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Getting the Right Birth Control for You: 5 Questions to Ask Your Doctor About Oral Contraceptives

Looking for guidance about contraception? There’s some good news.

ACOG, a professional group for obstetricians and gynecologists, recently published new guidelines for healthcare professionals on how to counsel female patients looking for appropriate safe and effective birth control options.1

The new guidelines are patient centered, encouraging doctors to “listen to patients’ preferences, insights, and lived experiences” when counseling their patients about selecting (or discontinuing) a contraceptive.1

These new guidelines empower women to share in the decision-making process about their birth control. The best way for you to benefit is to come prepared with questions. 1

Here are 5 questions that you can bring with you to your appointment, whether it’s in person or an online telehealth meeting.

 

Which oral contraceptives are appropriate for me?

To get started, your physician will ask about your medical history, and there may be medical testing involved. Depending on which contraceptives you’re considering, your blood pressure, weight and height (to calculate BMI), cardiovascular health, cholesterol levels, and liver enzymes may be tested. 2

Results of these tests will determine whether you have medical conditions that can make taking estrogen-containing pills potentially dangerous.2

 

What’s the difference between pills that contain estrogen and those that don’t?

Oral contraceptives are available as combined oral contraceptives (COCs) that contain estrogen and progestin, or as progestin-only pills. Remember that there are benefits and risks associated with different types of contraception. However, certain risk factors may determine whether a woman can safely take estrogen-containing pills or are better off with progestin-only pills. You and your doctor can explore which risk factors you may have.2

Am I a good candidate for progestin-only pills?  

Because estrogen-containing pills are not recommended for certain women if they have recently given birth or are breastfeeding, or because they smoke and are 35 years of age or older. Other factors that affect the decision whether to take estrogen-containing pills include BMI, history of cancer, migraine history, or risk of thromboembolism (blood clots embedded deeply in the veins or lungs), progestin-only pills should be considered. You can discuss this in more detail during your appointment.2

 

How will taking a progestin-only pill affect my period?

According to ACOG, progestin-only pills often make your period lighter, sometimes eliminating monthly flow altogether. So, women who suffer with heavy periods may benefit from taking it.  Make sure to share details with your doctor about your menstrual cycle and any challenges you are facing.3

 

I’ve just had a baby. When can I start taking oral contraceptives again?

Congratulations! During this time of joy, fatigue, and so many other emotions, self-care is especially important.

Experts recommend that during the period after pregnancy (postpartum), even if a woman is not breastfeeding, she should avoid taking estrogen-containing pills. COCs increase the risk of thromboembolism after giving birth.4 About 9% of all maternal deaths in the United States are due to these types of blood clots.5

In contrast, progestin-only pills can be taken after pregnancy, once a woman decides it is the right time for her to go back on contraception.3

As our lives change, our decisions about birth control also change. Regardless of where you are in your personal journey, make sure to ask questions, stay informed, and take care of yourself.

ACOG, American College of Obstetricians and Gynecologists; BMI, body mass index; STD, sexually transmitted disease.

 

References:

  1. Patient-centered contraceptive counseling. https://www.acog.org/clinical/clinical-guidance/committee-statement/articles/2022/02/patient-centered-contraceptive-counseling. Accessed November 7, 2022.
  2. Lauring JR, Lehman EB, Deimling TA, et al. Combined hormonal contraceptive use in reproductive age women with contraindications to estrogen use. Am J Obset Gynecol. 2016:215(3):330.e1-330.e7.
  3. Progestin-only hormonal birth control: pill and injection. https://www.acog.org/womens-health/faqs/progestin-only-hormonal-birth-control-pill-and-injection. Accessed November 7, 2022.
  4. American College of Obstetrics and Gynecology. ACOG practice bulletin: Use of hormonal contraception in women with coexisting medical conditions. Obstet Gynecol. 2019;133:e128-e150.
  5. Abe K, Kuklina EV, Callaghan WM. Venous thromboembolism as a cause of severe maternal morbidity and mortality in the United States. Sem Perinatol. 2019;43(4):200-204.