How I Practice Video Series
Eve Espey, MD, FACOG

HIP: Contraception from ACOG on Vimeo.

HIP: Contraception from ACOG on Vimeo.

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Whenever I see women who are in the reproductive age, I try to remember to talk to them about birth control. Sometimes it's women who come in for an annual exam and they're specifically there for birth control, but even women that I see in the emergency room or I see on the postpartum ward after delivering a baby; those are all great candidates to talk to about birth control. We have a very high rate of unintended pregnancy in this country and I think if we thought more about mentioning birth control at every single opportunity at every single visit, we would do a much better job at trying to lower that rate. I also like to consider birth control as an emergency, sort of a public health emergency. So if somebody calls the office and they need birth control, we don't give them an appointment in 2 or 3 weeks, we give them an appointment right away, hopefully the same day, but at least within 2 or 3 days. So I think just the way that we respond to considering contraception at every visit and as quickly as possible could make a big change in our country.

I think it's also good to focus on the high risk women, young women who have had a pregnancy or two or older women that have had many pregnancies; those are the ones that may have had less success in being able to prevent pregnancy. And probably the best tools that we have to be able to help prevent pregnancy are the methods that we recommend. And the best methods are the long acting reversible contraceptives: IUDs and the contraceptive implant. In our country the most commonly used methods are sterilization, condoms, and birth control pills. So the two most commonly used reversible methods, condoms and birth control pills, have a very high difference between typical use and perfect use, so relatively high failure rates. Whereas, the IUD and the contraceptive implant are very, very effective and once they're inserted, women use them perfectly. So the major advantage of both of these methods, is that once they're inserted, there's no active maintenance that is required to keep them going. So they're very effective, they're very safe, and they're actually good for almost all women.

We've typically considered that young women or women who haven't had a baby are not good candidates for IUDs, but research would suggest that they are actually very good candidates for those methods. So when I talk to a teen about IUDs or the contraceptive implant, I try to get a sexual history and a contraceptive history. I try to ask open-ended questions to let her tell her story. And then I talk about the full range of methods, but I emphasize the long acting methods of IUDs and implants. IUDs are great for teens, again because they don't require ongoing maintenance, they have a great side effect profile, they can reduce bleeding and reduce cramping from heavy periods. The contraceptive implant is another great method; it doesn't require a pelvic exam, it lasts for three years, and although it does have the negative side effect of irregular bleeding, it does reduce cramping and overall has a very high continuation rate. I do stress particular to teens and young women that just because the method lasts for 3 or 5 or 10 years, that they don't have to use the method for that long; they can discontinue it at any time that they would like.

For older women the IUDs are also great, the 10 year, non-hormonal, cooper IUD can help a woman go from age 40-50 without having to use another contraceptive method and we can consider it almost a reversible sterilization because it's as effective as sterilization, but does not require the same type of procedure. So, both of these methods have very few negative side effects, they have very few complications, the IUD in particular has the highest user satisfaction rate of any contraception method, but both of the methods are number one and two on continuation and effectiveness. This is how I practice.


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