Contraception Care and Counseling – PediaCast CME 112
Podcast: Download
Subscribe: RSS
Show Notes
Description
Dr Elise Berlan and Jo Taylor visit the studio as we explore contraception care and counseling… for teenagers. Discover evidence-based updates from the AAP and CDC, effective counseling strategies, and tackling misinformation online. We hope you can join us!
Instructions to obtain CME/CE (/FD-ED) Credit
- Read this information page.
- Listen to the podcast.
- Complete the post-test at Nationwide Children’s CloudCME.
- CME credit expires 3 years from this episode’s release date.
- You can view your transcript and print a certificate of completion at Cloud CME.
- Need help creating a Cloud CME account? Click Here.
- Still have questions? Contact CMEOffice@nationwidechildrens.org
Topic
Contraception Care and Counseling
Presenters
Dr Mike Patrick
PediaCast and PediaCast CME
Nationwide Children’s Hospital
Dr Elise Berlan
Adolescent Medicine Physician
Nationwide Children’s Hospital
Jo Taylor
Adolescent Medicine Nurse Practitioner
Nationwide Children’s Hospital
Learning Objectives
At the end of this activity, participants should be able to:
- Explain the importance of integrating adolescent sexual and reproductive health into pediatric primary care.
- Apply patient-centered counseling techniques to support adolescent contraceptive decision-making.
- Evaluate contraceptive options using updated CDC and AAP guidelines.
- Develop strategies to address misinformation and improve equitable access to contraception for adolescents.
Links
Adolescent Medicine at Nationwide Children’s Hospital
Young Women’s Contraceptive Service Program (BC4Teens)
Contraception Provider Tools (CDC)
U.S. Medical Eligibility Criteria for Contraceptive Use (CDC)
U.S. Selected Practice Recommendations for Contraceptive Use (CDC)
Contraceptive Counseling and Methods for Adolescents: Clinical Report (AAP)
Contraception for Adolescents: Policy Statement (AAP)
Confidentiality in the Care of Adolescents: Policy Statement (AAP)
Confidentiality in the Care of Adolescents: Technical Report (AAP)
Clinical Training Center for Sexual + Reproductive Health
Reproductive Health National Training Center
Birth Control Options (Bedsider)
Practice Tool: Prescribing Guidelines for Prescription Contraceptives (NCH)
Practice Tool: Hello Options
Birth Control: What’s Important to You? Flip Chart (UCSF)
Birth Control Methods. Where Do They Go?
Reproductive Health Hotline (ReproHH) (UCSF): 1-844-737-7644
Disclosure Statement
No one in a position to control content has any relationships with ACCME-defined ineligible companies.
Commercial Support
Nationwide Children’s has not received any commercial support for this activity.
CME/CE Accreditation Statement
In support of improving patient care, Nationwide Children's Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the American Nurses Credentialing Center (ANCC), and the Accreditation Council for Pharmacy Education (ACPE), to provide continuing medical education for the healthcare team.
AMA Statement
The Nationwide Children's Hospital designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
AAPA Statement
Nationwide Children's Hospital has been authorized by the American Academy of Physician Associates (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation.
APA Statement
Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibility for the content of the programs. Nationwide Children's Hospital designates this activity for 1.0 continuing education credits.
ASWB Statement
As a Jointly Accredited Organization, Nationwide Children's Hospital is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. Regulatory boards are the final authority on courses accepted for continuing education credit. Social workers completing this course receive 1.0 general continuing education credits.
ADA CERP Statement
Nationwide Children’s Hospital is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to the Commission for Continuing Education Provider Recognition at CCEPR.ADA.org. Nationwide Children’s Hospital designates this activity for 1.0 continuing education credit.
Contact Us
CMEOffice@nationwidechildrens.org
Episode Transcript
[Dr Mike Patrick]
This episode of PediaCast CME is brought to you by Adolescent Medicine at Nationwide Children's Hospital.
Music
[Dr Mike Patrick]
Hello everyone, and welcome once again to PediaCast CME. We are a pediatric podcast for healthcare providers.
This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It's episode 112.
We're calling this one contraception care and counseling. I want to welcome all of you to the program. So, we have an important episode for you this week as we consider patient-centered contraceptive care and counseling for teenagers.
And it's a little different than you may have learned to do when you were in pediatric residency or whatever other training program that you were involved with. Probably the contraception care that you gave, if there was any in your training, was more efficacy-based. We're going to recommend the things that work the best, but the things that work the best might not always be the thing that is best for a particular teenager and or their family.
And so, we want to talk about patient-centered contraceptive care and counseling for teenagers. And of course, we have a couple of really fantastic guests this week to help us do that. Dr. Elise Berlan, she is an adolescent medicine physician at Nationwide Children's. And Jo Taylor, who is an adolescent medicine nurse practitioner who does lots of counseling with teenagers and their families, again, at Nationwide Children's Hospital. So, both of them are going to be here. We're going to chat about new contraception options.
We last did an episode on this about 10 years ago, a really long time ago. And we're going to talk about what's new in the world of contraception care for teenagers. We will talk a lot more about patient-centered counseling strategies and ideas for addressing myths and misinformation in the age of social media.
We're also going to explore evidence-based updates for clinicians, including the latest guidance from the American Academy of Pediatrics and the U.S. Centers for Disease Control and Prevention. So, lots coming your way. Before we get to our guests, I do want to remind you that you can obtain free Category 1 CME credit for listening to this episode.
Really easy to claim that. Just head over to the show notes for this episode at pdacastcme.org. It's episode 112.
You'll find a link to the post-test in the show notes. Follow that link to Cloud CME. If you don't have an account, you'll need to sign up for an account.
It's free. And then once you're inside, you're going to click on the materials tab for this program. Taken past the post-test and the Category 1 credit is yours.
And we do offer credit to physicians, of course, but also nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists. And since Nationwide Children's is jointly accredited by all of those organizations, it's likely we offer the exact credit you need to fulfill your state's continuing medical education requirements. Of course, you want to be sure the content of this episode matches your scope of practice.
Complete details are available at pdacastcme.org. Also, I want to remind you the information presented in this episode is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals.
Also, your use of this audio program is subject to the PediaCast CME Terms of Use Agreement, which you can find at pdacastcme.org. So, let's take a quick break. We'll get our experts settled into the studio.
And then we will be back to talk about patient-centered contraception care and counseling for teenagers. It's coming up right after this.
Music
[Dr Mike Patrick]
Dr. Elise Berlan is an adolescent medicine physician at Nationwide Children's Hospital and a professor of pediatrics at the Ohio State University College of Medicine. Jo Taylor is an adolescent nurse practitioner at Nationwide Children's. Both have a passion for providing contraception support to teenagers and their families and supporting primary care providers as they incorporate contraception care into their practice. That is what they are here to discuss, patient-centered contraception care and counseling.
Before we dive into this important topic, let's offer a warm PediaCast CME welcome to our guests. Elise and Jo, thank you both for stopping by today.
[Dr Elise Berlan]
Mike, it's so great to be here. Thanks for having us.
[Jo Taylor]
Happy to be here. Thank you.
[Dr Mike Patrick]
Yeah, we are really glad that both of you were able to make it too. I know you both have very busy schedules, and we were able to find a time to record, and I'm really excited about it. So, Elise, let's start with you.
Why is sexual and reproductive health, including contraception, really an essential part of pediatric primary care?
[Dr Elise Berlan]
Yeah, this is such a great question. And, you know, when we think about children and adolescents, you know, many adolescents grow up having been seen by a pediatrician and being cared for in a pediatric medical home. Those are folks that know them, that understand the developmental nature of pediatrics.
And young people really do trust their pediatricians and their pediatric health providers for knowledge about sexual and reproductive health care. And believe it or not, they want to have very sensitive conversations with their pediatricians and actually feel much more satisfied when they have the time to do that. So, you know, adolescents have so many barriers to accessing contraception care, logistics, finance, confidentiality.
We can talk a little bit about that. Really meeting their needs when they're being seen is the best way to make sure they get the care that they need.
[Dr Mike Patrick]
Yeah. Yeah, so important. And to help with that care, and I know we're going to talk a lot about it today, but right out of the gate, I do want to mention that the American Academy of Pediatrics has a contraception policy statement.
And then also a technical report, which kind of fills in more of the details and the thinking behind the policy statement. And we will put links to those in the show notes over at pediacastcme.org. This is episode 112, so you'll find it in the show notes there.
But if you could just give us sort of a summary, what do these things add? The recent policy statement and the technical report, why is it going to be important for primary care physicians to check those out?
[Dr Elise Berlan]
Yeah, no, thank you so much for that question. So, in July of 2025, the American Academy of Pediatrics updated their contraception policy statement and technical report. The most recent prior to that had been 2014.
So, it really had been quite some time since they had done an update. I think the most important change, and my colleague Jo will talk about this, I think, later on in the podcast, is really centering on adolescent needs. You know, thinking about what are adolescents' priorities.
And the documents really help support the pediatrician to do counseling that's very patient-centered and focuses on shared decision-making. Before this, the thinking when the previous document was written, the 2014 document, was really on how effective a contraceptive is and really focusing on efficacy-based counseling. You know, assuming that that was the most important to everybody.
And, you know, we have really become more centered in reproductive justice and really understanding that people have a variety of preferences and values. And the work that we put into aligning with those preferences and values really helps a person pick a contraceptive method that is really the best for them, as opposed to thinking about what do we think is the best for them. And I think that is a really big change that the American Academy of Pediatrics has embraced and is recommending for pediatricians.
[Dr Mike Patrick]
So, on the surface, that seems easy enough to do. You know, hey, here's the options, I'll tell you about them, what questions do you have, and then I'm going to support whatever decision you make. But if we do have preconceived notions, it could be easy, as we're presenting all those options, to make some sound better than others.
And, you know, we all do that to some degree because we're after improving health literacy and changing behaviors and improving outcomes. And so, we do get an idea of what is best for patients. And so, we really need to be on the lookout for that within ourselves, right?
I mean, that's harder to do than it is to explain.
[Dr Elise Berlan]
It is so true. And, you know, we have biases that are explicit, right? I can tell you I've got A, B, C, D, like biases that, you know, I am aware of in myself.
We all have biases that are implicit as well that we're maybe not so aware of that can come out in something as nuanced as contraceptive counseling. So really, part of the approach is really kind of some self-examination about what our biases are and just being aware and, you know, doing our best to lead a discussion with a young person and their caregivers that focuses on what's important to them and not what's important to us.
[Dr Mike Patrick]
Yeah. Yeah. So important.
Jo, so from a practical standpoint, you do a lot of contraception counseling with teens and families. How has your approach to counseling sort of shifted to a more patient-centered approach?
[Jo Taylor]
Yeah. Thank you for that question. So, I would say about five or 10 years ago, we started to shift away from that model that Dr. Berlan talked about. So that efficacy or tier-based model, which involved presenting the most effective methods, oftentimes in a more positive light than the other methods. So, we would see them at the top of a contraceptive menu. We might see them brighter and larger.
That approach truly made pregnancy prevention the sole focus instead of what made that patient unique and what their individual goals were. We really look at that kind of counseling as coercive because it put pressure on patients to choose the most effective methods. So, we've shifted to this patient-centered model, which explores individual goals and preferences, which can be any number of attributes outside of efficacy.
So, it could be things like side effects, privacy, cost, what transportation entails getting the method. Because we know that patients value the experience on a method much more so over efficacy. Now, not all patients.
Some patients want the most effective method still. But many patients look to what the experience is. And we know that preferences related to contraception are unique.
There are a couple of what I would call key questions that we use to drill down on those preferences. One of the ones that we use quite a bit is what's important to you in a method. Now, sometimes adolescents don't know the answer to that question.
So, we have other questions that we use. One is, what would you like your birth control to do for you? So, we ask that quite a bit.
And that really starts the conversation. So, it's a much more collaborative process as opposed to provider or counselor or nurse led. It's characterized by shared decision making, like Dr. Berlan mentioned. And also, it's an opportunity for adolescents to be part, an interactive part of their care, sometimes for the first time.
[Dr Mike Patrick]
Yeah, yeah, absolutely. Do you find as you're having these conversations, is this something that as a primary care practitioner, would you recommend this sort of begin with the parent in the room or with the parent outside of the room? And so, we're talking a little bit about privacy, but I think this whole counseling session, who is involved with that?
[Jo Taylor]
Yes, this is an important question. So one-on-one time is really important with adolescents because we know that confidentiality is important to them. We've seen that time and time again.
We've heard that many times. And if there isn't confidentiality or it's not discussed or addressed, then some teens don't seek care when they need it. And so, our recommendation is to talk about confidentiality early in the visit to include the family in that discussion to set the expectations.
You know, to say this is how a visit in our clinic looks. We'll spend some time together talking about what both brought you to this visit today. And then mom or dad or caregiver will ask you to step out and we'll have a conversation together.
That is a really successful model. We find that that works really well. It's also important to frame that conversation as private and not secret.
But teens are much more likely to divulge sensitive information if they have that one-on-one time with their provider. And that's endorsed by all of the national organizations, including the AAP. So, making that a standard part of your practice, particularly when it comes to sexual and reproductive health, is critical.
[Dr Elise Berlan]
One thing that I would add would be this is where we shine as pediatric health care providers. You know, the developmental aspects of young people are very familiar to us. You know, we know that counseling a 13-year-old about birth control, you know, a person who has no experience, you know, has never considered possibly using a birth control method.
And it may be for something, as Jo mentioned, like a non-contraceptive purpose, like many young people have cramps, have acne, have PCOS. So, there's a tremendous number of reasons that a young person may want to use a contraceptive. And I think the pediatrician is really familiar with these conversations that differ by developmental stage.
So, you know, talking with a 13-year-old is really different than talking to a 19-year-old who may have previously been on contraceptives and maybe sexually experienced. So, I just really think that's part of why these conversations really belong in the pediatric home, because these are the nuances that we really know how to manage. And really, you know, conversations alone with the young person are recommended by Bright Futures starting around age 11.
So really normalizing time alone with the pediatrician is very important. And we know pediatricians really struggle in this area, and it is really so critical for identifying a young person's sexual and reproductive health needs, as well as other, you know, sensitive needs.
[Dr Mike Patrick]
Yeah, yeah. You know, you kind of answered a couple of questions I had as we were going along, but they're really important questions. One is, you know, when do you start, you know, having alone time with your adolescent patients?
So around age 11. So that's kind of the seventh grade. You know, you're doing the Tdap and, you know, making sure their immunizations are all up to date at that point.
So that's kind of a milestone one where it may be easy to say, okay, starting now, I'm really going to do this. And the reason I say that that's kind of an important decision in your practice is because a lot of us, especially if you've been in practice a while, you might have a really busy practice. And if you're looking to cut a little time in your schedule so the waiting room's not as busy, people aren't waiting quite as long, it seems like, especially if things seem to be going fine, you know, you're not expecting any issues, which, you know, we all get surprised by that.
But you may not be expecting anything. And so, if you're going to take a shortcut somewhere, it may be that piece of it. And yet it really is important and you're doing your patients and your families a disservice by not incorporating that into your teenage, especially their well check visits, their sports, physicals, those sorts of things.
As we're having these conversations, Jo, are there some resources that we can use, sort of decision aids that we can have available? And where do we find those to share with our teenagers?
[Jo Taylor]
Yes, there is a broad range of high-quality decision aids that are available to support different learning styles, levels of literacy, and also development. And we use these decision aids to highlight the differences among options that may best align with someone's goals. It allows both the counselor and the family to provide information and also learn information.
So, it bridges knowledge gaps that families and teens may have. So, there are contraceptive menus that are available that are arranged in different ways based on how you use them, what side effects they may have, also efficacy. There are tactile aids or models, so we may have anatomy models.
And then some of the contraceptive menus have body maps, which is important for teens to understand where these methods go and how do they use them. But there are some noteworthy aids that I would like to call out. So Bedsider and UCSF has a flip chart that's categorized by method attributes, and it's titled What's Important to You.
So, if you go to the Bedsider website, you can find it. That's a great tool to use in clinic. Also, the University of Chicago has had a project called Hello Options.
Actually, this tool is designed by teens. They use the principles of human-centered design, but it looks like a key chain, and it has real-size models of all of the contraceptive methods. Teens love this because they can hold the method.
They can see the actual size. It leads to greater understanding of the methods themselves. And then another menu that I know we called out in the show notes was one from CAI Global called Where Does Birth Control Go?
And although it's a paper menu, it has a body map that includes different body types, sizes, skin tones, and there's even a teen that has a disability represented. So that's also a nice menu for younger adolescents.
[Dr Mike Patrick]
Yeah, and we will put links in the show notes to all of these things that you've been talking about so folks can find them easily because it really can be helpful to have those. Because it is also difficult for the teen to remember everything that you're saying as you go along. They have to really be paying attention.
And we do know also that if you have the audio and vision as you're going through something, you're going to catch more people who may have different styles of learning and interacting with resources. And so having a visual aid along with your descriptions as you're talking can be very helpful. And again, we'll have links in the show notes for those.
Elise, in addition to the American Academy of Pediatrics, the CDC also has practice recommendations. And there was a document released last year in 2024, the U.S. Medical Eligibility Criteria and Select Practice Recommendations. And they had some things to say about contraception care in adolescents.
What's included in their recommendations?
[Dr Elise Berlan]
Yeah, the Centers for Disease Control for a number of years has had some documents available. They're available. You can go online and order some kind of print documents.
You can print out a PDF of these documents. There's actually a wonderful app. If people go on their smartphone, whether it's Google or Apple, and they enter CDC and contraception, they'll get a free app.
You know, the purpose of these two documents, which are the Medical Eligibility Criteria and the Select Practice Recommendations, the purpose of the Medical Eligibility Criteria is actually to facilitate the safe use of contraceptives and really to remove barriers that people may have about questions about medical eligibility. So, for example, a health care provider might think, well, gosh, I remember there was a thing about migraines with aura with combination birth control pills. Let me check that.
Or what about a medication interaction? Or what about chronic kidney disease? You know, so there are certainly a number of conditions that bear heavily on safety of contraceptive use.
So, the Medical Eligibility Criteria is really fantastic to simplify these decisions. And the Select Practice Recommendations is more kind of an FAQ about, well, how do we provide contraceptive care safely? So, it goes over, you know, these are the questions you should ask.
These are the tests you should do. This is the follow-up that's recommended for XYZ method. So very, very practical, you know, documents and tools.
I wanted to share a couple updates. Most of the updates, I will say, were not as relevant to adolescents specifically, but kind of broadly applicable. I think the most important and relevant to my practice taking care of adolescents is some changes around recommendations for Depo-Provera.
And so there has been research that's come to light and that was examined very carefully that demonstrates a little bit of an increased risk for blood clots for people using Depo-Provera compared to non-users. And this research has become available since the previous version of this document. And so, the CDC changed recommendations around Depo-Provera use to provide some caution in people for use with people who have conditions that increase their risk for blood clots already.
So without going through the laundry list of all of the conditions, I would just kind of call out that if people are interested in Depo-Provera and may have some conditions like, we'll say, sickle cell disease or an inherited thrombophilia or maybe other multiple conditions such as history of a DVT with some other high-risk conditions, their recommendations for Depo now are more cautioned and it's good for the providers to have that information so that they can counsel people around the safe use of the method. I will say that these guidance documents are intended as tools.
They are not rules. So, they are intended to inform shared decision-making so that the healthcare provider can really share the risks and the benefits and kind of go through that counseling with a patient. But they are really intended to inform that type of medical decision-making as we make for our peers.
So, you know, I have been practicing for a long time now, and I do really think, to Jo's point, we really need to be patient centered. And ultimately, any of these contraceptives used are actually safer than the health risk of pregnancy. I think that's, you know, that's something that I share with my patients a lot.
So, for example, we know that using combination hormonal contraceptives has, for users, there's a small increased risk of blood clots. Comparatively, it is actually a much lower risk than if that patient were to be pregnant. So, again, it's really important for providers to be informed about the risks, which these documents do a really great job.
I'm also going to share that there are, I think, an important change in the select practice recommendations around using medications to help with pain with IUD reduction. We know there is a lot of concern, particularly in social media, around pain with IUD insertion. And we, you know, in the clinical setting are, you know, talking to patients a lot and really validating people's experience with pain during IUD insertion.
The CDC looked at the evidence and now recommends considering use of anesthetic during IUD insertion, which is a change to what they are included. They are including now kind of injectable anesthesia like a paracervical block or some topical anesthesia like EMLA or topical lidocaine or something like that. So, there are now some tools that healthcare providers can use to kind of ease the comfort more during IUD insertion.
And so, I think, you know, for our listeners who might not be placing IUD themselves but maybe talking to adolescents and young people about IUDs, I think letting them know that there are approaches that have been shown to reduce pain during IUD insertion is a way to reduce the barrier to that method.
[Dr Mike Patrick]
And we will put links to the CDC's U.S. medical eligibility criteria and their select practice recommendations, again, in the show notes so folks can check those out for themselves. We do have an over-the-counter contraception pill now called Opill. Elyse, can you tell us about that and how is that changing things in your practice?
[Dr Elise Berlan]
Yeah, thank you. And I should disclose I was actually on the FDA panel that reviewed this. So, I've been aware of this product for some time and actually the panel unanimously supported the use of this product.
And the FDA in July 2023 approved a product called Opill. And the Opill is a progestin-only pill. It's a really safe contraceptive method.
And what is really unique, this is the first time in the U.S. that we have had an over-the-counter contraceptive medication available. And it's available to people of all ages. It is available online.
It's available wherever people buy over-the-counter medications such as a drugstore, big box store, etc. We know that because of the access barriers adolescents have that many do not use a contraceptive. And the most recent study that the CDC did around young people and contraceptive use found that only one-third of sexually active adolescents used a hormonal contraceptive, which is the most effective contraceptive, the last time they had sex.
And so, the hope is that really opening access via over-the-counter products such as a birth control pill will really help adolescents have access and other people have access who have diminished access to healthcare.
[Dr Mike Patrick]
Is this a product that could be used as advised by physicians? So, in other words, there are other reasons that we may want to use oral contraceptives. You had mentioned, you know, like acne, for example, heavy menstrual periods.
Is this something that could be used or is it going to be better to stick with a prescription one?
[Dr Elise Berlan]
That's a good question. And there are a lot of people who have medical contraindication to using a combination hormonal contraceptive that has estrogen in it. And, you know, that would be I think the most common one I see in my practice is migraine with aura.
So, lots of folks have migraine with aura. And that is what the CDC considers an absolute contraindication to using a product, a contraceptive with estrogen in it. And so, in those circumstances, we think about using progestin-only products.
For people who want pills, there are two types of prescription pills available right now. The over-the-counter pill is very similar to a prescription product. But I think it's interesting.
I think if you're counseling someone in your office and you have the ability to write a contraceptive prescription, I think most of the time it probably is more facilitative to write a prescription so that potentially the insurance is going to cover it. So that's kind of come to an end. There are some issues around insurance coverage with the over-the-counter product, and I don't think it's been worked out very well.
So, I think if you have a patient in particular who has insurance, then using a prescription product is probably a better way to go. But for example, if someone doesn't have insurance or there are other access issues, and this is a product that would fit their needs well, whether contraceptively or kind of for medical reasons, certainly it would be recommended for them to use it as well.
[Dr Mike Patrick]
Do we have an idea of how much it costs over the counter?
[Dr Elise Berlan]
Yeah, the last time I checked, there appears to be a sliding kind of a scale that changes based on how many products you purchase. When the product was launched, it cost about $20 a month. And then if you get more months in a pack, you get a discount.
There also is a service by the company to provide a discount. And so, patients can look online and find the number or apply online for a discount from the company.
[Dr Mike Patrick]
Might get a discount code, and you can order it online with your discount code.
[Jo Taylor]
Yeah.
[Dr Mike Patrick]
And then what are some newer prescription methods that are available in the last few years? We did a contraception update together, you and I, on this podcast, but it was a number of years ago.
[Dr Elise Berlan]
Yeah.
[Dr Mike Patrick]
And I think there probably are some new things available.
[Dr Elise Berlan]
Yeah, yeah. So, the most, I think, relevant one came out several years ago. And there is a new, kind of to your point about progestin-only pills and why would you pick one or the other.
There's a new progestin-only pill. So, for a lot of people, you might think of that as like a quote-unquote mini pill. So, there's a new progestin-only pill that's called SLYND.
It's S-L-Y-N-D. The generic for this product is that it's a drospirenone progestin pill. It has four milligrams of drospirenone in it.
And people may ask, well, why is this relevant to their practice? So, this particular progestin-only pill works more like a combination hormonal contraceptive in that it suppresses ovulation much of the time. And so, you don't have to be so finicky exactly about taking it at a specific time.
It's a little bit more forgiving than the norethindrone mini pill that we had for the last 40 years. So, this is a new progestin-only pill. To be clear, we still do recommend people take it with as much precision as possible at the same time of every day.
But this pill is a little bit more forgiving. And so, we have been prescribing this much more for our adolescents and really finding that they're quite happy with it. The bleeding control with any progestin product can be a little irregular, but it does appear to be quite acceptable to young people.
[Dr Mike Patrick]
Good, good. And what's the name of that one again?
[Dr Elise Berlan]
This one again, the trade name is Slynd. And then the generic, excuse me, it's not available generic yet, but the hormone inside of it is drospirenone. There's a couple more I'll tell you about just really quick.
There is a new contraceptive patch. So, for the last however many decades, we've had one type of contraceptive patch. And now there is another patch that's called Twirla.
And this new patch has a different type of progestin in it. Otherwise, it is very similar to the previous patch. I will say that some of my patients have a hard time with the patch that we've had for a long time sticking to them.
And this new patch appears to be a little stickier. It's kind of more like a fabric Band-Aid. And so, I am using this new patch, you know, similarly to the old weekly contraceptive patch, but in particular when people have problems with kind of adherence of the patch.
So yeah, those are I think the main updates I have for you.
[Dr Mike Patrick]
Are there any, so, and this I think is also important to bring up, especially, well, it's important to bring up regardless, but for folks who might be getting Opill, it's still going to be important to talk about the fact that the oral contraceptives do not protect you against sexually transmitted infections. So that's something, even if they're getting their contraception on their own, it's still something we need to talk about in the exam room. And along those lines then, some folks don't want a hormonal approach.
So, if we're talking patient-centered care, that may be something that they don't want to do. Are there any non-hormonal methods other than barrier-like condoms that you would suggest?
[Dr Elise Berlan]
There are some non-hormonal methods. The most effective one is actually a copper IUD. And there's now a new copper IUD that's coming onto the market.
The ParaGard is the one that we've had for many decades, and it is actually among the most effective contraceptives. It's reversible, it's safe, and it has no hormones. And so that is a great option for someone who wants really a no-hormone approach.
There's also a brand-new product that's called Phexxi. I'll spell it for you. It's P-H-E-X-X-I.
It is a prescription vaginal gel that is not a spermicide, but it's more like a sperm incapacitator. It acts by acidifying the vaginal area, and that's a prescription product. I have found, though, I was really excited about this product, but it is not appearing to be covered well by insurance in the market I work in.
And so, it may be cost prohibitive, but certainly an option for people. I really do think condoms are available in drugstores, in lots of places. Back to one of your points earlier, really counseling patients about the importance of condom use, because condoms, if they're used correctly, are extremely effective.
But young people need to use condoms through the whole time of having sex, a new condom every time, and making sure they have condoms on hand and can talk to their partners about condoms. So, I really think condoms are kind of the foundation of when we think about sexual health for young people, provide some contraception, and very importantly, a way to prevent the transmission of sexually transmitted infections.
[Dr Mike Patrick]
Speaking of information that folks may get online, some of it evidence-based and trustworthy information, and then there's a lot of myths and misinformation out there as well. Jo, what are some of the things as you're counseling teenagers, what are some of the points of misinformation that they're coming across on social media platforms and discussion boards?
[Jo Taylor]
Yeah, so social media and misinformation have a big impact on the information that teens receive and the thoughts and beliefs that they develop. The problem is most, or a lot of the information is incorrect and not medically accurate. So, it's a widespread problem.
Some of what we hear is related to side effects, discontinuing methods, and also a fear of hormones. So those are a lot of the things that we hear teens talking about when it comes to social media. We know that social media influencers share information that's unique to them but not always applies to everyone else.
And if teens are following those content creators, they often develop similar attitudes because of a perceived connection with them. So, the way that we combat that is we ask, what are you seeing? What are you hearing?
What are some of your concerns? Making that really an intentional part of the counseling process. Also helping teens and also families, so this applies to parents as well, but helping them develop some social media literacy.
You know, questioning who posted this? Why am I seeing this? What are they trying to tell me or even sell me?
Examining the source of information. And then to counteract some of that, always acknowledging what they're saying, never dismissing that, of course. I often thank patients for telling me.
But addressing and kind of finding what the underlying concern is. Is it a fear of hormones? Is there a side effect you're hoping to avoid?
And then following it up with accurate information. Also promoting reputable, youth-friendly sites is important as well so that when they leave your counseling or leave your office, they have those sites to go to. And Dr. Berlan mentioned it earlier, but the good news is that we know teens want information from the folks that they trust. So, parents, teachers, nurses, their provider. So that's all reassuring as well. It's just that sometimes they don't have access to all of us, so they have to access that information in a different way.
[Dr Mike Patrick]
Yeah. Are there some techniques that you use in the exam room to increase trust and, you know, to build that relationship?
[Jo Taylor]
Certainly, yeah. So, asking patients what they want to talk about, what they want to get out of that visit is important. Also, you know, using their pronouns, the names that they have for body parts, the name that they would like to be called.
Also just developing open understanding body language. I once had someone tell me to develop a good poker face if you're going to work in sexual and reproductive health. And I thought that that was such good advice.
I would also say learning about cultures, the cultures that you're serving, you know, the families that you're serving, how that may be different depending on where you are. I also like to give the reason why I'm asking sensitive questions. Sometimes teens can think, oh, maybe you're being nosy.
But if you're explaining what that information means to you and how you're going to use it and how it guides care for the day, I think that's a good way to build trust, too. Aside from all of the other things that we know, making small talk and building rapport, those are some of the things that really help in a contraceptive counseling session.
[Dr Mike Patrick]
Elise, did you want to add something?
[Jo Taylor]
Oh, I did.
[Dr Elise Berlan]
I was going to say that one of the great resources for young people online is the Bedsider website. And so, for our listeners, it can go to Bedsider. It's B-E-D-S-I-D-E-R dot O-R-G.
And they, I think, will be linked in the show notes. But I do reference patients to that website because they've got actually great patient facing information. They have actual videos of real users and talking about their experience with contraceptives.
And, you know, I think, you know, in addition to talking with their health care provider in the office, a lot of times young people also want to kind of have some time to think and reflect. And so, I think letting them know, you know, we're really happy to have a conversation. And, you know, being really explicit, you know, I'm here to respect your choices.
I really respect your bodily autonomy. I'm not here to judge you. Those are things I tell my patients when I meet them, especially for the first time.
And then really that, you know, this decision is yours to make. We can talk about something today. We can talk about a variety of things today.
And, you know, if you're not ready to make a decision and you want to do that later, that's no problem. Here is some information you can check out online. And please feel free to send me, you know, a message through our EHR portal or call my office.
And there are a lot of things we can just do kind of after the office visit. Or we might just need to do a quick telehealth or a quick pop-in. So really, I think, you know, I loved what Jo said.
And then, you know, like letting people know that it doesn't end, you know, when the visit ends. As I think that's, you know, a value of being within the pediatric medical home, right? Like we take care of our patients, and they can get in touch with us.
[Dr Mike Patrick]
Yeah, yeah. Jo, as you're doing counseling with teenagers, I'm sure that there's a wide variety of past experiences and sort of knowledge that teenagers come into the exam room with. How can you be sure that you're giving the same amount of care to everyone regardless of maybe their knowledge that they've had to begin with?
So, I'm really trying to get here at equitable care, thinking about disparities in contraceptive care. How can we make sure that we're treating everyone the same and that we are making sure that we're starting at the same starting line, that there is some basic understanding that folks have?
[Jo Taylor]
Yes, that's a great question. I would start with shared decision-making. I would also ask my patient, what do you know about contraception and what would you like to know?
Really letting them guide the discussion. I agree with what Dr. Berlan just said. So, emphasizing autonomy, putting the patient in control of that visit and what happens, letting them know you're going to respect their choices.
So, every time that I am providing counseling, I will say, you're the boss here. If you want to stop, if you want to start, if you'd like a follow-up visit, let me know. It's okay to start methods, stop methods, change methods.
We'll try this whole menu if we need to in order to find what's best for you. I think it's important to take a good look at your own biases, which Dr. Berlan also mentioned before. But thinking about your own experiences with contraception, growing up, what you were told, what you learned, those things can be quite different than the patients that we're taking care of.
I think it's important to develop, to help patients develop some health literacy. And oftentimes that means having materials in different languages that represent, like I said, different body types. Also, a lot of our work this year is focused on engaging with the community.
So, learning the most that we can about the people that we serve, having listening sessions, focus groups, understanding that the community and the patients that we're serving are the experts in their own care, and making sure that that's part of not only our care, but some of the interventions that we're rolling out. I would also say it's important, and we've learned this more and more through the years, but to understand that there is a history of reproductive oppression or trying to control the decisions that not only adolescents, but women and families make when it comes to contraception and childbearing. And so, understanding that, or learning a little bit more about that, acknowledging it, and what patients and families and generations bring to the table, that's an important part of what we do.
Because once you know that information, you'll see it show up. And back to trust a little bit. So, developing or building on trust, it's important sometimes to remember those things and to talk about them openly if that's what families would like to do.
[Dr Mike Patrick]
Yeah, absolutely. All important points. You've been doing this for a while, and if you think back to when you first began counseling teenagers on contraception, what are some pearls of wisdom you have for folks who may be new to this?
What are some of the challenges that they can expect, and what are some ways they can overcome those challenges?
[Jo Taylor]
Yeah, I think that's a great question. I love this question. Well, we're lucky because we have fantastic resources that exist.
And there are organizations that have made this work a lot easier for us than it used to be. But I would expect to have teens that maybe haven't made a lot of healthcare decisions on their own and also supporting the families and kind of getting to that place. And there's widespread misinformation, like we talked about.
But one of the best places that we could start or someone that's new to contraceptive counseling would be that AAP policy statement. That is really a fantastic, comprehensive resource. I described it as there's a little bit for everyone in there, but it really is a best practice framework for this work.
I would download those smartphone apps, so for the medical eligibility criteria and the select practice recommendations, so that safe contraceptive care isn't a guess. You have those guidelines right at your fingertips. Even though I am experienced, I use them frequently.
I refer to those quite a bit. Learning the basics of the methods that are available is important. Things change over time.
You've heard about the new methods today, so learning what methods are available, because your patients will ask you about those, and they'll expect that you know about those. There are some fantastic online training resources available, a lot of them free, a lot of them from professional organizations. I just attended one from the AAP on patient-centered humility, centering the adolescent voice in sexual and reproductive health.
So, finding, seeking out some of those learnings. There are also two other websites when it comes to training that I would recommend if you're interested in learning more. So, the Reproductive Health National Training Center and also the Clinical Training Center for Sexual and Reproductive Health.
They both have free, high-quality CEUs available, really a broad range of sexual and reproductive health topics, but also specifically adolescent health care and contraceptive care. Sometimes it's helpful in this work also to have a mentor if you're new to it, you know, to seek out someone that's a little bit more experienced, whether it's in your practice or outside of your practice. And then the last thing that I wanted to mention, and it's new, but there's a reproductive health hotline that's new, and it comes from the folks at UCSF, and they are, they produce phenomenal materials.
But it's a new and confidential phone service, and it offers clinical information for providers on sexual and reproductive health topics. So, another resource for all of us to have, but the number is 1-844-ReproHH. So, I would say that too, but those are some things for new providers.
I would also say start small. You don't have to provide everything. If you're going to provide contraception, you don't have to do it all from the beginning.
You can start with some methods and then build over time on your practice. If you do that, I would have good referral pathways. So, establish some relationships with other providers that maybe provide the full range of methods or those that have same-day placement, offer a sliding fee scale, some of those things that your practice might not offer.
[Dr Mike Patrick]
Yeah, yeah, and we will put links to all of the things that you have mentioned in the show notes again so folks can find them readily. And again, this is episode 112 over at pdacastcme.org. Alyse, I'm going to ask you the same question from your lens as you think back to when you were an adolescent medicine fellow.
What are some things you've learned along the way and some tips that you can give young providers?
[Dr Elise Berlan]
Oh my gosh. So, I think Jo spoke so well on this topic. I don't have too much more to add.
But since I trained, IUDs have become a recommended first-line contraceptive option for young people. And this is a little bit old news for those of us who've been doing this for a while. But when I started, young people did not have access to IUDs.
And we have people very excited and a pretty high demand for IUDs, which are very effective. That's a big change. The availability of contraceptive implants has been a big change.
And I think to highlight what we've talked about already, which is this focus now on person-centered counseling. You know, when I spoke with you, Mike, last time, I think it was about 10 years ago, you know, we really did recommend efficacy-based counseling. And that was the recommendation, you know, kind of all over the world and certainly all over in the U.S. But you really needed to sit down and go through, like, you know, here's the first one, here's the second one, here's the third one. And, you know, you were recommended to go through all of them. I think the amazing benefit of really understanding person-centered care is that it actually is so much more efficient. Because you, you know, ask some questions to help identify a young person's, you know, preferences and values.
And you can really sit down and talk about one or a handful of methods that are going to be really well aligned with that patient. And then, you know, use the time that you have to then talk about, you know, follow-ups and side effects and kind of other important things to the young people. So, I actually think even though the how we do it has changed, it actually does really simplify and enable you to use your time really well now in the counseling session.
[Dr Mike Patrick]
As you think about relationships with between teens and their parents, in your practice, do you find that the confidentiality is a really big thing as we think about parents for your teenagers? And do you encourage them to talk to their parents about these things? Which I know is going to be great for some families and not so great for other families.
And so, you really are kind of walking a fine line there. How do you approach it?
[Dr Elise Berlan]
That's a really interesting question. So, what I have found is that often a young person does find it acceptable if their parents or caregivers know they are using a contraceptive. Often there are non-contraceptive reasons they are using contraceptives.
And often we find that we can have conversations with young people that are respectful, that allow us to kind of involve the parents in the understanding that a contraceptive will be used. I think what is really key though is the young person knows that their own sensitive personal health information will not be shared with other people. And so, keeping the details of a young person's sexual history and that really sensitive information you're getting private is extremely important.
And if a young person is comfortable with sharing the information around their interest in using contraceptives, often that can be shared with the family. But I would say it's very important for the healthcare provider to understand what needs to be kept confidential and to assume that details around sexual history is usually intended to be kept confidential.
[Dr Mike Patrick]
And this is, I would think, an area where you really do have to rely on your experience, your gut feeling. There's more of an art than necessarily a science to that counseling process in terms of, you know, each family is unique and different. And the dynamics between the kids and the parents are going to be different.
And all that makes this challenging but also probably very rewarding too to help these teenagers sort of walk through this. Jo, what about schools? Do you interact with school nurses, with health classes at all?
[Jo Taylor]
Certainly. Yes, we do. We know that comprehensive sexual health education makes significant impact in risk-taking behavior and outcomes.
And unfortunately, depending on where you live, that health education may or may not be mandated by policy. So, we know there are some gaps when it comes to schools and what information teens get. So, partnering with schools and nurses, being that subject matter expert, attending parent meetings and other health events is absolutely important.
I would also put in a plug for school-based health centers and say supporting them. We know all the good work that they do when it comes to not only services, you know, but outcomes and access and all of those things as well.
[Dr Mike Patrick]
Yeah, yeah, absolutely. And especially if you are a pediatric provider in a smaller community that maybe doesn't have as many resources as larger communities, you really can make a big difference in your schools in terms of offering your expertise. And especially if you have a lot of experience doing this sort of counseling.
Before we go, this has been a fantastic conversation. Before we go, Elise, can you tell us a little bit more about Adolescent Medicine at Nationwide Children's Hospital and all of the things that you guys provide?
[Dr Elise Berlan]
Oh, thank you for that. So Adolescent Medicine at Nationwide Children's Hospital offers a wide variety of services. We offer primary care.
We offer contraceptive care. We offer care for young people with substance abuse disorders. We offer care for people with eating disorders, you know, so kind of all, we can take care of all young people for their medical needs.
I will highlight that we have a fantastic contraception clinic called BC for Teens. And the really unique thing about this clinic is we offer young people access to the contraceptive that they desire and that's safe for them on the same day as their appointment. And so, you know, young people face many and, you know, people who are pregnancy capable face tremendous barriers to contraception.
Even something like an IUD, some providers and some systems require up to three visits to get an IUD. And so, in our BC for Teens clinic, you know, we have a wonderful kind of team-based approach with nurses and health care providers like Jo. And, you know, our nurses are, you know, doing the contraceptive counseling and our providers are able to offer, you know, the contraceptive such as an IUD to a young person who walks in even not knowing anything about contraceptive.
So, this, I think, really highlights, you know, most clinics may not be able to offer an IUD when folks come in. But the idea of this clinic is something that can be replicated in other settings, which is like really help the young person get the service they need at the place they're at. But we definitely are excited to share information about that clinic with folks.
[Dr Mike Patrick]
And we will put links in the show notes to Adolescent Medicine at Nationwide Children's Hospital so folks can find your info easily. And we'll also put a link to BC for Teens as well. So, folks, there's going to be lots of resources and links available this week in the show notes.
Again, it's episode 112 and you can find that over at pdacastcme.org. So once again, Dr. Elise Berlan and Jo Taylor, both with Adolescent Medicine at Nationwide Children's Hospital. Thank you so much for stopping by and chatting with us today.
[Dr Elise Berlan]
Mike, it was such a pleasure. Thanks for having us.
[Jo Taylor]
Thank you.
Music
[Dr Mike Patrick]
We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast CME a part of it. Really do appreciate that. Also, thank you again to our guests this week, Dr. Elise Berlan and Jo Taylor, both with Adolescent Medicine at Nationwide Children's Hospital. Don't forget you can find us wherever podcasts are found. We're in the Apple Podcast app, Spotify, iHeartRadio, Amazon Music, Audible, YouTube, and most other podcast apps for iOS and Android. Our landing site is pdacastcme.org.
You'll find our entire archive of past programs there, along with show notes for each of the episodes, that CME information, our terms of use agreement, and a handy contact page if you would like to suggest a future topic for the program. Reviews are also helpful wherever you get your podcasts. We always appreciate when you share your thoughts about the show, and we love connecting with you on social media.
You'll find us on Facebook, Instagram, Threads, LinkedIn, X, and Blue Sky. Simply search for PediaCast. So, you've listened to the podcast.
Now, be sure to claim your free Category 1 Continuing Medical Education credit. Really easy to do. Simply head over to the show notes for this episode, 112, over at pdacastcme.org.
You'll find a link to the post test in the show notes. Follow that link to Cloud CME. Click on the Materials tab, taken past the post test, and the Category 1 credit is yours.
You will need an account at Cloud CME, but those are free and are really easy to set up. Super easy. And again, we offer credit to physicians and also nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists.
Of course, you want to be sure the content of this episode matches your scope of practice. Complete details are available at pdacastcme.org. I do want to remind you about a couple of other podcasts that I host.
One is PediaCast without the CME. It is an evidence-based pediatric podcast for moms and dads. Lots of pediatricians and other medical providers also tune in as we cover pediatric news, answer listener questions, and interview pediatric and parenting experts.
Shows are available at the landing site for that program, pdacast.org. Also available wherever podcasts are found, simply search for PediaCast. And a newer one that I have started is a faculty development podcast called FAMEcast.
It is from the Center for Faculty Advancement, Mentoring, and Engagement at The Ohio State University College of Medicine. So, if you are a teacher in academic medicine or a faculty member in any of the health sciences, then this is a podcast for you. We talk about work-life balance, promotion and tenure, the use of AI in clinical teaching and also in clinical research, mentorship, coaching.
All those kinds of faculty development topics you're going to find, again, over at FameCast.org. And really, wherever podcasts are found, simply search for FAMEcast. F-A-M-E-C-A-S-T.
Thanks again for stopping by, and until next time, this is Dr. Mike saying stay informed, keep it evidence-based, and take care of those kids. So long, everybody.
Music
