According to the Centers for Disease Control, 62 percent of American women of child-bearing age are currently using contraception. However, for women with certain medical conditions (see sidebar), traditional birth control methods may be dangerous to their health or have an increased risk of failure, leading to unwanted pregnancy. Jenny Robinson, M.D., MPH, from the Division of Family Planning at Johns Hopkins Bayview, explains how some women may benefit from complex contraceptive services:
What are complex contraceptive services?
Complex contraceptive services are for women who cannot use certain birth control methods due to health problems, who have had a bad reaction (i.e. persistent bleeding) to a particular contraceptive, or who may have had difficulty with IUD (intra-uterine device) or implant placement.
Many women think that the birth control pill is their only option. What they don’t realize is that there are so many other options that won’t interfere with their health and can also help them meet their family planning goals.
What can I expect when I see you for an appointment?
The first thing we do is go over your medical history. Do you have any health conditions that may make getting pregnant difficult or dangerous to your health? Are you on any medications that may make contraceptives less effective? Have you had any issues with birth control methods in the past?
Then, we talk about your goals for family planning. How long do you want to prevent pregnancy? When do you think you would like to become pregnant? What are your most important considerations in choosing a birth control method? For example, some women prefer to have a regular period each month, while other women prioritize how well a method works to prevent pregnancy, regardless of the effects on bleeding.
Once we get to know you and what you are looking for, we can talk about your options.
How is this different from an appointment with my Gyn/Ob?
Gynecologists and obstetricians are able to provide contraceptive counseling for most women; however, family planning providers are specially trained in addressing potential interactions between medical problems and birth control methods. The selection of a safe contraceptive is more challenging for women who have a history of a blood clot, are taking medications to control seizures, or who have uterine fibroids. Family planning providers also have extensive experience placing IUDs and implants, especially for women who may have had an unsuccessful attempt at placement
For more information or to schedule an appointment, call 410-550-9840.
Female Birth Control Options | Family Planning
Jenny Robinson, M.D., MPH, discusses the various types of contraceptives available to women who may not be able to use traditional birth control methods.
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My name is Jenny Robinson.
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I'm an OB/GYN at John Hopkins Bayview and I work
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in the Women's Center for Family Planning, which is a sub-specialty
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clinic that provides complex contraception care and also provides
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care for women facing either abnormal or unplanned pregnancies.
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Women who have high blood pressure, who have poorly controlled diabetes,
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or a seizure disorder, they might be taking medications that can impact
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how effective, for instance, the birth control pill might be.
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Or there can be women that having pregnancies might actually be
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detrimental to their health.
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So a woman who's had a history of a blood clot, for example,
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it would be really important for her to avoid pregnancy until
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she's ready to plan it and can do so safely.
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So that makes the choice of a safe and
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effective birth control method a little bit more complex.
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This is a chart that we often use when talking to
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patients about what their contraceptive options are.
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And it lays out all the different available contraceptive methods
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by efficacy.
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So the methods that you see at the very
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top are the most effective ones.
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So they have the lowest risk of failure,
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the lowest risk of an unplanned pregnancy.
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And those methods are the birth control implant,
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the different versions of the IUD, or
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sterilization, which is obviously permanent, so not necessarily
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gonna meet the needs of somebody who does want future pregnancies.
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The next tier down are other reversible methods,
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which are more shorter acting.
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So things like the Depo Provera shot, the birth control pill,
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the contraceptive patch, the vaginal ring, or the diaphragm,
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which is a barrier method.
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And then, the bottom tier are the ones that have the highest
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failure rate.
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So those are methods such as male and female condoms, spermicide,
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withdrawal, or periodic abstinence.
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So this is an example of one of the intrauterine devices,
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which is a long-acting reversible birth control method.
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This is the copper IUD, which is approved for use for
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up to ten years.
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So it's a nice option for
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women who want a long-acting birth control method, but
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don't wanna take away the option of having children in the future.
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It's also a really nice method for women who want to avoid hormones,
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since there's no hormone that's part of this IUD.
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The way it prevents from pregnancy is the copper actually interferes
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with how sperm are able to fertilize an egg.
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So it doesn't change a woman's menstrual cycle and
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there's no hormones in it whatsoever.
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So if a woman has a medical reason why it would be unsafe for
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her to use hormones, this might be a nice option for her.
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So other options within the family of intrauterine devices
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are the hormonal IUD.
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And there's currently two that are available.
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One was designed for use for up to five years and
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the other is designed for use for up to three years.
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The major difference is the dose of hormone that's present in the IUD.
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So the one that last for five years has a higher dose.
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And the one that lasts only for three years,
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is a little bit smaller.
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So it's been specifically designed for
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women who've never been pregnant before.
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But both are options for women who have or have not been pregnant.
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And the benefit of the hormone in the IUD is it tends to make
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periods both shorter and lighter and less crampy.
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So, not only do they provide really excellent pregnancy prevention, but
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they can also treat conditions like heavy periods or painful periods.
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This is the birth control implant, which also has a hormone in it.
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It's designed for use for up to three years.
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And this is just a little flexible plastic rod that releases
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the hormones slowly.
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The rod is placed under the skin of the upper arm.
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So it's not visible, but it should be palpable.
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So if a woman were to run her finger over the area where the implant is,
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she can feel it.
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It's another example of forgettable birth control.
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Once it's placed, you don't have to do anything else.
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It's just there doing its job.
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It can also reduce the amount of bleeding that a woman has during
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her period,
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although it can cause a person's periods to become irregular.
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But it's very, very effective with a relatively low side effect profile.
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So it's a nice option, again, for someone who's looking for
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a long-acting but reversible birth control option.
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This is an example of the contraceptive vaginal ring.
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So it falls in the same category as the birth control pill.
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It has a similar combination of hormones in it as the pill,
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which means it contains both estrogen and progesterone.
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But instead of a pill that you have to take every day,
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the ring is placed in the vagina just once a month.
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So it's a little bit easier to manage if somebody is having a hard
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time remembering a daily pill.
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So the hormones get released into the vagina,
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it's a very effective way of avoiding pregnancy and
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has the same kinds of effects on periods as the pill does.
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So it tends to make periods very predictable, and
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also tends to reduce bleeding.
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And it's really flexible.
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I mean, some people get a little nervous about the idea of
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placing and then removing the ring themselves,
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which is how it's designed to be used.
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But it's actually very easy to place and then take out.
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This is the updated version of the diaphragm,
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which is a barrier birth control method.
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So in the past, when women wanted to use the diaphragm it usually meant
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coming into the office for a pelvic exam and
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been fitted with a diaphragm of the appropriate size.
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This version has been redesigned so
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that one size will fit most women whether or not they have had a baby.
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So it makes the act of getting the diaphragm a little bit easier.
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And basically, it's designed to be used with a spermicidal gel.
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So you place the spermicidal gel on the inside cup of the diaphragm, and
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then the diaphragm gets placed in the vagina so
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that it creates a physical barrier between the cervix and the uterus,
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and the vagina.
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So that sperm are blocked from being able to get inside the upper part of
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the female reproductive tract.
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So in our clinic,
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we do accept most insurance plans including Maryland Medicaid.
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And most insurance plans do cover all of these contraceptive options,
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including the long-acting reversible devices like the IUD and
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the implant.
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Some insurances, in the past, have required prior authorizations.
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So patients would have to fill out an additional form before being
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able to get the IUD.
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But we've been able to streamline the process, a lot of times, so
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that people can come in, have a visit with one of us, if they select
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to use an implant or an IUD, very often we can place it the same day.
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So it makes things a little bit more convenient.
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It doesn't require people to come back at a later date.
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