who have medical comorbidities such as epilepsy, diabetes, and hypertension, choosing a family planning method can be challenging. The September 1, 2010 issue of AFP reviewed the risks and benefits of hormonal contraceptives for these patients, based on guidelines from the American College of Obstetricians and Gynecologists. However, the scope of that article did not include nonpharmacologic options such as barrier or fertility awareness-based methods, also known as natural family planning (NFP). Two letters in the July 1st issue of AFP remind readers that NFP is an effective family planning option for appropriately educated couples and provide helpful training resources for clinicians. As Drs. Robert Conkling and Leslie Chorun observe:

Counseling in natural methods of fertility regulation is currently being provided by a growing number of trained physicians, nurse practitioners, and allied health professionals. ... These family planning methods should not be confused with calendar rhythm method and are not dependent on the regularity of a woman's cycle. Population-based surveys have shown a significant interest in NFP—approximately 25 percent of women and 40 percent of men are interested in using NFP to avoid pregnancy, and 33 percent of women are interested in using NFP to conceive. This interest is not associated with religion, education, age, or income level.

For further reading on patient outcomes associated with various fertility awareness-based methods, family physicians can consult a clinical review published in the Journal of the American Board of Family Medicine. Also, a recent AFP By Topic collection compiles the journal's current online content on all aspects of family planning and contraception, including preconception care, the infertility evaluation, and advantages and disadvantages of hormonal and non-hormonal methods.