Counseling on adverse events of intrauterine contraception

The study in the journal Midwifery assessed 140 messages from the discussion boards of 43 Swedish posters. Repeated searches of the discussion boards were conducted in 2019 and 2020.¹

In Sweden, registered nurse-midwives and physicians offer contraceptive counseling, contraception prescriptions, insertion of long-acting reversible contraception (LARC), and follow-up consultations after insertion of LARC. Most healthy patients who desire contraception are provided care by nurse-midwives.

Two themes emerged from the discussion boards: difficulties patients have in making an informed decision about intrauterine contraception, due to insufficient and untrustworthy information about adverse reactions from counselors; and patients feeling dismissed by counselors when communicating their experience of adverse reactions.

In addition, counselors were perceived as overly optimistic about intrauterine contraception and emphasized only mild or common reactions. In fact, some patients noted that their counselor had guaranteed that they would not incur any adverse reactions or that the device could even result in an adverse reaction.

Besides not listening to their patients, some counselors tried to convince their patients to try intrauterine contraception by touting it as the ultimate contraception. Other patients referred to their contraceptive counseling as a “sales talk,” with the goal to get as many patients as possible to try intrauterine contraception. 

Patients became frustrated and dissatisfied with care when counselors dismissed their adverse reaction concerns.

Patients who experienced systemic reactions stated that professionals had not been honest about clearly informing them of risk. As one poster stated: “The risks are there but no one talks about it!” 

Some patients regretted not reading more information about potential adverse reactions before deciding to have the contraception inserted. Others cited that the information they received during counseling differed from the information they had read.

Several patients incurred systemic adverse reactions with a hormonal intrauterine device (IUD), even though they were told by the professional that the hormones only have a local effect. 

The informed decision over which contraception to select was easier when the midwife informed the patient about possible adverse reactions.

The discussion boards also mentioned resistance among counselors to submit a formal report about an adverse reaction. 

“It makes me angry when health professionals don't acknowledge my reactions because the device is not hormonal,” read one poster.

Some posters encouraged patients themselves to report adverse reactions to the responsible authorities, rather than relying on counselors. Posters also advocated for patients to share their experiences on the discussion boards to promote increased overall knowledge about adverse reactions.

Some posters noted that some patients were not offered a follow-up visit to discuss adverse reactions, despite being recommended.

In contrast, when counselors validated a patient’s adverse reaction and conveyed that the patient was not the only one experiencing the same reaction, the patient felt hope that the reaction would be alleviated.

“Posters expressed that professionals who took their situation as patients seriously and took action to report the adverse reaction provided the care that they needed,” wrote the authors.

The findings underscore the importance of patients who experience adverse reactions of intrauterine contraception to feel acknowledged by their counselor and be offered adequate support, according to the authors, who noted the value of follow-up services.

Reference

1. Stern J, Molin MS, Fernaeus M, et al. Contraceptive counseling about adverse reactions of intrauterine contraception: exploration of narratives found in web-based discussion boards. Midwifery. Published online October 7, 2021. doi:10.1016/j.midw.2021.103166