Does structured counselling influence combined hormonal contraceptive choice?

OBJECTIVE To assess the effect of structured counselling on women's contraceptive decisions and to evaluate gynaecologists' perceptions of comprehensive contraceptive counselling. METHODS Belgian women (18-40 years old) who were considering using a combined hormonal contraceptive (CHC) were counselled by their gynaecologists about available CHCs (combined oral contraceptive [COC], transdermal patch, vaginal ring), using a comprehensive leaflet. Patients and gynaecologists completed questionnaires that gathered information on the woman's pre- and post-counselling contraceptive choice, her perceptions, and the reasons behind her post-counselling decision. RESULTS The gynaecologists (N=121) enrolled 1801 eligible women. Nearly all women (94%) were able to choose a method after counselling (53%, 5%, and 27% chose the COC, the patch, and the ring, respectively). Counselling made many women (39%) select a different method: patch use increased from 3% to 5% (p<0.0001); ring use tripled (from 9% to 27%, p<0.0001). Women who were undecided before counselling most often opted for the method their gynaecologist recommended, irrespective of counselling. CONCLUSION Counselling allows most women to select a contraceptive method; a sizeable proportion of them decide on a method different from the one they initially had in mind. Gynaecologists? preferences influenced the contraceptive choices of women who were initially undecided regarding the method to use.