Best prescription for birth control?

A fully informed decision.

Early In 2022, the American college of Obstetricians and Gynecologists (ACOG) issued new guidance related to contraceptive counseling. This new guidance places emphasis on the need for a patient-centered framework to help women achieve their reproductive goals.

A joint statement by ACOG’s Committee on Health Care for Underserved Women, Contraceptive Equity Expert Work Group, and Committee on Ethics states: “Counseling is an opportunity to solicit an individual’s values, preferences, and insight into what matters most to them as it relates to contraception.”

Among several others, this committee statement underscored two key imperatives:
  • Prioritize patients’ values, preferences, and lived experiences in the selection or discontinuation of a contraceptive method

  • Adhere to the recommended ethical approach of shared decision-making

There are several crucial aspects of decision-making when birth control options are being evaluated, and should reflect the woman’s involvement. A woman’s preferred method of birth control may change over her lifetime and be influenced by many factors.

For example:
  • Age and health history

  • Reproductive goals

  • Martial status, number of sexual partners, frequency of sexual activity

The best method of birth control for you is one that is safe, that you are comfortable using, and that you are able to use consistently and correctly.

It’s important for women to speak with their healthcare provider about their medical history and how it might affect their choice of birth control. Some important questions to ask your healthcare provider:

  • How can I determine which method of birth control is best for me?
  • How will hormonal birth control affect my body or health?
  • Will the hormonal birth control method I might select increase my risk for blood clots?
  • What role might my health history and family health history impact my choice of birth control?
  • Can I be tested to determine if I have any clotting condition that might increase my clotting risk?
  • Are there hormonal birth control options for me that have a lower dose of hormones?
  • What hormones are in the birth control options that might be safer than others?
  • Are there hormonal birth control pills with lower doses of estrogen that might be right for me?
  • Should I avoid any medications that might impact the effectiveness of the birth control pill?
  • Are there any side effects of hormonal birth control that I should be aware of?

Safety & Self-Screening Questionnaire

Safety is a key factor that should be emphasized during the decision-making process. Public health experts recommend that women consider their tolerance for the possible side effects associated with different methods of birth control. Some methods, such as hormonal birth control, pose more side effects — and potentially very serious side effects — than others.

Female pharmacist at window talking to woman

Pharmacist-Prescribed Contraceptives

Within the past several years, there has been a trend toward having a pharmacist, as opposed to a physician, provide contraception counseling and prescriptions. Oregon was the first state to legislate this policy, and today there are 17 states, as well as the District of Columbia, where pharmacists are allowed by state regulators to prescribe contraceptive care or contraceptive prescriptions. Similar legislation is presently pending in 14 additional states.

Each state has its own specific protocols that need to be followed by pharmacists, but the prescriptive authorities in each state have a standardized process that needs to be followed before a pharmacist can issue a prescription. This process is fairly standardized at the state level, and involves routine screening, counseling, documentation/reporting, and monitoring.

As part of this process, a screening questionnaire is required to confirm that each woman seeking a prescription for hormonal birth control meets CDC’s U.S. Medical Eligibility Criteria for Contraceptive Use.  The questionnaire used at the pharmacy level is fairly uniform from state to state, and adapted from the earliest self-screeners that were developed by medical and pharmacy experts in Oregon and California – the first two states to implement this type of legislation in 2016 – in collaboration with the public health experts from the Centers for Disease Control and Prevention.

If you are evaluating your birth control options, and will be obtaining your contraception prescription from you pharmacist, make sure to discuss all of your questions with them. They will require you to complete a risk assessment test to make sure that it is safe for you to be prescribed hormonal birth control, and they will discuss your safe birth control options with you.

Read more about blood clots and hormonal birth control here.