Version June 2024
| Phase of counseling | Provider question | Possible patient responses | Provider follow-up |
| Initiating the conversation | "Do you have a sense of what is important to you about your method?" | "I haven't really thought of that before. What do you mean?" | "Well, methods vary on a bunch of factors, like how you take them, effectiveness, and how they change your period. Can we talk a bit about how you feel about those?" |
| "I just don't want something that is going to change my period." | "Thanks for sharing that. Can you tell me more about what types of changes in your bleeding bother you?" | ||
| "I just want to get my depo shot and get out of here." | "Absolutely, if that is what you want, we can do that. Would you be interested in hearing about any other methods, just to make sure you know about all your options?" | ||
| Eliciting informed preferences | "Birth control methods can be taken by mouth, be a patch on your skin, be a ring in your vagina, be a shot, go inside your arm, or go inside your uterus. What do you think about those options?" | "I don't want something inside my body – I want to make sure that I can stop it at any time." | "Great, that's really helpful to know. Now I want to find out how you feel about how often you take your method." |
| "There are methods you take once a day, once a week, once a month, or even less frequently. Is that something that makes a big difference to you?" | "Any of those would be fine with me." | "Great – then that isn't something that will limit your choices." | |
| "While all methods prevent pregnancy for most women, there are differences in how frequently they prevent pregnancy. For some methods, 20 in 100 women get pregnant in a year, while for others, less than 1 in 100 women get pregnant. How important is effectiveness at preventing pregnancy to you?" | "It would be the end of the world for me if I got pregnant." | "Ok, I have noted that, and we can talk about that more after we review a few other method characteristics." | |
| "What I am most worried about is side effects." | "Thanks for telling me that. What side effects are you most worried about?" | ||
| "Most methods cause changes in your bleeding, with some making it lighter, others making it heavier or less regular, and some making it go away completely. How would you feel about those changes?" | "Having a lighter period sounds great, but I wouldn't want my period going away." | "Some women don't like the idea of not having a regular period for a range of reasons. But I do want to make sure you know that it is safe not to have a period when using these methods, in case safety is a concern for you." | |
| "What do you mean by less regular?" | "Great question. Some methods cause frequent bleeding either between periods, or instead of periods. How would you feel about that?" | ||
| "Can you tell me if there are any other side effects of birth control methods you are particularly worried about?" | "My friend told me the ring made her crazy." | "That's too bad your friend had that experience. I haven't heard of that before, and I can tell you it definitely doesn't happen frequently. In general, no contraceptive methods have an effect on mental health. Since everyone is different, I wouldn't expect the same thing that happened to your friend to happen to you. | |
| "Some birth control methods have benefits, such as decreasing acne, making period cramps less, or lowering your risk of cancer." Are any of those particularly important to you?" | "Well, I love the idea of a lower risk of cancer." | "Great. When we go over the methods, I can tell you which ones have this benefit, and you can see if that makes a difference for you." | |
| "Is it important to you that other people can't tell that you are using birth control?" | "Well, I just don't want my roommate to know about my private life." | "Ok, let's talk about what methods you would be able to keep private from your roommate." | |
| "When or if you might want to become pregnant in the future is something you want to consider in choosing a method. Do you think you want to become pregnant in the near future?" | "Definitely not for a few years, but then maybe." | "Ok, so permanent methods – like sterilization – won't be a good fit, but since no other methods affect your fertility in the long term, we can consider all of them." | |
| Facilitating decision making | "I have heard you say that an important thing to you is to use something that is the best at preventing pregnancy. Is that right?" | "Absolutely." | "Ok, given that you want to have children at some point, we can't consider sterilization. IUDs and implants are the most effective reversible methods. Is it okay if I tell you more about those?" |
| "You've told me that it is really important to you to not have to remember a method and that you want something that makes your acne better. Are these the most important things to you?" | "Yes, it would also be great if they could lower my risk of cancer like you mentioned." | "As you can see on this chart, unfortunately, the methods you don't have to think about – IUDs and implants – don't affect your acne. The pill, patch, and ring do help your acne and also lower your risk of ovarian and uterine cancer. What more information can I give you to help you think about these different types of methods?" | |
| "Given what you have said about wanting to have a regular, lighter period, do you want to focus just on the pill, patch, and ring, since those are the methods that have that effect on your bleeding?" | "Sure. But I forgot to mention that I really can't remember to take medicines on a regular basis." | "In that case, taking the pill, patch, or ring might be hard for you. Do you want to think about whether remembering something every week or every month – like the patch or the ring – would work for you? If not, we can talk about other methods and the effect they would have on your period." | |
| Making the final decision | "Given what we talked about, and what is important to you about your method, what do you think would be the best choice for you at this time?" | "I guess I will try the ring." | "Great, that seems like the best fit since it will make your period lighter. If you find it is too hard for you to remember to take it out every month – or want to change for any other reason – there are a lot of other options we can talk about, so please come back and we can talk other options." |
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