Physician at UBMD OBGYN specializes in complex contraception and family planning
By Chris Motola
Q: Tell us about the new complex contraception and family planning program you’re running through UBMD OBGYN.
A: We opened up a new office on Youngs Road, which was something our previous chair had initiated. Then, when Dr. [Sarah] Berga came a year ago, we were able to finalize that move. And the new space on Youngs Road is much bigger and updated than our prior space, which has allowed us to expand our services, one of them being our family planning. We’ve mostly been focused on complex contraception in that clinic. That’s being able to provide contraceptive counseling to patients with various medical conditions who might have been told they can’t use contraception or that they shouldn’t because their medical conditions might put them at risk of side effects. With this clinic we’re able to tailor what those options are for these patients and usually offer something, regardless of their medical history.
Q: What types of contraception tend to cause problems for individuals with medical conditions?
A: The most common birth control that we might steer clear of are those that contain estrogen. So we most commonly think of birth control as “the pill.” That does contain estrogen and, for people with certain medical conditions, that may increase the risk of blood clots or stroke. So we would probably try to avoid those. But we have a lot of other options these days. We have long-acting, reversible contraception. Implants is one of them. There’s one that goes right under the skin of the arm. That one provides a steady amount of progestin; there’s no estrogen in that. There are also IUDs [intrauterine devices]. There’s one that has progestin, but since it sits within the uterus, it’s less systemic. There are also non-hormonal IUDs as well, which are made of copper and can be a very effective form of birth control without introducing any hormones.
Q: How does the copper one work?
A: The copper IUD, for lack of a better term, is toxic to sperm. So it prevents the sperm from being able to mobilize within the uterus, which keeps it from meeting the egg.
Q: And that doesn’t have any side effects?
A: You mean long-term?
Q: Long or short.
A: A copper IUD doesn’t have any long-term effects in the sense that it doesn’t create any scar tissue or inflammation. Some people may experience slightly heavier periods with it. So for people who have heavier periods as a baseline, it may not be the best option for them. And that’s what this clinic is all about. It’s about really getting to know our patients, seeing what they’re looking for in a birth control, or helping them regulate their menstrual cycles or helping them control any bleeding they may be having.
Q: How big is the implant that goes in your arm?
A: It’s about the size of a matchstick. And it goes right under the skin of the arm. So you shouldn’t be able to see it if you look at your arm, but if you palpate your arm gently, you should be able to tell that it’s there.
Q: Generally speaking, what are you finding is most popular with your patients?
A: I see a trend with the long-acting reversible contraception and progestin IUDs. The biggest side effect from that IUD is that people’s periods get later or stop altogether. And that can be very appealing to most reproductive-age women, to have fewer periods or no periods at all.
Q: What are the circumstances under which someone might be referred to a complex contraception specialist?
A: I would say right now most of our patients are self-referred. But we might see someone who is having issues with their birth control and may just want a second opinion. Or somebody who was told that they couldn’t be on birth control containing progestin hormones if they’re at risk of blood clot. But studies show they’re actually pretty safe, even if they have a history of blood clots. And ultimately hormonal contraceptives are safer than pregnancy, which will put them at a higher risk for blood clots if they have that history.
Q: Are patients usually open to switching birth control methods or do they tend to find something they like and stick with it?
A: Usually the best form of birth control, which is something I tell the residents I mentor, is the one that the patient is most happy with and that they’re going to continue with. So if someone is on birth control that’s safe for them and they’re happy with, I don’t feel that we necessarily have to switch them to one that I personally might think is better. I do find that, if a patient was prescribed a medication that would not be safe for them, I find that after counseling them on the risks of continuing versus an alternative that’s safer, most patients are willing to switch to something that’s safer. And they’re usually happy with that switch.
Q: Generally speaking, do you find contraception is more widely accepted nowadays relative to the recent past?
A: I think it depends on the patient and their interactions with the medical system. I think there are still a lot of barriers to getting contraception out there to patients. It’s something that physicians should be ready to discuss with patients, and not just OB-GYNs. For example, somebody who might have a cardiac history, their cardiologist may want to know what their contraception options are. As a society we still have a ways to go, because there are still institutions, usually connected to religious organizations, that won’t prescribe birth control to their patients. That can be a barrier to care for patients whose insurance restricts who they can see or might not know they can go somewhere else for their contraception needs.
Name: Rachelle M. St. Onge, M.D.
Position: OB/GYN at UBMD Obstetrics and Gynecology and assistant professor at the Jacobs School of Medicine & Biomedial Sciences
Hometown: Morrisville, New York
Education: SUNY Upstate Medical University: Master of Public Health degree (2015) and medical degree (2015); University of Rochester, residency in OB-GYN
Affiliations: Oishei Children’s Hospital; Millard Fillmore Suburban Hospital; Erie County Medical Center
Organizations: American College of Obstetricians and Gynecologists
Family: Wife, one child
Hobbies: Hiking, snowboarding, paddle boarding