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Current Practice vs Evidence

Felicia H. Stewart, MD; Cynthia C. Harper, PhD; Charlotte E. Ellertson, PhD; David A. Grimes, MD; George F. Sawaya, MD; James Trussell, PhD

JAMA. 2001;285:2232-2239.

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.

Author Affiliations: Center for Reproductive Health Research and Policy, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco (Drs Stewart, Harper, and Sawaya); The Population Council, Mexico City, Mexico (Dr Ellertson); Family Health International, Research Triangle Park, NC (Dr Grimes); Woodrow Wilson School of Public and International Affairs, Office of Population Research, Princeton University, NJ (Dr Trussell).

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