By Melinda Young
EXECUTIVE SUMMARY
For medical students — in any discipline — to provide optimal care to women, they need to learn more about contraception, postpartum care, intimate partner violence, and sexual and reproductive health.
- Students often tune out when women’s health is discussed, so curricula should include cases and examples of how reproductive-age patients with any medical issues could benefit from the doctor asking them about contraception and their reproductive health.
- One module gives physicians resources to learn about different types of contraception and which methods work well for patients with various medical conditions.
- Another educational module touches on intimate partner violence and shows how screening tools can find problems that patients may not bring up unprompted.
Medical students need to learn more about contraception to do a better job in treating women, and two new case-based curricula provide them with some answers and information.1,2 “We recognize that there is an underuse of hormones beyond the indication of pregnancy prevention at the clinical level,” says Deborah Bartz, MD, MPH, an associate professor at Harvard Medical School, and an obstetrician-gynecologist at Brigham and Women’s Hospital in Boston, MA.
“There is a real recognition that this probably starts with medical school training and the idea that students — at the baseline — don’t get enough reproductive health, women’s health, and preventive medicine, in general,” Bartz explains. “And when those topics are talked about in medical schools, they’re often talked about in a way that allows members in the class to tune out,” she adds. “A fair amount of students say, ‘I’m not going into women’s health, so I don’t need to know this.’”
Medical professors and others working with medical students need to assert that no matter what area of medicine they practice, they will need to be able to take care of reproductive-age people and other people who would benefit from hormonal therapy, Bartz says.
There also is a new educational module for OB/GYN clerkship students. It provides more information about contraception, intimate partner violence (IPV), postpartum care, and following a patient through pregnancy. A study of the module shows that students and facilitators benefited from the additional education.2 “It’s an interactive module. It’s a clinical scenario of a woman going through presenting to gynecologic visit and talking about her interests and needs with contraception,” says Faith Dunn, MD, a third year OB/GYN resident at the Medical University of South Carolina (MUSC) in Charleston.
“The module goes further into different resources that are available for how to counsel and tailor recommendations or patients depending on their desires for contraception and their specific comorbidities,” Dunn says. The module provides resources that physicians can use to learn about different types of contraception and which methods work well for patients with various medical conditions.
The OB/GYN clerkship module takes about 1.5 hours to complete, and it can be done in a classroom with eight to 10 students, or it can be presented over a virtual platform with a facilitator who discusses it with students, she explains. “It has a lot of questions and prompts students to come up with answers on their own. It facilitates discussion throughout it,” Dunn adds. There is more nuance to contraceptive counseling than students realize, and the additional education gives them exposure to the broad depth of questions to ask patients about when they are seeking contraception, she explains.
“It also empowers them and lets them know of resources like the U.S. Medical Eligibility Criteria that talks about various contraceptive indications,” Dunn says. “It’s important for medical students to know of a method that might not be effective or of options that are associated with more risks for a patient based on their medical comorbidities and to counsel them on risks associated with that.”
For example, patients with severe hypertension should not be started on combined oral contraception without a physician talking with them about the increased risk of stroke. Medical students planning careers in fields that are not focused on women’s health need to learn more about patients with conditions where their treatment could have an impact on their reproductive health.
One of the cases featured in Bartz’s study about the benefits of hormonal contraception is of a patient with rheumatoid arthritis who is started on a new medication. Providers working with this patient need to keep the patient’s reproductive potential in mind while engaging in decision-making with the patient, Bartz says.
Pregnancy prevention should be considered because of their condition. For example, for patients with arthritis, an unintended pregnancy could lead to poor outcomes for the mother and baby, according to the Arthritis Foundation.3 For patients with rheumatic conditions, long-acting reversible contraceptives (LARC) are the best option because they are highly effective and last for years.3
“All too often, the patient’s care plan focuses on the medical condition and doesn’t notice the patient’s reproductive potential and how the disease might affect a potential pregnancy or how a pregnancy might affect the newly diagnosed medical condition,” Bartz explains. “This curriculum is a recognition that clinicians need to have pregnancy prevention as part of the care plan to ensure the medical condition can be [helped] or the patient is not being placed on medication that would impact pregnancy.”
A second case in the curriculum is about a patient with a nonbinary identity. This case provides an opportunity to talk about hormone care, teaching students to not make assumptions based on a patient’s organs that are incongruent with their identity or sexual practices, she says.
“This patient has been misgendered in the past and assumptions have been made about their sexual activity and risk for pregnancy,” Bartz explains. “Although they were female-assigned at birth and do not yet have sexual practices that place them at risk for pregnancy, they also have very heavy, irregular vaginal bleeding.” So, the patient would benefit from hormones, such as contraceptives that can reduce or regulate their menstruation.
“The idea is to teach students how to talk about the hormones we find in our birth control methods that have expanded indications beyond birth control,” Bartz says. “And [clinicians can] do that in a way that is sensitive and trauma-informed, especially for patients who have had poor interactions with the healthcare system in the past because of certain gender and sex assumptions.” Discussing this case with medical students can show them how to provide sensitive gynecologic care in a trauma-informed manner, she adds.
A third case involves a 47-year-old cisgender woman with perimenopausal symptoms that suggest she would benefit from hormonal therapy. “This case provides us an opportunity to talk about perimenopause, which is a newly recognized phenomenon both in the general populace and within the medical community, in general,” Bartz says. “The potential hormonal therapy, both with regard to various birth control methods and moving into hormonal replacement therapy, gives us an opportunity to talk about multimodal needs of patients and therapies for patients as it relates to mood disturbances and sexual relationships that are highly disturbing to patients.”
For instance, in the featured case, the perimenopausal woman has mood changes, vaginal changes, and relationship changes. Mood-stabilizing medication or vaginal estrogen could be therapies, she adds. “It’s a very complex case, and the complexity is part of the learning, as these are cases that physicians have historically shied away from and not treated fully,” Bartz explains.
Teaching medical students about these types of cases and how reproductive healthcare can be woven into about any medical treatment, particularly for people capable of pregnancy, is a message everyone in medicine needs to hear and understand. “We need to make sure we’re teaching to the whole classroom,” Bartz says. “We need to stop teaching women’s health as just women’s specific care.” Medical students who receive that message may tune out because they do not believe it is relevant to their own area of practice.
“It’s how sex and gender medicine needs to be incorporated within all medicine and medical education, so it’s not just, ‘We’re doing OB/GYN, and now we learn about women,’ and the rest follows male-based patterns and male-based science,” Bartz explains.
Dunn’s research involving the OB/GYN module focuses on IPV, an issue that often is overlooked by physicians. “It’s easy for people to miss the prevalence of it,” Dunn says. Screening for IPV and assessing danger and planning safety for those affected by the violence can be more accessible to clinicians with use of validated tools, she notes.
“There are various screening tools that are available and can be very easily implemented whether by a gynecologist or in a primary care visit or emergency department visit,” Dunn says. Routine questions on intake forms about IPV may work better than asking questions only when the physician has a suspicion of a problem.
“A lot of times, patients don’t come in and say, ‘I’m experiencing intimate partner violence and I want help,’” she says. “They come in with other complaints, so as a healthcare provider, you have the opportunity to dig in further with that and find resources that might help them.”
Open-ended assessment questions on patient forms could include the following:
- Do you feel safe in your home?
- Have you been abused in any way physically, mentally, or emotionally in the past month?
- In the past month, has anyone slapped, kicked, or punched you?
“If someone is repeatedly seeing a patient for fractures or bruises, or if they note they have an injury and have many injuries in various stages of healing, that is something that could cause suspicion of abuse,” Dunn explains. The module uses the Radar Screening tool for IPV and also asks three questions about safety, including whether there are weapons in the home.4
Bartz would like medical professionals to be better informed when they meet a patient in the clinic: “They need to take into account aspects of the patient’s identity.” Reproductive healthcare may improve once more doctors understand and prescribe contraceptives and accept patients’ experiences with gender identity and contraception needs and desires. But as studies that even mention gender-diverse and other populations are being defunded, it is especially important that medical students are trained to understand their various patient populations that may seek contraception and reproductive healthcare.
“I think what is going on right now is people are trying to be homogenized toward the majority [instead of] recognition and celebration of their differences and how those affect their health,” Bartz says. “As a physician and medical educator, I have to be brave and do what I can within the confines of my specific setting but not comply in advance and not give in to fear and continue to stick to my mission, which is to celebrate, recognize, and teach about the biological and social-cultural differences our patients have.”
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Panakam A, Pelletier A, Johnson NR, et al. Benefits of hormonal contraception across the lifespan: A case-based, interactive curriculum. MedEdPORTAL. 2025;21:11512.
2. Wagoner K, Dempsey A, Dunn F, Chardukian M. A flipped classroom case to introduce OB/GYN clerkship students to contraception, postpartum care, and intimate partner violence screening. MedEdPORTAL. 2025;21:11505.
3. Rath L. Best (and worst) birth control for people with arthritis. Arthritis Foundation. Jan. 11, 2022. https://www.arthritis.org/health-wellness/healthy-living/family-relationships/family-planning/best-worst-birth-control-for-people-with-arthritis
4. Screening for Intimate Partner Violence — RADAR. Adapted from the RADAR action steps developed by the Massachusetts Medical Society. https://www.endfamilyviolence.uci.edu/projects/pdfs/Human-Options-RADAR-Handout-2017-High-Res-1.pdf
For medical students — in any discipline — to provide optimal care to women, they need to learn more about contraception, postpartum care, intimate partner violence, and sexual and reproductive health.
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