Birth control: Lots of options, but little guidance

Amina Carter, medical assistant and health center director at Planned Parenthood of Southern New England, said it was “our job to make birth control counseling comprehensive”. Credit: Planned Parenthood in Southern New England Photo

When Natalie Plebanek was 16 years old at the University of Connecticut, she suffered from heavy menstrual bleeding and subsequent fainting. But when she asked her pediatrician for a prescription for birth control pills, proven In order to significantly reduce menstrual bleeding, the doctor reluctantly cited a popular myth. “She thought I was becoming extremely sexually active,” Plebanek said.

The 21-year-old Plebanek is thinking about a more convenient method of contraception. When she sought advice from a gynecologist about her options, she received a brochure. “I had the feeling that I wasn’t really informed about my options,” said Plebanek.

Plebanek isn’t the only one who is proactive about her contraceptive options. The majority of women of childbearing age – 65% of women aged 15 to 49 – are using some form of birth control, according to recent reports data from the Centers for Disease Control and Prevention (CDC).

In recent years, the use of some contraceptive methods has increased significantly and others have decreased. Sterilization of the woman is still the most popular form of contraception, but its use has steadily declined since the 1970s. the pill remains the second most common method of contraception, however long-acting reversible contraceptives (LARCs) gain almost third in traction.

Despite personal investments in their health and the contraception they choose, women do not always get the information they need to make smart, informed decisions.

A Kaiser Family Foundation 2020 Health survey for women reported that only four in ten women (44%) between the ages of 18 and 49 rate their contraceptive provider as excellent in four areas of contraception advice. The study says that only 36% of black women and 38% of Hispanic women received excellent advice, compared to 49% of white women. And low-income and uninsured women were less likely to say that they received excellent care.

Contraception counseling topics included: respecting them as a person, letting them say what’s important, taking their birth control preferences seriously, and giving them enough information to make an informed decision.

Dr. Aileen Gariepy, associate professor from OB / GYN & Reproductive Services at Yale School of Medicine observed that patients are more interested in what is going on in their body. “In the past five years, it seems patient interest in non-hormonal contraceptives has increased,” she said.

Kikelomo Otuyelu-Garritano, the only obstetrician and gynecologist with YOUR wellness health center in Wilton, agrees but says that this desire to be proactive does not always result in better information. “You hear from a friend who took the pill and gained 30 pounds. They don’t necessarily dig deeper, ”she said. “They hear: If you use birth control, you will gain weight.”

New birth control products that are capitalizing on a trending interest in hormone-free options include FDA-cleared ones Phexxi®. The first non-hormonal prescription contraceptive vaginal gel acts as a barrier and changes the pH of the vagina, thereby immobilizing the sperm.

Ads for Phexxi emphasize that it is hormone-free. The hormone estrogen, found in certain birth control pills, is known to increase the likelihood of stroke in users with pre-existing risk factors such as high blood pressure, previous thrombotic events, smoking, a history of migraines with aura, and advanced age.

“I think Phexxi is a game changer because it works with vaginal pH, sperm, and is non-hormonal,” Gariepy said. But she admits that there are compromises. For example a Multisite study found that Phexxi was 86% effective in preventing pregnancy when used regularly, compared to about 93% effectiveness of the pill when used correctly. In addition, Phexxi does not allow women to be spontaneous as it has to be applied with an applicator up to an hour before intercourse.

Direct mailing to consumers for contraceptive options like Phexxi is no substitute for accurate and unbiased information from a healthcare provider.

Risk factors, patient advice

Mark Alberts, Chief Physician of the Hartford HealthCare Neuroscience Institute and chief neurologist at Hartford Hospital, sees many stroke patients. And many patients are surprised if they have an increased risk after a stroke. “Often the comment is: I had no idea or nobody told me about risk factors,” said Alberts.

Fortunately, Alberts says, the amount of estrogen used in birth control pills has steadily declined over the years. “As the doses of these compounds decreased, so too did the risk of stroke,” he said. Nevertheless, women whose health behavior or medical history increases their risk of stroke should refrain from estrogen-containing birth control pills.

However, research shows that doctors don’t always offer this advice. In one recently to learn oral contraceptive use in women, only 15% of users with one or more stroke risk factors remembered being advised not to start oral contraceptives; 36% remembered a doctor who advised them to stop.

“Our job is to ensure that patient advice is really comprehensive. Historically, we think of birth control as the pill. But that doesn’t mean it’s the best option, ”said Amina Carter, medical assistant and health center director at Planned Parenthood in Southern New England. “Sometimes it’s just a matter of education.”

As birth control options become more accessible, largely thanks to President Obama’s birth control mandate under the Affordable Care Act (ACA), patient education becomes increasingly important. The law allows more women to choose comfort-focused options like IUDs, a long-acting reversible birth control (LARC) that offers years of protection with little time, effort, or money.

“It’s ‘set and forget'” Carter said. “It doesn’t require any thoughts after the first appointment.”

However, to be fully informed and ready to decide to use a LARC or any other form of birth control requires thought and it is most helpful when healthcare professionals provide guidance. The Court of Auditors has even included a provision specifically for advice and services related to birth control. However, the health system does not always allow or encourage sufficient time for such advice.

Otuyelu-Garritano knows this only too well. She dropped out of medicine three times before finally opening her own practice, which gives her the time she thinks necessary to give thorough exams and health information to her patients. Otuyelu-Garritano says patients are most likely to find the birth control that is right for them when they have a healthcare provider willing to consider the options from different perspectives.

“You have to look at things from all angles,” she says. “That is only possible if there is time [during the medical visit] speak.”


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