Tips (not from TikTok) for contraception discussions with patients

SAN DIEGO — Internal medicine physicians “really share the responsibility” for patients seeking contraception, according to Pelin Batur, MD, FACP, NCMP.

“We can do better,” she said during a presentation at the 2023 ACP Internal Medicine meeting.

Batur, of the OB/GYN & Women’s Health Institute at Cleveland Clinic and a professor of OB/GYN and reproductive biology there, shared with the audience what she considers the “one key question”: Would you like to be pregnant in the next year?

“If they say, ‘Oh, no,’ well, we are pretty OCD as internists if you haven’t noticed already so the natural inclination is to talk about all these great options.” However, Batur suggests asking patients another question: How would you feel about an unintended pregnancy?

“Not everybody is a mega planner,” she said, and there are patients who would welcome a pregnancy.

“About half of pregnancies are unintended, and just under half do get an abortion, and when you survey those who went to have an abortion, many of them were actually trying to use contraception but it failed them for whatever reason,” Batur said.

She emphasized the difference between emergency contraception and abortion.

“Emergency contraception is not abortion. It is something you give to delay ovulation with pills before a pregnancy test turns positive, and anything you do after a positive pregnancy test is abortion,” she said, adding that the distinction is important in today’s climate since the Supreme Court’s decision in Dobbs vs. Jackson Women’s Health Organization.

When talking to a patient about contraception options and their individual effectiveness, Batur recommends the CDC’s Effectiveness of Family Planning Methods, a PDF resource.

“The risk of an unintended pregnancy is always greater than the risk of any contraceptive,” she said.

When choosing an appropriate contraception method for a patient, Batur recommends the CDC’s Summary Chart of US Medical Eligibility Criteria for Contraceptive Use, which categorizes contraceptives by age, conditions and subconditions.

“The best contraceptive for any given woman is the one she wants to use,” Batur said.

Batur said TikTok has been a breeding ground of misinformation and “trend diagnosis.”

She said a patient comes to her at least once a day and says, “I need my hormone balance checked.”

“How do you know a patient is in menopause? The simple answer is you don’t,” she said. “People are trying to help, but hormone testing makes no sense when you are on birth control pills.”