Birth Control, Risk, and Understanding your options

Birth Control, Risk, and Understanding Your Options

Birth control, contraception, fertility management… Who hasn’t thought about it in some way?

There are so many different types & methods available these days-  but not all of them are right for every woman.

And trying to find the ‘right’ one can be a tremendous challenge.

Because finding the ‘right’ one means something different to every woman.

‘Right’ could be most effective- or least invasive; with hormones- or without; with monthly bleeding-or no bleeding for months; easiest to start- or easiest to stop; most secure against STIs- or safe while breastfeeding …. Or all of these!

There is a host of interwoven elements that make the process so personal.

Which is why having a provider to talk about what you WANT out of a birth control method is so important.

Because the truth is, not every woman can use every method.

Sometimes this is because of a current medical condition.

And sometimes it is because of a past medical history or family medical history.

Because every woman is so unique, her individual RISK profile  is unique too.

So what does that mean?

When I talk about a ‘risk profile’ I mean the risk of being on a certain type of method given a woman’s unique history and her health risks should she become pregnant.

While it is true that pregnancy is a natural and healthy state for most, it is also true that there are inherently increased risks associated with it.

This may sound unpopular to some, but the truth is, simply in terms of what we call ‘risk ratio’ many times the risk of a contraceptive method is less risky than the risk of a pregnancy for an individual woman based on her health status.

Certainly, this isn’t true for every woman, but it’s important to consider when you hear news stories about catastrophic events associated with birth control methods.  Rarely (if ever) is any background on the woman’s risk profile- or health history, mentioned.

Recently, there has been a lot in the news about the risks of Nuva Ring, a type of birth control that works like birth control pills but is a vaginal suppository.  It has been widely popular since it doesn’t require a daily pill, the hormones don’t go through the entire system the way a pill does, and it involves only once a month insertion so a woman is able to control its monthly placement and removal.

Hearing of bad outcomes associated with the Nuva Ring certainly gives me some pause, however without knowing anything about the underlying health status of someone that had a bad outcome- it is important not to become too reactive.

This is one reason it’s important to know and feel comfortable with the healthcare provider that supports you in your contraceptive choices.

By having a provider who takes the time to know you, your personal & family history, your health preferences, your health & lifestyle concerns, you have someone working on your health team that is willing to help you find the right method(s) for you.

By using a provider who as the most current information, recommendations and guidelines on contraception options & use, that information can be shared with you in a way you understand, and you have all your questions answered.

When I hear of tragedies related to birth control, I often wonder if the person involved felt confident in her choices, options and decision on what to use.  Did she know her options? Her risks? Did she feel comfortable with her provider to ask the questions she had? Did she have all of her questions answered?

For all too many in this health system of ours, birth control visits have turned into the healthcare world’s version of fast food.  I know, I’ve seen it first hand- a woman typically walks in and out of such visits in 15 minutes—or less.

During that time many women barely have a chance to get comfortable talking about the fact they have sex, let alone have the time to feel supported in knowing the options given their unique health status.

Or providers put up hurdles that limit the availability of options. Like the largely antiquated requirements of having a Pap and STI screening weeks in advance of IUD placement,  or a vaginal exam for birth control pills. (Current research is clear that neither of these are generally needed, although in certain situations your unique health care needs may suggest otherwise.

Unfortunately what that means to a lot of women is a delay in access to the method that is right for them OR- for many women- having to endure an invasive procedure unnecessarily.

It is hard given such scenarios to imagine every woman is able to make the best decision for her needs.

That’s one reason I believe so strongly in doing things differently.

When a woman comes in to see me about contraception, we talk about a lot of things- including what she wants out of a birth control method- and what she doesn’t. We evaluate her risk profile together and collaboratively formulate a plan.

We formulate a plan together because there are a lot  of options for women to manage their fertility. From the gentle, non-pharmacological monthly fertility awareness methods, to the highly effective pharmacological methods of implants I want women to get their needs met.

If you are in need of contraception, have questions or concerns about your current contraception method or would like to establish care with a provider who does things differently than the standard 15-minute visit (All New Patient visits are scheduled for a full hour), please schedule an appointment with Sarieah Macdonald, CNM today.






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