Mood and sexual side effects of hormonal contraception: physicians' and residents' knowledge, attitudes, and practices.
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OBJECTIVE: To explore physicians' knowledge, attitudes, and practices related to sexual and mood side effects of hormonal contraceptives, and to compare residents with practising doctors. DESIGN: A mixed-method study with faxed or e-mailed surveys and semistructured telephone interviews. SETTING: British Columbia. PARTICIPANTS: A random sample of family doctors, all gynecologists, and all residents in family medicine and gynecology in the College of Physicians and Surgeons of British Columbia registry. A subsample was interviewed. MAIN OUTCOME MEASURES: Estimates of rates of mood and sexual side effects of contraceptives in the practice population and how the physicians informed and advised patients about these side effects. RESULTS: There were 79 residents and 76 practising doctors who completed the questionnaires (response rates of 42.0% and 54.7% of eligible residents and physicians, respectively). The reference sources most physicians reported using gave the rates of sexual and mood side effects of hormonal contraceptives as less than 1%, and yet only 1 (0.6%) respondent estimated similar rates for mood side effects, and 12 (7.8%) for sexual effects among their patients. The most common answers were rates of 5% to 10%, with residents reporting similar rates to practising doctors. Practising doctors were more likely to ask about sexual and mood side effects than residents were (81.1% vs. 24.1% and 86.3% vs. 40.5%, respectively; P < .001). Practising doctors were also more likely to recommend switching to barrier methods (37.3% vs. 16.5%; P = .003) or intrauterine devices (54.7% vs. 38.0%; P = .038) than residents were and more likely to give more responses to the question about how they managed sexual and mood side effects (mean of 1.7 vs. 1.1 responses, P = .001). In 14 of the 15 interviews, practising doctors discussed how they had learned about side effects mainly from their patients and how this had changed their practices. CONCLUSION: Physicians' perceived rates of mood and sexual side effects from hormonal contraception in the general population were higher than the rate of less than 1% quoted in the product monographs. Practising doctors reported that they learned about the type, frequency, and severity of side effects from their patients.
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