7 responses to “What I talk about when I talk about family planning”

  1. Please redact as there is significant risk in some of these recommendations.

    Ulipristal acetate effects the progestin component of hormonal contraception therefore if someone is taking a hormonal contraceptive and then also uses ulipristal acetate it can cause their regular contraceptive to become ineffective for the next 5 – 7 days – this is a serious missed step in these recommendations.

    The referenced websites are American. The clinic locations does not include Canadian options. Why not use the Canadian SOGC website instead: http://www.sexandu.ca or the BC Options for Sexual Health: http://www.optionsforsexualhealth.org

    Also, it’s great to “normalize” abortion, except that providers then must also integrate mifgymiso prescribing into their practice if they are going to offer abortion as a “contraceptive” option. It is irresponsible to not offer this yourself if you want to promote termination as a birth control method. Abortion is not in fact a “contraceptive” in the true sense since the word “contraceptive” means prevention of pregnancy…not termination of pregnancy. Downloading abortion services to already busy clinics who do offer this is not ideal practice and not accessible or affordable for many women in the province who live rurally or remotely.

  2. Response to Hannah Varto:

    Please redact as there is significant risk in some of these recommendations.
    I welcome an evidence-based discussion surrounding risks, in this offering of an evidence-based approach.

    Ulipristal acetate effects the progestin component of hormonal contraception therefore if someone is taking a hormonal contraceptive and then also uses ulipristal acetate it can cause their regular contraceptive to become ineffective for the next 5 – 7 days – this is a serious missed step in these recommendations.
    Ulipristal acetate (UPA) is a serum progestin receptor modulator, it does not primarily work by effecting the progestin component of hormonal contraception. It is important to advise against continued non-contracepted intercourse after taking any oral emergency contraception. Thank you for pointing out it is also important to counsel restarting of progestin containing contraceptives 5 days after taking UPA but not due to the mechanism proposed in the comment. Apologies for this oversight, as we have only so many words to get a take home message across.

    Please see this study for further details on the impact of CHC OCP on UPA: Edelman AB, Jensen JT, McCrimmon S, Messerle-Forbes M, O’Donnell A, Hennebold JD. Combined oral contraceptive interference with the ability of ulipristal acetate to delay ovulation: A prospective cohort study. Contraception. 2018 Dec;98(6):463-466. doi: 10.1016/j.contraception.2018.08.003. Epub 2018 Aug 14. PMID: 30118684; PMCID: PMC6204102 (View).

    UPA use and thorough counselling is more than the scope of this article. You can complete this online learning course on Emergency Contraception for more information.

    The referenced websites are American. The clinic locations does not include Canadian options. Why not use the Canadian SOGC website instead: http://www.sexandu.ca or the BC Options for Sexual Health: http://www.optionsforsexualhealth.org
    Thank you for the comment. These websites are both excellent resources.

    Bedsider was shared particularly for the troubleshooting aspect that is excellent for patient health information access. For example, within the FAQs there are “what should I do if my patch falls off” evidence-based troubleshooting guidances which patients have found helpful. For example: https://www.bedsider.org/questions/2090-will-the-patch-fall-off

    Also, it’s great to “normalize” abortion, except that providers then must also integrate mifgymiso prescribing into their practice if they are going to offer abortion as a “contraceptive” option. It is irresponsible to not offer this yourself if you want to promote termination as a birth control method. Abortion is not in fact a “contraceptive” in the true sense since the word “contraceptive” means prevention of pregnancy…not termination of pregnancy. Downloading abortion services to already busy clinics who do offer this is not ideal practice and not accessible or affordable for many women in the province who live rurally or remotely.
    Thank you for this comment. Please note, I am not offering termination as a “birth control method”, rather this piece was about “family planning options”. Mifepristone is available as emergency contraception in countries outside of Canada. At the moment, Mifepristone is not indicated for emergency contraception in Canada.

    I am not proposing offering abortion as contraception, nor trying to conflate. The change in practice article is attempting to move us from “contraception-only” to “family planning” discussions.

    Thank you for the excellent point, this practice is not being offered as ideal, however some food for thought given review of evidence, changes in access. As you have pointed out, it may be even more important to review all family planning options in rural and remote areas to assist with decision making given the context of access in remote and rural areas.

    I appreciate you taking the time to read and share your thoughts.

  3. Excellent info and comments. Thank you.

  4. This was beautiful to read, thank you for taking the time to share.
    On the topic at the beginning, when the question of “Would you like to be pregnant in the next year?” I have been more and more preparing young families for the idea of budgetting for assessment of tethered oral tissues, as it is unfortunately mostly private care at this time. HealthlinkBC has an updated multidisciplinary document about Tethered oral Tissues and would be a great piece to share with them as they plan for their infant’s care needs following birth.
    Please find the new link attached.

    https://www.healthlinkbc.ca/pregnancy-parenting/parenting-babies-0-12-months/baby-health/tongue-tie-and-tethered-oral-tissues

  5. I appreciate Dr. Chan’s thoughtful, democratic, and considerate approach to family planning, especially after seeing with alarm what has happened in this field in the United States. Having an escape mechanism, when required, would also be appealing in other areas of health care – were that available.

    Note that after performing a systematic review and critical appraisal of randomized trials that compared ulipristal acetate with levonorgestrel, we were unable to conclude that ulipristal has been proven superior. (https://www.ti.ubc.ca/2024/07/29/150-emergency-contraceptives/)

    Levonorgestrel, which is widely available to British Columbians at no charge and without a prescription, also remains a good option for emergency contraception.

    Tom Perry MD, FRCPC
    Editor, Therapeutics Letter
    UBC Therapeutics Initiative

  6. Response to Thomas L Perry:

    Thanks for sharing this wonderful information and the work TI does. This TCMP utilized SOGC guidelines to mitigate any bias and thus the comment about weight and what the provincial study was based on back when it was performed in 2019.

  7. After this article I will provide prescription for Ulipristal as “stand by ” for patients; the “talking tip” is very useful in this article. In the past I relied on patients going to Pharmacists and asking for Plan B.
    Talking to patients about their options at all points of care when related to Birth control or sexual health makes a difference in my experience.
    Thanks for the added confidence to add abortion to the conversation, this article will change my practice in this regard.

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