Mood and sexual side effects of hormonal contraception: physicians' and residents' knowledge, attitudes, and practices.
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.