Blog of the Society for Menstrual Cycle Research

The contraceptive doctor–patient disconnect

June 17th, 2014 by Saniya Lee Ghanoui

Guest Post by Jennifer Aldoretta

There seems to be a growing disconnect in recent years between physicians and their patients, and women are especially susceptible to this given our reliance on doctors for information about contraception. When compared to the questions many of us ask our doctors, the information we receive isn’t always up to snuff.

Patient autonomy, as defined by medical dictionaries, is “the right of patients to make decisions about their medical care without their healthcare provider trying to influence the decision.” Based on many conversations with other women, in addition to my own personal experiences, patient autonomy often does not exist for women seeking information about contraception. And this is a huge problem. Deadly (and rare) birth control side effects have become a hot-topic in the news as of late – which is likely contributing to this physician–patient disconnect – but the growing patient interest in control and autonomy means that this cannot simply be dismissed as a side effect of the media.

A recent study, published in the Journal of Contraception, asked both women and healthcare providers to rank the importance of 34 questions relating to contraceptive options. They found that the things that are most important to women are often not as important to their healthcare providers. For example, knowing exactly how a method works to prevent pregnancy was ranked by women as the most important piece of information, whereas how to use a method correctly topped the list for providers. Effectiveness, while still important, was ranked fifth by women, which is a stark inconsistency if you consider just how central a method’s effectiveness is in ads and in the media. The study also found that questions regarding potential side effects ranked in the top three for 26% of women, but only 16% of providers.

These stats may seem inconsequential – after all, physicians should be educating patients about proper use of contraceptive methods. But here’s the problem: the methods suggested by physicians don’t always align with a woman’s stated preferences. I’m certain I’m not the only woman who has been pressured to use a hormonal method (despite my voiced concerns) simply because these methods are considered to be easy and effective. While it seems like a logical solution for physicians to advocate for hormonal methods over methods with higher typical-use failure rates, this approach is ultimately a detriment to women.

A growing number of women seem to be turning to withdrawal, and while this isn’t inherently bad, it becomes bad when a patient isn’t educated on how to properly use it simply because her physician is hesitant to discuss “unreliable” methods. This means that women are turning to potentially unreliable internet sources (or, worse, misinformed friends) for this information. The same can be said for diaphragms, cervical caps, and fertility awareness-based methods. If we want to continue to drive down unintended pregnancy rates, dismissing patient concerns and eliminating patient autonomy isn’t the route we should take. Contraceptive methods aren’t one-size-fits-all, which should be obvious by the huge differences in side effects experienced from person to person. So why do so many contraceptive consultations continue to be carried out in this one-size-fits-all fashion?

Empowering women through family planning is more complex than simply prescribing the most effective methods. It must be coupled with engagement in an open dialogue, including acknowledgement of patient concerns and a respect for patient autonomy. Patients are increasingly demanding autonomy, and if healthcare providers wish to remain a respected part of a woman’s health, it’s time to set aside contraceptive biases and listen.

Getting Over The Pill

January 15th, 2013 by Kati Bicknell

Here’s a notion: Birth control pills are not the only way manage your reproductive health.

The pill came out more than 50 years ago, and at the time, it was a symbol of liberation and freedom for women. Suddenly, they no longer had to worry about unplanned pregnancy. It was great. But now that 50-year-old technology is starting to lose much of the appeal it once had.

Adapted from a photo by Jess Hamilton // Creative Commons A-NC-SA 2.0

Today many women get on the pill as teenagers to “regulate” irregular cycles, and they get off the pill in their late 20s or early 30s when they want to get pregnant. The unfortunate reality is many women find it’s not as easy as they thought it would be to get pregnant. Ten or fifteen years of being on oral contraceptives doesn’t “fix” an irregular cycle; it just kind of pushes the pause button on your reproductive system.

When you come off the pill in your late 20s or early 30s because you finally want kids, your body has to pick up where it left off when you were a teenager. Often women at this stage of their lives find it takes longer than expected to conceive and wind up on the assisted reproductive technology track — reproductive endocrinologists, expensive and annoying tests, procedures, hormone injections ,and all that jazz. And, heartbreakingly, after several years and thousands of dollars, that doesn’t always work.

The side effects of the pill are a real pain in the ass for many women, too. Weight gain, depression, loss of libido, and “not feeling like myself” (AKA “I seem to have gone insane”) are some of the more common complaints cited. In fact, a CDC report on contraceptive use states that 10.3 million women have stopped taking the pill due to side effects, or fear of side effects.

All women need a way to have children when they want them, and to not have children when they don’t. And they need to feel good about the whole thing — not freaked out, bloated and crazy. Imagine how the world would be different if this was a reality.

This reality is possible thanks to the wonderful simplicity of the Fertility Awareness Method — the technology behind Kindara. Instead of women’s reproductive reality being like this:  “Oh my god,  I don’t want to get pregnant” during her twenties, followed by “Oh my god,  I want to get pregnant NOW!” in her thirties, the Symptothermal Method makes it one question: “When do I want to get pregnant?”

Charting your cycle using the Fertility Awareness Method can help you achieve your reproductive goals without pills, side effects, or stress, whether you want to have kids in the next few years, in 10 years, or never. By charting your cycle, you will see if and when you are ovulating, and you will know when you are fertile, which is the trick to knowing when you can or cannot pregnant. Charting your cycle could help clarify issues that need to be remedied before you can get pregnant too. You can even confirm pregnancy with your chart. Exciting!

If women were taught the basics of Fertility Awareness as soon as they entered their reproductive years and knew that they could avoid or plan for pregnancy by charting their primary fertility signs (temperature and cervical fluid), they would save a lot of time, money, and stress.

What a different world we would all be living in if each woman shifted her thinking from “I need this pill so I don’t have unplanned pregnancies, and I need my doctor to prescribe this pill” to “I know just what is going on with my cycle at all times. I am calm, confident, and empowered. I manage my own fertility thank you very much, and I don’t need pills to do it.”

Now I’m not saying that oral contraceptives have no place in the world. They are a wonderful invention. Thanks to the pill, women today can take it as fact that pregnancy can be prevented easily and effectively. But because this is now a forgone conclusion, we are free to look for even better options — options like the Fertility Awareness Method that can prevent pregnancy easily, effectively, autonomously and without side effects.

Originally published at on December 15th, 2012

Riddle me this: What’s wrong with birth control?

April 20th, 2010 by Laura Wershler

I read The Birth-Control Riddle by Melinda Beck, published today in The Wall Street Journal with interest and frustration.  As a veteran pro-choice sexual and reproductive health advocate, I’ve spent decades contemplating this “riddle”. I have two specific comments in response to the piece, and a few suggestions for potential follow-up stories.
 1) I find it discouraging, but understandable, that the article failed even to mention fertility awareness based methods (FABM) of birth control, which when taught so that women/couples can use the method effectively and confidently have a 99.4% effectiveness rate. Don’t take my word for it. The German study called: The effectiveness of a fertility awareness based methods to avoid pregnancy in relation to a couple’s sexual behaviour during the fertile time: a prospective longitudinal study was published in the prestigious journal Human Reproduction in late 2007. 

In addition to the typical North American dismissiveness (by healthcare providers) of FABM as ineffective, is the dismissive response given to North American women who express an interest in learning FABM.  A quick google search or a week’s hits on a google news alert for “Fertility Awareness” (the secular, pro-choice variation of the religiously contextualized Natural Family Planning) quickly establishes the burgeoning interest and use of these methods by young American women. Why is this so readily ignored by the mainstream sexual and reproductive health community (of which I am a part)? I have been mulling over this question for years. I have arrived at several answers. How I would love to see a journalist, any journalist, start asking this question.

 2) My second comment is that this article is a missed opportunity. It is useless merely to list (yet again) the birth control “choices” available to women, as if just knowing about these methods of contraception should make the problem of unintended pregnancy go away. Of one thing we can all be certain: it can’t and it won’t. What this piece lacks is any attempt to explore in depth the writer’s accurate but unexamined statement – Why are the numbers so high? The answer is a complex tangle of cultural, religious, behavioral, educational and economic factors.  Why not make an effort to get to the bottom of the so-called birth control riddle?  

Should Beck be interested in continuing to write about this issue, one angle she might consider exploring is barriers to access to information, support and services for women seeking to use non-hormonal methods of birth control effectively and confidently, including diaphragms, cervical caps and fertility awareness based methods. This is a huge issue of concern to me and the many women who can’t, won’t or don’t want to use hormonal birth control.

I have a theory that a good number of unintended pregnancies happen because women are finding little or no support to access and effectively use non-hormonal methods. Yet this lack of support is not enough to keep them on the pill, patch or ring, or to agree to submit to invasive shots or implants.  Therefore, care providers’ dismissal of young women’s requests for non-hormonal methods may actually be the cause of some of the unintended pregnancies we seem to be so puzzled by. Another issue not being talked about is that some women are getting pregnant while using the pill, patch or ring. These unintended pregnancies, which oddly don’t seem to pull down the “typical use” effectiveness rate of these methods, is partly behind the growing interest in IUDs.  The other reason IUDs are growing in popularity is backlash against traditional hormonal methods.

Another story idea is to question the hierarchy with which contraceptive methods are presented. As illustrated by Beck’s contraceptive method list, hormonal methods are always at the top, suggesting that these methods are always superior choices (that is how they are usually presented – to young women especially) even if for many women they are not. What if we presented birth control methods as three distinct sets of choices that all women and sexual health care providers should be equally knowledgeable about, and – in the case of the healthcare provider – supportive of? These method groups – alphabetically identified as barrier, hormonal and natural methods – could be presented as equally valid choices based on what suits best a woman’s needs, health concerns and values. After all, the old adage states that the best kind of birth control is one that you will use.

I am always amazed at young women’s perception that only hormonal methods are truly effective, and anything else is second best. Wherever did they get this idea? And with this impression, how possibly can they hope to be successful using other methods?  The challenge is that if we present these method groups as equally effective and worthy of choice, then we are going to have to find better ways to provide information, training and support so that women and their partners can use all of them with confidence.  

Included in any discussion about contraceptive methods would be strategies for moving effectively and confidently between method groups as our health and fertility needs change across our reproductive lives. This latter would require caerful evaluation of our sexual decision-making skills. One of my major concerns with the over-reliance on hormonal birth control is the mindset young men and women develop around 24/7 sexual availability, or what I call “mindless sexuality.”  It is time to reconnect our minds and bodies, and to align sexual activity with all of its potential benefits and outcomes including fun, pleasure, relational connection, STIs and pregnancy.

Contraceptive Injections Increase Risk of Bone Loss

December 27th, 2009 by Elizabeth Kissling

DEXA scan of femur.New research from the University of Texas Medical Branch at Galveston finds that nearly half of women using depot medroxyprogesterone acetate (DMPA), commonly known as the birth control shot, will experience high bone mineral density (BMD) loss in the hip or lower spine within two years of beginning the contraceptive. Women who smoke, have inadequate calcium intake, and have never given birth are at higher risk of BMD loss.

The study, published in the January 2010 issue of Obstetrics and Gynecology, followed 95 DMPA users for two years. In that time, 45 women had at least five percent BMD loss in the lower back or hip. A total of 50 women had less than five percent bone loss at both sites during the same period. The researchers followed 27 of the women for an additional year and found that those who experienced significant BMD loss in the first two years continued to lose bone mass.

“These losses, especially among women using DMPA for many years, are likely to take an extended period of time to reverse,” says first author Dr. Mahburbur Rahman, assistant professor in the department of obstetrics and gynecology and Center for Interdisciplinary Research in Women’s Health.

The researchers note that while this study will help physicians counsel women with modifiable risk factors who wish to use DMPA, prevention of bone loss while using the contraceptive and reversibility of BMD loss are still not well understood and further research is needed.

DMPA, an injected contraceptive given every three months, is used by more than two million women in the U.S.; nearly one-quarter of them teens. DMPA is popular with young women because it is less expensive than many other forms of birth control, has a low failure rate, and does not require daily use.

[Via Red Tent Sisters]

What is the future of YAZ?

September 26th, 2009 by Elizabeth Kissling

The popular birth control pill, Yaz is in the news again. Readers may remember that last autumn, Bayer (the maker of Yaz) was sanctioned by the FDA for their television commercials, “because they encourage use of Yaz in circumstances other than those in which the drug has been approved, over-promise the benefits and minimize the risks associated with Yaz.” The FDA actually required Bayer not only to end the advertising campaign immediately but to make amends by publicizing corrective information — an unusually bold move from the FDA. That led to the ad shown at right.

Bayer was cited by the FDA again earlier this year, for failure to follow proper quality control in the plant that manufactures the synthetic hormones used in Yaz.

Bayer is now defending itself against 74 lawsuits filed by users who developed health problems, such as blood clots or heart attacks. Bayer is taking the FDA citations seriously and plans to “defend itself vigorously against the suits.” Dr. David A. Grimes, a clinical professor of obstetrics and gynecology at the University of North Carolina medical school and paid consultant to Bayer says the risk of injury from Yaz is tiny. “My dictum is that a multiple of a rare event is still a rare event,” says Grimes. And the New York Times seems far more concerned with how the FDA citations and the lawsuits will affect Yaz’ image and sales than they are with women’s health.

Didn’t these people learn anything from the saga of the Dalkon Shield?

October 2, 2009

Edited to Add: The New York Times report neglected to mention that Swissmedic is investigating the death of a young woman from the effects of pulmonary embolism that may be linked to her use of Yaz.

Readers should note that statements published in re: Cycling are those of individual authors and do not necessarily reflect the positions of the Society as a whole.