Clinical Breast and Pelvic Examination Requirements for Hormonal Contraception: Current Practice vs Evidence

Clinical breast and pelvic examinations are commonly accepted practices prior to provision of hormonal contraception. Such examinations, however, may reduce access to highly effective contraceptive methods, and may therefore increase women's overall health risks. These unnecessary requirements...

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Bibliographic Details
Published in:JAMA : the journal of the American Medical Association 2001-05, Vol.285 (17), p.2232-2239
Main Authors: Stewart, Felicia H, Harper, Cynthia C, Ellertson, Charlotte E, Grimes, David A, Sawaya, George F, Trussell, James
Format: Article
Language:English
Subjects:
Adolescent
Adult
Biological and medical sciences
Birth control
Breast Neoplasms - diagnosis
Contraception - standards
Contraceptive Agents, Female
Contraindications
Decision Making
Estrogens
Ethics
Female
Genital Diseases, Female - diagnosis
Gynecology. Andrology. Obstetrics
Hormonal contraception
Humans
Medical History Taking
Medical sciences
Medical screening
Physical Examination
Physical examinations
Practice Guidelines as Topic
Prescriptions
Progesterone Congeners
Progestins
Risk
Sexually Transmitted Diseases - diagnosis
Uterine Cervical Neoplasms - diagnosis
Women
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Summary:Clinical breast and pelvic examinations are commonly accepted practices prior to provision of hormonal contraception. Such examinations, however, may reduce access to highly effective contraceptive methods, and may therefore increase women's overall health risks. These unnecessary requirements also involve ethical considerations and unwittingly reinforce the widely held but incorrect perception that hormonal contraceptive methods are dangerous.This article reviews and summarizes the relevant medical literature and policy statements from major organizations active in the field of contraception. Consensus developed during the last decade supports a change in practice: hormonal contraception can safely be provided based on careful review of medical history and blood pressure measurement. For most women, no further evaluation is necessary. Pelvic and breast examinations and screening for cervical neoplasia and sexually transmitted infection, while important in their own right, do not provide information necessary for identifying women who should avoid hormonal contraceptives or who need further evaluation before making a decision about their use.
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.285.17.2232