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How doctors can help demystify birth control amid online confusion

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Some content creators do intend to cast doubt on the safety and effectiveness of hormonal birth control by purposefully spreading false information, or disinformation. That’s in contrast to social media containing misinformation, inaccurate information that could be misleading.

But for some potentially misleading social posts about hormonal birth control, there’s a larger takeaway: That some health care providers don’t fully discuss risks and side effects of hormonal contraception and don’t take patients who experience side effects seriously.

Posts about personal experiences with hormonal birth control, whether a pill, a shot, an IUD, an implant, a patch or a ring, can reveal a disconnect between the priorities of doctors and patients during contraceptive counseling visits. Physicians often lead with how effective a method is and tend to minimize problematic side effects. But a lack of side effects is an important feature for many women, along with how well a method works to prevent pregnancy.

“People want to know about side effects and the potential experiences they might have using different methods, especially hormonal methods,” says Anu Manchikanti Gómez, a sexual and reproductive health equity researcher at the University of California, Berkeley.

Some providers are falling short in meeting patients’ needs. “We have, as a health care community, often dismissed and considered invalid people’s concerns about methods,” says Christine Dehlendorf, a family medicine physician and reproductive health researcher at the University of California, San Francisco. This can “interfere with people’s ability to trust us and get the information that they need and the support that they need.”

To regain that trust, there are growing calls for a person-centered approach to contraceptive counseling (SN: 5/19/23). The approach focuses on the values and priorities of the patient and uses shared decision making rather than a physician-directed process. It recognizes that the right contraceptive method for a person can change over time, that the information from family, friends and social media can be instructive and that a productive conversation can include both scientific research and lived experiences.

It starts, Gómez says, “with the basic principle of meeting the patient where they are.”

The evolution of birth control methods

Hormonal birth control has been available in the United States since 1960, the year the U.S. Food and Drug Administration approved the pill, ushering in a new era of fertility control that opened doors to educational and career opportunities for many women. The pill paved the way for additional hormonal contraceptive choices (SN: 5/21/66). Almost two-thirds of U.S. women ages 15 to 49 were using contraception of any kind from 2017 to 2019, according to the U.S. Centers for Disease Control and Prevention. Of those, 14 percent were on the pill, 10 percent were using an IUD or an implant and 3 percent were using the shot, ring or patch.

The pill, the patch and the vaginal ring are combined hormonal methods, which means they contain both estrogen and progestin, the lab-made version of progesterone. These methods prevent pregnancy by stopping the ovaries from releasing eggs and by thickening cervical mucus, which waylays sperm trying to reach the uterus.

Other hormonal methods contain only progestin, such as certain IUDs, the implant, the shot and progestin-only pills, including Opill, which became available over-the-counter in 2024. Along with its mucus-thickening, sperm-detaining action, progestin thins the uterus lining, which keeps a fertilized egg from implanting. In progestin-only methods except the IUD, the hormone also helps halt ovulation. (There is also a non-hormonal IUD that contains copper, which creates an environment that is toxic to sperm.)

Hormonal birth control essentially overrides the body’s regulation of the menstrual cycle, which is orchestrated in part by estrogen and progesterone. That can understandably lead to questions about how these medications affect all of the biological processes in which these hormones are involved.

There are some rare but serious health risks from taking hormonal birth control. The different methods may also come with side effects, including changes to mood and weight, nausea, headaches and irregular bleeding. Not everyone will experience side effects, and for those who do, the effects can resolve over time. But side effects can be disruptive to people’s lives, and there isn’t a reliable way to figure out who may be affected.

“People want to make their decisions with full information.”

Anu Manchikanti Gómez, sexual and reproductive health equity researcher

More than 52 million U.S. women ages 15 to 49 reported they had used the pill at some point in their lives, and more than 13 million reported they had used an IUD, according to the 2015–2019 National Survey of Family Growth. Among the roughly one-third of each group that stopped these methods because of dissatisfaction, about 64 percent of them said it was due to side effects.

It’s no wonder, then, that people’s experiences taking birth control can be big topics on social media, which can amplify misunderstandings and misinformation about hormonal contraception and health.

What the science says about birth control

Scientific evidence can often provide reassurance or context here. For example, using hormonal contraception is not linked to later infertility. Studies have found that a person’s ability to become pregnant within a year after stopping hormonal contraception is similar to that of people who weren’t using a contraceptive method or who stopped using barrier methods such as condoms. How quickly a person’s menstrual cycles return to their baseline depends on which method they were taking.

Some social media content describes hormonal birth control as a carcinogen. There is a risk of developing breast cancer, but it’s very small. A 2017 New England Journal of Medicine study of 1.8 million women in Denmark ages 15 to 49 years old reported that for every 7,690 women using hormonal contraception for one year, there would be one additional case of breast cancer than would be expected to occur among women who had never used these contraceptives. The risk was even smaller for women under 35 years old: One additional case for every 50,000 women using hormonal contraception.

There is also a low risk of developing blood clots from combined hormonal contraception, ranging from 5 to 12 cases per 10,000 women, depending on the type of progestin. For women not on these birth control methods, the risk is 2 cases per 10,000. Other aspects of a person’s health history — including smoking, migraines, high blood pressure or a family history of developing a blood clot before the age of 50 — can increase the risk of blood clots and might rule out the use combined hormonal contraception. The signs of a blood clot include intense leg pain or swelling, feeling breathless and chest pain.

But the science isn’t so straightforwardly helpful for some potential side effects, particularly changes in a person’s mood or weight.

The data on the association between hormonal contraception and the risk of depression is mixed. Some studies have found that hormonal birth control is linked to an increased risk, while others have reported a link between the medications and improved mood. It’s a similar story for weight gain. There is inconclusive evidence for an association between changes in weight and combined hormonal contraceptives and limited evidence of a small gain with progestin-only formulations.

In studies that observe how people feel on a contraceptive method, it can be hard to tease out the effect of hormonal birth control from other health changes or other factors in people’s lives. Studying side effects of contraceptive methods is “inherently challenging,” Dehlendorf says.

The benefits of patient-centered contraceptive care

What is sometimes implied — and sometimes said outright — in social media posts about hormonal birth control and side effects is frustration with medical providers. That could stem from providers’ limited time during medical visits, their push for certain methods over others or the notion that discussing side effects may scare people away. But whatever the reason, it leaves patients hanging.

“People want to make their decisions with full information,” Gómez says. Without it, people can have experiences “that they didn’t feel they were prepared for.”

Centering the patient during contraceptive counseling means validating and exploring their concerns and talking about “what you can do to support them in a treatment plan that feels good to them,” says Andrea Hoopes, an adolescent medicine physician-researcher at Kaiser Permanente Washington Health Research Institute in Seattle.

It’s also important to understand “what some of the side effects that might feel most problematic to them are and why,” she says. “That can help guide the selection of methods.” If a person experiences side effects, “we can make an adjustment,” including stopping the method.

Another way to respect a patient’s preferences is to avoid framing the discussion around which methods are most effective at preventing pregnancy. For example, implants or intrauterine devices are highly effective — more than 99 percent — but dependent on the provider for placement and removal. Some people would rather use a method that they can start and stop on their own, valuing the autonomy that comes with the pill, patch or ring, even if those methods are slightly less effective at 93 percent.

Male condoms, which are 87 percent effective at preventing pregnancy with typical use, avoid hormonal side effects completely, if that’s a top priority, and protect against sexually transmitted infections.

There are still providers who feel that “it would be great if everyone would just use an IUD or an implant,” Gómez says. “But starting from a place like that, when someone is not at all interested in that, can be very harmful for the relationship” between the provider and the patient.

Women’s contraceptive preferences can also differ across racial and ethnic groups, Dehlendorf and colleagues reported in Contraception in 2016. Compared with white women, Black, Hispanic and Asian Pacific Islander women were more likely to report that the ability to get off a method at any time was an extremely important feature. That’s an understandable preference, Dehlendorf says, considering these communities are more likely to experience biased reproductive care from physicians.

With social media, providers might think their main role is to be a fact-checker for patients. But that can stifle conversation. “I think it’s so important as a clinician to ask permission to provide advice or address a concern that might be based on misinformation, rather than just coming out and shutting it down,” Hoopes says. “Asking for permission to correct misinformation can really lead to a more productive, partnered conversation.”

For teens she has counseled, social media “is a way that teens are learning to develop their questions.” Providers can use a discussion about what their patients have seen on social media as a springboard to understanding their goals and concerns, she says.

Research shows that when patients’ preferences, experiences and concerns are centered in discussions about contraception, they are more satisfied with the counseling they receive. It means framing the conversation around their priorities, their relationship status and what else is happening in their lives. These things will change, as will the birth control method that works best for a person.

“Changing methods is a relatively common experience for a person over their life,” Hoopes says. “Contraceptive use for most people is a journey, not an endpoint.”

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