After learning their goals, this doctor helps women plan

Your contraceptive choice depends on your family plans, your symptoms and your lifestyle

When Dr. Madolyn H. Krengel talks to a new patient about contraception, her first question is always, What’s your goal?

“Contraception is effective in preventing a pregnancy, but that’s not always a patient’s first priority. It can also be used for controlling acne, cramps, heavy flow, PMS symptoms and other conditions,” she says. “I can walk through options that fit best with their lifestyle.”

As a primary care physician at Pacific Medical Centers (PacMed) Northgate, Dr. Krengel’s patients come to her for a wide range of preventive care and treatment. When appropriate, she tries to add contraception to the conversation, to better understand her patient’s perspective.

“If they’re hesitant, I start by asking, ‘How would you feel if you were to become pregnant in the next year?’ That helps me understand their needs. We don’t need to make a decision right away either — I’m happy to explore options,” she says.

The power to choose

“Contraception has been available long enough that we can take it for granted. But I think it’s a really powerful thing to be able to choose when you get pregnant,” Dr. Krengel says.

Every contraception has a different level of effectiveness. Dr. Krengel can explain the benefits and risks, and help you find the method that’s right for you. Would you prefer to “set it and forget it,” or do you like having daily control?

“Young women are more likely to be focused on preventing a pregnancy,” adds Dr. Krengel. “Women in their 30s may be ‘between children’ and thinking about timing their next pregnancy. I also remind patients: as long as you’re having a period you can get pregnant, regardless of your age.”

Non-hormonal options:

• Copper IUD: Inserted by a healthcare professional into the uterus, it should be removed after 10-12 years. “It’s just as effective as getting your tubes tied, though it can cause heavy or more painful periods.”
• Condoms: Less effective as a contraceptive, but the only form of birth control that lowers your risk of contracting sexually transmitted diseases.

Hormonal options:

• Pill: “There are dozens of birth control pills available with varying levels of hormones, so if you tried one and had a bad experience, it doesn’t mean that all pills are off the table,” Dr. Krengel says.
• Patch: Sticks to the skin; replaced once a week.
• Ring: A flexible circular device you insert in your vagina; replaced once each cycle.
• IUD: Inserted in the uterus by a healthcare professional; effective for about five years.
• Nexplanon: A small, flexible strip implanted in the arm by a physician; removed after three years.
• Injection (the Depo shot): Injected by a doctor every 90 days. “It’s a great method for women who want to keep their contraception use private from a partner or anyone else living at home,” Dr. Krengel says.