Navigating the hormonal contraceptive counseling session
By Carly Harsha
You are working at your community pharmacy and a patient considering hormonal contraceptives approaches. She asks for help in determining which option would be the best fit for her. This scenario reflects an opportunity for pharmacists to help improve patient access and education on hormonal contraceptives. Such improvements are needed, according to a 2011 study published in Contraception that suggested 49% of pregnancies in 2006 were unintended.
Fortunately, there is a growing trend of allowing pharmacists to help with education and provide hormonal contraceptives, and it is important to understand the counseling considerations that go into providing this care.
The trust factor
The most important part of your patient–pharmacist relationship is trust, which entails building rapport and providing accurate and personalized information. It is okay to ask your patient for a moment so you can double check information before giving an answer. Such honest interactions help build trust, as does practicing empathy while listening to your patient’s concerns.
Use the skill of active listening by considering your patient’s needs and building your questions around her concerns and health history. Body language is another very important aspect of your communication. Convey openness and attention by putting down other paperwork, uncrossing your arms, and ensuring that you make eye contact and nod appropriately. Think about the environment of your consultation window as well and use the pharmacy area to arrange a private space if necessary.
Your goal is to help the patient select a hormonal contraceptive option that is efficacious, satisfies her needs, and will encourage long-term adherence. You can apply the Pharmacists’ Patient Care Process (see Figure 1) from the Joint Commission of Pharmacy Practitioners to these conversations.
Selection is lifestyle driven
Knowing the many options for contraception is just as important as the conversation style. Selecting the best method is lifestyle driven. In the pharmacy curriculum, student pharmacists learn to understand medications in order to weigh advantages and disadvantages. Hormonal contraceptive options include combined oral contraceptives (COC), vaginal contraceptive rings, intrauterine devices, implantable devices, transdermal contraceptives, and injectable hormonal contraceptives. Understanding how each product affects phases of the menstrual cycle and understanding the adverse effects of progestin and estrogen allows pharmacists to suggest products that might have benefits for patients in addition to contraception.
A large selection leads to many considerations. COC options with lower doses of ethinylestradiol provide cycle control with less metabolic effects. For example, as noted in a 2016 Human Reproduction Update article, a patient with a family history of diabetes or obesity would benefit from a pill with lower effect on increased insulin resistance. Selecting a third or fourth generation COC with less androgenic progestins provides a decrease in acne and hirsutism. A well-known benefit of using COCs in general is the reduction or elimination of dysmenorrhea. A patient may prefer to have her period monthly but others may prefer a COC where they only experience a period four times a year. When considering implantable and intrauterine devices, skipping pills all together could be very beneficial for a patient struggling with pill burden. These options can last 3 to 5 years and are safe while breastfeeding.
By following these discussion points, you can help women feel better about their contraception method, which will lead to greater satisfaction and increased adherence.
Take the initiative
Lastly, you must not forget to use resources! APhA provides a training course titled, “Increasing Access to Hormonal Contraceptive Products.” Also, CDC offers a large selection of downloadable guides and applications. Check out www.cdc.gov/reproductivehealth/contraception/index.htm for more information.
Take the initiative today to expand your hormonal contraceptive information base and provide the exceptional patient counseling that will increase accessibility in your community.