Contraception Confusion


Which way do I turn?

"My sister's friend's aunt's boyfriend's barista had an IUD and it got lodged in her brain!"


"Birth control pills make you gain weight/lose weight/grow hair/lose hair/get bigger breasts/get smaller breasts..."


"The arm implant is just the government's way of tracking your every movement." *


Confused about contraception? A lot of people are. How do you separate the truth from the noise when you don't want to get pregnant? I've been practicing almost 20 years now and I have seen lots of exciting developments in contraceptive options, but with new choices come new questions. And while Dr. Google is great at educating women about some conditions, she's not very good at giving contraceptive advice.


So what to do? Make an appointment with a healthcare provider and talk about your personalized choices! But first, I'm going to give you a quick cheat sheet so you can be thinking about your options now.


First off, a focused, medically accurate online search can be very beneficial to start looking at all the options. Here are a few of my favorite sites:


www.bedsider.org

www.cdc.gov/reproductivehealth/contraception

www.whoopsproof.org

www.cdc.gov/reproductivehealth/contraception/unintendedpregnancy/pdf/Contraceptive_methods_508.pdf


So because these pages give you such an excellent birds-eye view of your options, I'm not actually going to tell you about those options in today's post. Instead, we'll discuss how I think about contraceptive choices when I'm meeting with a patient. After all, women approach contraception with different bodies, different health histories, different needs, and different priorities.


Question # 1: How important is it to you that you don't get pregnant in the next year?


The answer can vary: some people would rather eat nails than find themselves accidentally pregnant, while others may feel like although it's not optimal, it wouldn't be the end of the world either. If you really really really really don't want to get pregnant, we're going to be talking about the most effective methods out there, such as IUDs and Nexplanon. If you take a more casual approach to preventing pregnancy, we might be talking about condoms, cervical caps, pills and the like.


Question # 2: What is your health history?


There are certain medical conditions that may alter the choices available to a woman, such as migraine headaches with aura, high blood pressure, diabetes, or a strong family history of blood clots in the legs or lungs. Certain health conditions + estrogen = increased risk of bad things happening. This is where the nuance comes in and where a knowledgeable professional can guide you in the right direction.


Question # 3: How do you feel about having periods?


Some women dread their monthly periods and are overjoyed to learn that they don't have to keep suffering. Other women really like having a period every month--it makes them feel more natural and gives visual reassurance that a pregnancy is not in the works. That's a personal preference that may shape our decision-making process. For example, estrogen-containing methods such as pills, patches, and rings can improve heavy flow and cramps. They can also regulate a woman's irregular period which can make life a lot easier when planning beach trips and wearing white pants.


Question # 4: Are there other things we should be thinking about?


Maybe the patient has acne and is looking for methods that will help treat acne. Maybe she is going to be working in rural South America without convenient toilet access, or maybe she is a swim instructor at the YMCA...either way, she may want to avoid having a period at all. Maybe she has such significant cramping every month that she needs to stay home from work or school and these absences are impacting her performance. Regardless, women approach contraception with different concerns, values and priorities and so we must address those as well.


So you can see that contraception options have changed dramatically since the birth control pill was invented (before I was born!). Let us guide you through the options to determine the best choice for you!


* A patient actually said this to me once. I wasn't quite sure how to respond.

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