How physicians might assist clarify birth control in the face of internet uncertainty

In a TikTok video, a young woman opens a medicine information package insert to uncover a big piece of paper that covers her coiled body. The caption says, “When they forget to give you a blanket but you brought your birth control side effects page.”

sharp-witted commentary? Verify. False information? Maybe. It’s unclear which long-term birth control package insert the woman is displaying, but it’s unlikely to have just negative effects. While warnings, precautions, and adverse reactions are listed on a significant number of these inserts, the inserts also typically provide a wealth of additional information on the medication, including dose, drug interactions, and mechanism of action.

Certain content creators deliberately disseminate inaccurate or misleading material in an attempt to raise questions about the efficacy and safety of hormonal birth control. On the other hand, false and potentially misleading information can be found on social media.

However, there is a bigger lesson to be learned from certain possibly deceptive social media posts regarding hormonal birth control: certain medical professionals don’t thoroughly address the dangers and adverse effects of hormonal contraception and don’t treat patients who have side effects carefully.

Posts detailing individual experiences with hormonal birth control—whether it be a shot, pill, IUD, implant, patch, or ring—can highlight a discrepancy between patients’ and doctors’ goals during contraceptive counseling sessions. Doctors tend to minimize negative side effects and emphasize a method’s effectiveness. But for many women, the effectiveness of a method in preventing conception is just as crucial as its lack of negative effects.

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

Certain providers are not fulfilling the needs of their patients. “People’s concerns about methods have often been dismissed and considered invalid by the health care community,” says Christine Dehlendorf, a reproductive health researcher at the University of California, San Francisco and family medicine physician. “People’s ability to trust us and get the information that they need and the support that they need” may be harmed by this.

There are increasing requests for a person-centered approach to contraceptive counseling in order to reclaim that trust (SN: 5/19/23). Instead of using a procedure that is driven by the doctor, the approach emphasizes shared decision making and focuses on the values and priorities of the patient. It acknowledges that an individual’s preferred method of contraception may change over time, that information from friends, family, and social media can be enlightening, and that both scientific study and firsthand experience can contribute to a fruitful discussion.

“With the basic principle of meeting the patient where they are,” according to Gómez, is where it all begins.

The development of birth control techniques

The United States has had access to hormonal birth control since 1960, when the U.S. The pill was approved by the Food and Drug Administration, launching a new age of birth control that gave many women access to higher education and professional prospects. More hormonal contraception options became available as a result of the pill (SN: 5/21/66). According to the U.S., about two-thirds of women in the country between the ages of 15 and 49 used some form of contraception in 2017. the Centers for Disease Prevention and Control. Among them, 3 percent used the shot, ring, or patch, 10% had an IUD or implant, and 14% were taking the pill.

Because the pill, patch, and vaginal ring are combined hormonal treatments, they contain progestin, which is progesterone produced in a lab, along with estrogen. By inhibiting the release of eggs from the ovaries and thickening cervical mucus, which obstructs sperm from entering the uterus, these procedures prevent conception.

Some hormonal techniques, like some IUDs, the implant, the shot, and progestin-only pills like Opill, which went over-the-counter in 2024, are only made of progestin. Progestin thins the lining of the uterus in addition to its sperm-detaining and mucus-thickening effects, which prevents a fertilized egg from implanting. The hormone also aids in stopping ovulation with progestin-only techniques, with the exception of the IUD. (An further non-hormonal IUD that includes copper and poisons sperm’s surroundings is available.)

The menstrual cycle, which is partly regulated by the body and partly controlled by estrogen and progesterone, is effectively overridden by hormonal birth control. Naturally, this can raise concerns about how these drugs impact each and every biological activity that these hormones are involved in.

The use of hormonal birth control carries a small but significant danger to your health. The various techniques may potentially have adverse consequences, including as mood and weight fluctuations, headaches, nausea, and irregular bleeding. Side effects are not always felt by everyone, and for those who do, they usually go away with time. However, side effects can seriously disrupt people’s life, and it’s impossible to predict who might be impacted.

“People prefer to have complete information when making decisions.”

Researcher on sexual and reproductive health inequities Anu Manchikanti Gómez

The 2015–2019 National Survey of Family Growth revealed that over 52 million American women between the ages of 15 and 49 said they had used a pill at some point in their lives, and over 13 million said they had used an IUD. About 64% of the approximately one-third of each group who discontinued these procedures owing to unhappiness cited side effects as the reason.

Therefore, it seems sense that social media users’ experiences of birth control can generate a lot of discussion and spread false information regarding hormonal contraception and health.

What birth control science has to say

Here, context or assurance can frequently be found in scientific evidence. Hormonal contraception, for instance, is not associated with infertility in the future. According to studies, the likelihood of getting pregnant a year after quitting hormonal contraception is comparable to that of individuals who were not using a method of birth control or who ceased using barrier methods like condoms. Depending on the procedure used, a person’s menstrual periods may take longer to return to baseline.

Hormonal birth control is called a carcinogen in certain social media posts. The chance of getting breast cancer is present, although it’s extremely low. According to a 2017 New England Journal of Medicine study involving 1.8 million Danish women aged 15 to 49, there would be one more case of breast cancer for every 7,690 women who used hormonal contraception for a year than would be predicted for those who had never used these methods. For women under 35, the risk was much lower: one extra case for every 50,000 women who used hormonal contraception.

Additionally, depending on the type of progestin used, there is a small chance of blood clots from combination hormonal contraception, with 5 to 12 occurrences reported for every 10,000 women. The risk for women who are not using these birth control techniques is one case per 10,000. A person’s medical history may also make the use of combined hormonal contraception unnecessary if they have a history of smoking, migraines, high blood pressure, or a family history of blood clots before the age of 50. Breathlessness, severe limb pain or swelling, and chest pain are symptoms of a blood clot.

However, the science isn’t exactly clear-cut when it comes to some possible adverse effects, especially ones involving mood or weight changes.

There is conflicting information about the relationship between the risk of depression and hormonal contraception. While some studies have established a link between hormonal birth control and improved mood, others have found the treatment to be associated with an increased risk. The tale of weight increase is similar. There is modest evidence of a slight gain with progestin-only formulations and conflicting data regarding the relationship between changes in weight and combined hormonal contraceptives.

It might be challenging to distinguish the effects of hormonal birth control from other health changes or external influences in people’s life in studies that track how people feel while using a contraceptive technique. According to Dehlendorf, researching the negative effects of contraceptive techniques is “inherently challenging.”

Patient-centered contraception care’s advantages

Frustration with medical providers is something that is occasionally mentioned and sometimes suggested in social media posts concerning the negative effects of hormonal birth control. That may be the result of medical professionals’ short attention spans, their preference for one approach over another, or the belief that talking about adverse effects will make patients avoid them. But for whatever reason, patients are left in suspense.

According to Gómez, “people want to make decisions with full information.” People might encounter situations “for which they didn’t feel they were prepared” without it.

According to Andrea Hoopes, a physician-researcher specializing in adolescent medicine at Kaiser Permanente Washington Health Research Institute in Seattle, centering the patient during contraceptive counseling entails acknowledging and discussing their concerns as well as discussing “what you can do to support them in a treatment plan that feels good to them.”

Knowing “what some of the side effects that might feel most problematic to them are and why,” she adds, is also crucial. If a person has side effects, “we can make an adjustment,” which may include stopping the procedure, “that can help guide the selection of methods.”

How five patients’ decisions about birth control evolved over time

Selecting birth control is a continuous process. As demonstrated by the birth control choices of these participants (whose identities were concealed to preserve their anonymity) in a study on the use of contraceptives over time, the most effective form of contraception can vary depending on an individual’s needs, relationships, and preferences throughout their reproductive lives.

travels with contraceptives

Ignoring to frame the conversation around the best contraceptive options is another way to honor a patient’s preferences. Implants and intrauterine devices, for instance, have a 99 percent success rate but require expert installation and removal from the provider. Even though the effectiveness of pills, patches, and rings is only 93 percent, some people would like to utilize a method that they can start and stop on their own, appreciating the autonomy that comes with those forms of self-administration.

Male condoms, when used as recommended, are 87% successful at preventing pregnancy. They also totally avoid hormonal adverse effects and offer protection against STDs.

According to Gómez, some healthcare professionals still think that “it would be great if everyone would just use an IUD or an implant.” However, it can be quite detrimental to the patient-provider relationship to start from that point when the other person has no interest in it.

Dehlendorf and colleagues (2016) revealed in Contraception that there can be variations in women’s choices for contraception among different racial and cultural groupings. Black, Hispanic, and Asian Pacific Islander women were more likely than white women to say that being able to stop using a method whenever one wanted was a very significant characteristic. Dehlendorf argues that this is a reasonable decision given the likelihood that members of these communities will get biased medical care about reproduction.

Providers may believe that their primary responsibility on social media is to verify patients’ information. However, that might impede communication. “As a clinician, I believe it’s crucial to get consent before offering advice or addressing a concern that may be founded in false information, instead of just addressing it head-on and dismissing it,” Hoopes adds. “A more fruitful, partnered conversation can really result from asking permission to correct misinformation.”

Providers should use a discussion about what their patients have seen on social media as a springboard to understanding their goals and worries. According to the kids she has counseled, social media “is a way that teens are learning to develop their questions.”

Studies reveal that patients are happier with the advice they receive when it is around their preferences, experiences, and concerns regarding contraception. It entails focusing the discussion on their priorities, current relationship state, and other life events. Both of these things and the most effective birth control method for an individual will alter.

According to Hoopes, “a person changing methods is a relatively common experience for them over their life.” “Most people’s use of contraceptives is a journey, not a destination.”