Communicating With Patients About Contraceptives


Jenna Beckham, MD, MSPH, FACOG, and Thomas Kimble, MD, highlight key points to share with a patient who has just been prescribed a contraceptive.

Jenna Beckham, MD, MSPH, FACOG: We talked about sort of when we start that conversation. But when we've just prescribed a contraceptive or started a new method, what are the most important sort of talking points or things to make sure that patients know about that new method?

Thomas Kimble, MD: I always counsel them on some of the potential adverse effects that she may experience, some of the risks that are associated with it. Some types of birth control may have an increased risk of cancer, for example. That's a little controversial but there's also a very known although extremely rare risk of cardiovascular issues with certain types of birth control. I just let them know about those risks, things to look out for. And these are the things you want to call me about or take very seriously. But then we also have the conversation about things like I mentioned earlier, the period, her period may change. And some forms of birth control you're going to have a planned schedule period every month. There are certain types where you may have a planned but scheduled period but every 3 months. There are some where you may stop having your period at all. There are some where you may have some unscheduled bleeding and spotting. I have that conversation because that could be concerning to people if they weren't counseled on it, and they get home and start having a change in their schedule that they're used to.

Jenna Beckham, MD, MSPH, FACOG: Absolutely. The other thing I always think is important to share with patients is sort of the timing of when that new method will become effective. And if they need to use some backup method of contraception which depends on sort of where they are in their cycle if you can determine that. Or if they switch from another method. And then for things that do require them to take something or switch out a ring or a patch sort of what to do if they miss one or were late on that. And where to go to if they have those circumstances arise. That they can keep themselves protected from an unintended pregnancy if that's what they're trying to do.

Thomas Kimble, MD: I agree.

Jenna Beckham, MD, MSPH, FACOG: In your experience, what percentage or sort of balance of these conversations do you feel are happening with patient, sort of primary care providers versus their OB/GYNs?

Thomas Kimble, MD: I'll use my academic center as an example. When I do contraception lectures or contraception procedure lectures, I do it to both, for both our family medicine program and our OB/GYN resident program. Because it's very important for both. And all primary care providers or people who are providing reproductive health should have even if it's just a very high-level conversation on birth control with their patients. And if it's not something that they routinely manage themselves or feel comfortable managing, have that person that you can refer your patients to, to have more that deeper conversation and maybe even have it provided with that other person. But in my experience, I see a lot of patients who are shared patients between family medicine and are obstetrics and gynecology practice. The percentage is almost equal. And that's really ideal.

Jenna Beckham, MD, MSPH, FACOG: I think similar. We train family medicine residents and a lot of them are really interested and you feel very comfortable. And they do inpatient obstetrics and knowledgeable about contraception at least in their training, I think once they get out into practice sometimes that shifts. But I agree I think primary care providers and even certain other medical specialists even if it's not a full breadth of complex knowledge but just sort of that higher level conversation. Particularly those providers who are caring for patients who could become pregnant and have significant medical conditions that could make pregnancy dangerous for them. Or taking medications that aren't safe in pregnancy even if they're not the person prescribing or managing that contraceptive. To just address it and make sure that there's not an unintended pregnancy in some of those medical scenarios. Or with patients taking certain medications.

Thomas Kimble, MD: And there's growing interest amongst other providers. I was contacted recently by one of the largest children's hospitals in the region. And their emergency medicine program reached out to me and said, hey, will you come and train us on doing some birth control procedures and on counseling and providing birth control? And they said, all the time we have adolescents come in and they are coming into the ER for one reason. But as part of our medical and our social history, we find out that they are sexually active, and they're not covered with contraception. And we felt at a disadvantage because a lot of us haven't had a thorough training, or it's been a long time since we've had that training. And we want you to come and refresh us. And when that happened, I was, my gosh, I was so excited because I thought we are finally getting there as far as the social aspects of increasing access to contraception.

Jenna Beckham, MD, MSPH, FACOG: That's amazing. And particularly thinking about sort of use of certain emergency contraceptives. The emergency department can be a critical place for that. So that's awesome.

Transcript edited for clarity

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