Clinical breast and pelvic examination requirements for hormonal contraception: Current practice vs evidence
Stewart,Felicia H.; Harper,Cynthia C.; Ellertson,Charlotte; Grimes,David A.; Sawaya,George F.; Trussell,James
Journal of the American Medical Association 285(17): 2232-2239
Publication date: 2001
Clinical breast and pelvic examinations are commonly acceptedpractices prior to provision of hormonal contraception. Suchexaminations, however, may reduce access to highly effectivecontraceptive methods, and may therefore increase women's overallhealth risks. These unnecessary requirements also involve ethicalconsiderations and unwittingly reinforce the widely held butincorrect perception that hormonal contraceptive methods aredangerous.This article reviews and summarizes the relevant medical literatureand policy statements from major organizations active in thefield of contraception. Consensus developed during the lastdecade supports a change in practice: hormonal contraceptioncan safely be provided based on careful review of medical historyand blood pressure measurement. For most women, no further evaluationis necessary. Pelvic and breast examinations and screening forcervical neoplasia and sexually transmitted infection, whileimportant in their own right, do not provide information necessaryfor identifying women who should avoid hormonal contraceptivesor who need further evaluation before making a decision abouttheir use.