Chapter 1

“Come Back Any Time”: Reasons to Return

Assure every client that she is welcome to come back any time—for example, if she has problems, questions, or wants another method; she has any major change in health status; or she thinks she might be pregnant. Also if:

  • She needs more pills.
  • She wants ECPs because she started a new pack 3 or more days late or missed 3 or more hormonal pills or, if she is using pills with 20 μg of estrogen or less, because she started a new pack 2 or more days late or missed 2 or more hormonal pills.

General health advice: Anyone who suddenly feels that something is seriously wrong with her health should immediately seek medical care from a nurse or doctor. Her contraceptive method is most likely not the cause of the condition, but she should tell the nurse or doctor what method she is using.

Planning the Next Visit

  1. Encourage her to come back for more pills before she uses up her supply of pills.

  2. An annual visit is recommended.

  3. Some women can benefit from contact after 3 months of COC use. This offers an opportunity to answer any questions, help with any problems, and check on correct use.

Repeat Visits

  1. Ask how the client is doing with the method and whether she is satisfied. Ask if she has any questions or anything to discuss.

  2. Ask especially if she is concerned about bleeding changes. Give her any information or help that she needs (see Managing Any Problems).

  3. Ask if she often has problems remembering to take a pill every day. If so, discuss ways to remember, making up missed pills, and ECPs, or choosing another method. Adolescents may need extra support.

  4. Give her more pill packs—a full year’s supply (13 packs), if possible. Plan her next resupply visit before she will need more pills.

  5. Every year or so, check blood pressure if possible (see Medical Eligibility Criteria, Question 5).

  6. Ask a long-term client if she has had any new health problems since her last visit. Address problems as appropriate. See new health problems that may require switching methods.

  7. Ask a long-term client about major life changes that may affect her needs—particularly plans for having children and STI/HIV risk. Follow up as needed.