UPDATE: CONTRACEPTION

Good counseling → informed choice → adherence and continuation

With all forms of progestin-only contraception, unpredictable bleeding occurs often and is the most common reason for method discontinuation.

Counseling that explicitly discusses the high likelihood of unpredictable menstrual bleeding allows women to prioritize this issue in their choice of a contraceptive.

Informed choice leads to a better continuation rate for progestin-only methods.

Seeking understanding. We lack full understanding of exactly what it is about changes in bleeding patterns that matter to women. Have definitions of bleeding and spotting that researchers utilize missed quality of life concerns that are more relevant to women? Are women concerned about how many days are spent avoiding sexual activity? Do religious restrictions figure prominently for some? How dissatisfied are they with days of cramping or bloating without bleeding? What do women want to know when they consider the bleeding patterns for their contraceptive options?

The answers to these questions likely vary from patient to patient—and that observation leads us back to grasping the art of contraceptive counseling: Our counseling needs to be concise, relatable, and honest.