Table 5.

Key themes and quotes pertaining to participant’s experiences with contraception counseling from qualitative data

Themes	# of Responses	Selected Quotes
Feeling dismissed by provider	8	“I experienced severe mood swings on the regular “pill” and when I mentioned this to my GYN he looked at me and said ‘sometimes that’s just life you have a bad day you have to learn to live with it’.” “Mood changes [were the worst side effect] and I was dismissed when I mentioned it to my GYN” “When I was PMSing while on the hormonal birth control pill, my anxiety became debilitating. I tried to talk to my doctor about switching off the pill and to an IUD, but did not feel heard and ended up off the pill and without an IUD.” “I’ve always taken BC pills… I recently tried to talk to my gyn about non hormonal options and she told me there weren’t really any good ones. Full stop. I’ve never felt like a doctor really wanted to help find the best unique solution for me.” “I have a horrible gynecologist who infantilizes me and does not listen to my preferences for contraceptive methods or concerns.” “I had a lot more questions than I felt comfortable asking. That may not be the case with all patients, but I wished the visit felt less routine and more focused on what, to me, was a big step in my life.” “Much of the counseling I have received has felt rushed, and like the provider is playing a guessing game along with me but they don’t have much time to collect detailed info. It has never felt very safe to try a new method of birth control, and it has not felt as if the provider would be able to adequately determine the actual cause of any symptoms or which methods might help alleviate them. I get a lot of “we can try it out, and see how it goes,“ which feels like gambling with my physical and mental health each time… I have often felt guilt about asking questions, especially when I was younger, because providers have used a tone with me as though my worries, concerns, and questions are “not that big of a deal.” “[I] was barred from getting my tubes tied, several times at different ages, even though I have never wanted children. I can only hope for better options in the future or a doctor that listens.”
Lack of Discussion of Side Effects	16	“Providers shouldn’t automatically refill hormonal contraceptive prescriptions without asking about complications/side effects/contraindications: shortness of breath, leg swelling, smoking status etc.” “I first started hormonal contraception when I was a teenager over 20 years ago. I received very little counseling at the time and side effects were almost completely dismissed.” “Looking back I don’t believe I was told the truth w/regard to side effects of oral contraceptives.” “I don’t feel as though I was adequately informed about the possible psychological impacts of birth control when I started.” “I didn’t know how to answer the counseling q’s because my original gyno did a terrible job of explaining anything and addressing the concerns of high bp after taking the pill. She just said you’re going to college so you should go on the pill.” “Mood/psych symptoms and libido changes were never discussed when I started on hormonal OCPs at 18, and I did start developing mood and anxiety symptoms around the same time.”
Lack of discussion on options	18	“my original gyno did a terrible job of explaining anything and addressing the concerns of high bp after taking the pill. She just said you’re going to college so you should go on the pill.” “I was not counseled on all contraceptive options when I was first given birth control, only pills.” “I’ve changed providers multiple times, by far, the worst in terms of education was the first gynecologists’ I saw. Perhaps fewer options were available, but I just accepted that the pill was the only option other than condoms. I don’t think I was adequately informed about the available options such as an IUD, or the even lower dose versions of the pill. Even as an adult, most of the information I have has been self discovered, and then discussed with my physician.” “Hormonal birth control sucked and beyond condoms or abstinence there was no other alternative offered.” “I’ve always taken [the] BC pill… I recently tried to talk to my gyn about non hormonal options and she told me there weren’t really any good ones. Full stop. I’ve never felt like a doctor really wanted to help find the best unique solution for me.” “I feel like providers don’t talk enough about non-hormonal options if mood is affected. I [currently] have a non-hormonal iud, which I really had to talk my doctor into agreeing with me, and my moods have seen an improvement since I’ve been using it.” “I’ve found the most support in my contraceptive experience from my friends, and I provide that support as well. I also work in the psych field and there is no course or even single lesson on contraception and its potential impact on mood/hormones that interplay with psych meds or mental health experiences aside from 5 minutes on the interaction of birth control methods and mood stabilizers. Big area to expand on here, I would love more education and awareness around this topic.” “I can only hope for better options in the future.”
Positive Experiences	6	“My experience with oral contraceptives has been positive for me.” “My experience with hormonal birth control pills has been extremely positive and I have no desire to change contraceptive methods.” “I have so far been happy with this choice.” “Doctors (primary care) and gynecologists have been wonderful at advising me about contraception.” “My experience was excellent.”