What goes into prescribing birth control pills?

Dear Scared and Confused,

It's natural to feel frightened when experiencing something new, especially when it involves something as personal as birth control or as private as a gynecological exam. It's great that you're seeking information about what’s involved to ease your concerns. During your appointment, the medical professional will likely ask you questions about your medical history and then conduct a physical and gynecological exam. This will provide them the information they need to recommend some birth control options for you. However, at the end of the day, after working with your health care provider, you will be the one deciding which birth control method is most appropriate for you.

The first visit typically starts with a discussion about your medical and sexual history. As with any general physical examination, your health care provider will check your blood pressure, listen to your heart and lungs with a stethoscope, and check your weight. The actual gynecological examination consists of a breast exam, abdominal exam, pelvic exam, and depending on your age, a Pap smear. After gathering all this information, you and your health care provider can discuss whether birth control pills are an appropriate option for you. It’s critical that people with a uterus or ovaries have these exams and discussions with their providers as they can reveal risk factors that make some forms of contraception a safer and more effective option for you.

After seeing a health care provider, if you decide that the pill is the right choice for you, they may prescribe a particular formulation based on your needs and interests in non-contraceptive benefits (e.g., acne control, pre-menstrual symptoms, etc.).There are many different brands and formulations of birth control pills, so your provider can adjust your prescription accordingly depending on any side effects that you may or may not experience in the first few months.

If you and your provider determine that the pill isn’t the best fit for you, you can discuss alternative forms of contraception, such as the ring, the patch, the shot, an IUD, the contraceptive implant, or barrier methods such as condoms and diaphragms. Although your health care provider can provide guidance, you will decide what method will best fulfill your pregnancy protection needs and your current lifestyle. Some questions to ask yourself to help make your decision include:

• How well will it fit into my current lifestyle? Will I find it convenient to take or use on a routine basis?
• How effective is it in preventing pregnancy?
• What are the side effects?
• How much will it cost?
• Will it help prevent sexually transmitted infections (STIs)?

If you still find yourself struggling to gather the courage to go for an exam, here are a few ideas that may help:

• Make a list of all the fears you can imagine and assess how realistic they may be. (Hint: Yes, you may feel a little discomfort during an exam, but no, your pubic hair is not a big deal.) 
• Talk with friends, especially those who’ve had a gynecological exam, about their fears and their experiences.
• Tell the provider about your fears or concerns — your list may help. They can explain any procedure in detail and discuss why different components of the exam are key for your health.
• Approach the exam as a learning experience. Sexual and reproductive health can be pretty interesting, so ask lots of questions! If you are learning more about your body and what the health care provider is doing, you may feel more at ease with the exam itself.

You're about to take a great step in your own health care; congratulations! Best of luck as you prepare for your visit,