Physician Blog

IT’S A TRAP! Sneaky Things that can lead to Pregnancy

Published on March 27, 2020 by admin

IT’S A TRAP! Sneaky Things that can lead to Pregnancy

Not being consistent with your birth control

Skipping leg day at the gym is WAY different than skipping a pill in your pack. Consistency is key when taking the pill or mini-pill. Creating a routine can be difficult especially if you know you do not do well with hormonal changes. Here are some tips:

You can take the pill anytime of the day, as long as it’s around the same time every day. Work it into a morning routine,
after lunch, or before bed.
- Set an alarm on your smart phone to remind you to take your pill on time
- Some women suffer from nausea from their birth control, if this is you, take your pill with food and water.
- Some women suffer from inability to sleep with birth control, if this is you, try to take it earlier in the day.
The mini-pill is more sensitive to time delays. This leaves you more at risk for breakthrough bleeding and unplanned
pregnancies.
Life happens, if you forget to take a pill for that day, be sure to take two pills the following day. What happens if you miss
2 days of pills? Then take 2 pills for two days in a row, now you’re back on track. If you are worried you are at risk, use backup protection for 7 consecutive days.

Using the Pull-Out Method

This is the original Russian roulette. As a female, if you are basing your hormonal health on the “pull-out method,” we need to talk. Stop giving ALL of the control to your sexual partner. You may have had some luck thus far, but this method is not reliable, predictable, or sustainable. The Pull-our Method or withdrawal results in pregnancy 22 out of 100 times. So if
you plan on having sex utilizing the pull out method long-term, statistically speaking, you should start picking out baby names.

Not Using Birth Control Postpartum

“You can’t get pregnant if you’re breastfeeding”= Fake News

Your chances of getting pregnant are low if you are exclusively breastfeeding. Breastfeeding keeps your hormones suppressed, and your chances of pregnancy low. But if you are supplementing breastmilk with formula, then you are opening the door to your next pregnancy. Progestin-only containing hormonal contraceptives including the mini-pill, injection, IUD, and implant are safe for you and your baby immediately following postpartum. Women taking combined hormonal contraceptives must wait 21 days postpartum to begin breastfeeding, assuming they do not possess risk factors for a blood clot. In the event they do, they must wait 42 days postpartum to begin breastfeeding.

Other Medications

Some antibiotics and other medications can interfere with your birth control! Many birth control options contain estrogens. Some prescription medications cause the liver to increase the break-down of estrogen and can drastically decrease the levels of estrogen in the body and ultimately decrease the effectiveness of birth control. This has the potential to cause unplanned pregnancy. We are NOT discouraging the use of antibiotics or other necessary medication! We are encouraging you to learn your risk factors when using new medications. If you need to go on a new medication, be sure to ask your prescriber if your new medicine can disrupt your birth control. Consider using condoms or another back up method while on antibiotics or other medications that can interfere with your birth control.

Getting off your current Hormonal Birth Control

Getting off the pill is a lifestyle decision. Whether you are trying to get pregnant, or suffer from side effects and want to go natural, it is essential to know what your body will do next. Roughly one week after ending birth control, the average female’s body begins ovulation. This means that an egg will release and has the opportunity to be fertilized, or remain
unfertilized. It is important to note that when you stop birth control, your period might not be regular right away. This means it is less predictable. So if you are trying to track your period, you may notice inconsistencies and naturally be more susceptible to pregnancy. Also note, if you are trying to get pregnant, due to this irregularity, it becomes hard to predict when you may be ovulating. Don’t get discouraged; most women regain period regulation within 3-6 months.

Comparing Contraceptive Options

Published on March 27, 2020 by admin

Comparing Contraceptive Options

The number of choices seem endless with birth control which can make it pretty confusing to know which one is right for
you. So how do you get started? A good place to start is to figure out your priorities. Is your main priority to limit side effects or to get value-added benefits?

If you know you do well with hormonal contraceptives and experience limited side effects, congratulations, you’ve hit
the jackpot. According to the National Center of Biotechnology Information (NCBI), nearly 60% of all subjects in their study discontinued their oral contraception prescription by six months. If you know your body is not sensitive to hormonal changes, you can begin to look at options with value-added benefits. Some contraceptives help with acne, reduce bloating, and allow you to skip periods for months at a time, #goals.

If you are with the other 60% of the population, you might be more sensitive to hormonal changes. In this case, the
focus should be on finding the option that works best for you to limit your side effect profile. This can be challenging and take a few attempts to get it right. Don’t concentrate on value-added benefits of contraceptives until you get this piece of the puzzle right. Although having clearer skin might seem glamorous, is it worth daily vomiting and diarrhea?

Below are side by side comparisons of the positive and negative attributes to hormonal contraceptive options:

Mobile Portrait Mode Users Only Please rotate your device to landscape for an improved viewing of the table below.

	Description:	Positives:	Negatives
Combination Pill	– Daily pill – Contains estrogen and progestin – Other names: “The pill”	– Easily accessible – Affordable – Most widely used contraceptive option worldwide – Decreased risk of ovarian and endometrial cancers, ovarian cysts, benign breast disease, and ectopic pregnancy – Improvement in acne – Less-severe menstrual cramps (dysmenorrhea) – Reduction in androgen production caused by polycystic ovary syndrome – Reduction in heavy menstrual bleeding due to uterine fibroids and other causes (menorrhagia) – Can shorten, lighten, and improve regularity of periods – Some options allow for skipping of periods – Reduction in iron-deficiency anemia – Relief from premenstrual syndrome (PMS) – Can be ceased at any time, followed by a quick return to fertility	– Must be taken daily – Many exclusionary factors, so it is not safe for everyone. – Side effects can come from estrogen: heart attack, blood clot, and stroke – Side effects can come from progestin: nausea, vomiting, diarrhea, hair loss, etc.
Progestin Only Pill	– Daily pill – Contains only progestin – Other names: “The minipill”	– Easily accessible – Affordable – Can be safely taken by many women who are not good candidates for combination oral contraceptives. For example women over the age of 40, daily smokers, and those breastfeeding – One of the safest forms of hormonal contraceptives – Can be ceased at any time, followed by a quick return to fertility	– Must be taken at the same time every day. – Less reliable than the combination pill. – Side effects can come from progestin: acne, nausea, vomiting, diarrhea, hair loss, decreased libido, depression, etc.
Vaginal Ring	-Transparent plastic ring that’s inserted into the vagina. – Contains both estrogen and progestin. – Other names: NuvaRing, Annovera	– Comfortable and easy to use – No daily action required, insert it and leave it for three weeks. – Can be removed at any time, followed by a quick return to fertility – Safe for women with latex allergies – Easier to use for women who have trouble swallowing pills or remembering to take their pill	– Expensive without insurance – Can cause vaginal irritation and discomfort – Side effects can come from estrogen: heart attack, blood clot, and stroke – Side effects can come from progestin: acne, nausea, vomiting, diarrhea, hair loss, etc.
The Shot	- Injection every 3 months - Combination and Progestin only options – Other names: “Deep shot” “Depo-Provera”	– No daily action required, the shot is administered every three months – Good option for women who cannot safely take or want to avoid estrogen-containing contraceptive options – Easier to use for women who have trouble swallowing pills or remembering to take their pill	– Can reduce bone density in females using it for a long time. Should not be used for more than 2 or 3 years to avoid osteoporosis – Fertility may take longer to return after discontinuation then other contraceptive options – Side effects can come from progestin: acne, nausea, vomiting, diarrhea, hair loss, etc.
The Patch	– Patch that goes on your skin – Combined hormonal contraception – Other names: “The Patch”	– Comfortable and easy to use – No daily action required, place it and leave it for three weeks. – Good option for women who cannot safely take or want to avoid estrogen-containing contraceptive options – Can be removed at any time, followed by a quick return to fertility – Easier to use for women who have trouble swallowing pills or remembering to take their pill	– Can cause skin irritation – Not eligible to use the patch if you are over 198 pounds. – Side effects can come from estrogen: heart attack, blood clot, and stroke – Side effects can come from progestin: acne, nausea, vomiting, diarrhea, hair loss, etc.
IUD	– T-shaped plastic frame that’s inserted into the uterus – Two types: Hormonal and Non-hormonal options – Brands: “Mirena” “Kyleena” “Liletta” “Skyla” “Paragard”	– No daily action required, can be left in between 3 and 10 years depending on the device – Good option for women who cannot safely take or want to avoid estrogen- containing contraceptive options – The most effective option at preventing unwanted pregnancy – It can be removed at any time, allowing for a quick return to fertility – Easier to use for women who have trouble swallowing pills or remembering to take their pill	– Very expensive without insurance – Requires a medical procedure and medical intervention for removal – Increased risk of uterine perforation – Increased risk of ectopic pregnancy if you do become pregnant. – Increased risk of pelvic inflammatory disease – Painful implant procedure – Side effects can come from progestin: acne, nausea, vomiting, diarrhea, hair loss, etc. – Side effects can come from copper: spotting, painful and heavier periods
Implant	– A rod like matchstick that is inserted into the arm. – Brand: “Nexplanon”	– No daily action required, can be left in for 3 years – Extremely effective option at preventing unwanted pregnancy as limited user error – It can be removed at any time, allowing for a quick return to fertility – Easier to use for women who have trouble swallowing pills or remembering to take their pill	– Very expensive without insurance – Requires a medical procedure and medical intervention for removal – Side effects can come from progestin: acne, nausea, vomiting, diarrhea, hair loss, etc. – Painful implant procedure

Mayo Clinic website

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1903378/

Why You Might Not be a Good Candidate for Hormonal Contraceptives

Published on March 27, 2020 by admin

Why You Might Not be a Good Candidate for Hormonal Contraceptives

Nobody likes to hear the word “No,” but sometimes it is good for us.

I took hormonal contraceptives for 17 years until I was informed that I did not meet the CDC guidelines to receive the combination pill. My mom started me on the pill when I was 14 years old. I was the girl with the horrible headaches and vomiting and other ailments, especially when I got my period. Once I received the first prescription, the rest just followed.
It turns out that the horrible headaches with vomiting, sensitivity to light and sound, and numbness in my limbs made me a prime stroke candidate. I have what they consider “complex migraines” or “migraines with aura.” They weren’t daily, or even weekly, so I never thought them a significant problem. Sometimes I could beat them naturally; other times, medical intervention is/was necessary. Thankfully, I was lucky and never experienced a stroke. It was all thanks to a physician that took the time to listen, investigate, and care (thanks Doc).

[Side note: Not all migraines are a bad match for birth control. Actually, if you do not experience migraines with aura, birth control can actually help with common migraines caused by hormonal changes. If your migraines include: limb numbness, speech or language difficulty, muscle weakness, visual changes like zigzag lines, flashes of light, or blind spots, be sure to contact your healthcare provider].

There are a lot of reasons why a female might not be the right candidate for a particular type of hormonal contraceptive. Perhaps it is due to age, lifestyle choices, past medical history, prescription drug use, or even just metabolism. For example, females over 198lbs should not be on “The Patch” because the efficacy (or effectiveness) decreases. Women who have high
blood pressure, shouldn’t be on combination pills as it increases the risk of heart attack, clots, or stroke. Similarly, women who are over the age of 35 and smoke regularly, should also not be on a combination contraceptive due to increased risk of heart attack, clots, or stroke.

The United States Medical Eligibility Criteria (USMEC) issued by the CDC, lists in detail the eligibility criteria for women seeking hormonal contraceptives. So why are so many girls slipping between the cracks?

We are unaware of a pre-existing condition. It is well understood that not everyone has access to affordable healthcare within the United States. It is essential to ask, listen, and learn when you get on any new prescription.
We aren’t keeping up or revisiting long term prescriptions, be sure to check in every year with the physician that put you on your original prescription. Let them know about any new medications that you are taking.
We are miscommunicating at the age of 14, and I didn’t know the difference between migraines or headaches, never mind with or without aura. I just said no. It’s safer to overshare with healthcare professionals, then keep it to ourselves. Likely, they’ve heard and seen far worse than any question we can throw at them.

So what happens if you are not a good candidate for hormonal contraceptives? You can still play it safe, but you need to be more careful.

Consider diaphragms, male or female condoms, and/or spermicides. Female and male condoms also protect against sexually transmitted infections, and most insurances cover female condoms.
Calendar rhythm methods are becoming more prevalent and reliable with emerging technology. There is a higher risk of unplanned pregnancy if this is your only contraceptive method, and using backup protection, especially when you are first beginning is strongly recommended. Natural Cycles and Femometer are two great options in this category.

https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf

Not All Side Effects are Created Equal

Published on March 27, 2020 by admin

Not All Side Effects are Created Equal

When you get an unwanted side effect from any medication, it may seem like the worst-case scenario. In terms of hormonal contraceptives, not all side effects are created equal.

If you’ve ever read the package inserted of hormonal birth control, you may quickly get cold feet. The list is long and quite frankly, not very attractive. Somewhere between diarrhea, acne, and a stroke, a girl starts to question what unlucky straw (if any) she may pick. But these side effects are not all miscellaneous, and some can be attributed to lifestyle. In this article, we will discuss: how and why some side effects occur, which ones are important to your safety, and which ones are just annoying.

When you answer medical questions at a doctor’s office, they are ensuring that you are a good candidate for hormonal birth control and ensuring the medical benefits out way the risks. Statistically speaking, healthcare professionals are wonderful at filtering patients at risk for major complications. Healthcare workers can do this by considering a patient’s: age, blood pressure, weight, medical history, BMI, physical activity level, and environmental factors such as smoking. It is proven that women who smoke are more inclined to experience a heart attack, stroke, and blood clots when they utilize combination contraceptives. This risk factor increases exponentially if a woman is over the age of 35 and smoking. Combination contraceptives are the most widely used birth control in the world. They include an estrogen and progestin derivative and help with regularity and reduced spotting.

Some non-lethal side effects can still drastically impact your life long-term. Generally speaking, side effects like diarrhea, nausea, and vomiting are incredibly frustrating, but will not kill you like a heart attack. BUT, if a female is on the pill and experiences diarrhea, nausea, and vomiting after taking her pill every day, she may not actually be receiving the full dose of the medicine. Her body is unable to digest the active ingredients in time, leaving her susceptible to unplanned pregnancies. Over the first five to ten days of taking a new pill, all females should utilize backup protection to ensure proper safety. If you experience consistent diarrhea, nausea, and vomiting after taking your pill, try to take it with food, and always be sure to drink plenty of water. If it persists, tell your medical professional. Some pills cause these side effects more than others, so switching maybe your best option.

So what about side effects that don’t kill you or impact your birth controls effectiveness, but make you feel awful? Side effects such as acne, mood swings, difficulty sleeping, hair loss, weight gain, and even depression can make it really difficult. You might not even feel like yourself. Wait it out as long as you’re comfortable. There is no reason to make yourself crazy or miserable, but usually, your body gets used to the new hormones and adjusts accordingly. Plus hormonal birth control can decrease your risk of certain cancers, ovarian cysts, keep you more regular, and protect you from unplanned pregnancy.

Here are some tips for your next appointment:

Be honest and know your contraceptive past! Tell your medical healthcare provider what worked well for you or caused deal-breaking side effects. Know the names of your old prescriptions. A pill is just a pharmaceutical recipe; if you know one of the ingredients doesn’t make you feel well, tell somebody. That way, you can receive an option with different ingredients.
Go in with realistic expectations. Some people do well with hormonal changes; others do not. The longer you are on the same birth control, the longer your body gets used to and reduces your side effects. Don’t allow yourself to suffer, but know that side effects are common and usually decrease over time. Decide what your tolerance level will be, and what side effects are a deal-breaker.
Learn the difference between dangerous and annoying. If you are noticing extreme: chest pain, shortness of breath, loss of consciousness, swelling in your legs, etc. get to your closest emergency facility.

Other Medications Could Be Your Birth Control’s Worst Nightmare

Published on March 27, 2020 by admin

Other Medications Could Be Your Birth Control’s Worst Nightmare

The love/hate relationship with antibiotics/medications and birth control is real! Both provide incredible health benefits individually (with some side effects), but together, they are a false narrative that can change your life forever.

Combination pills are the most widely used form of birth control in the world. They are easy, affordable, and require less medical intervention than other types of birth control. But what happens when you get sick? Many illnesses require medical intervention via antibiotics or other medications, which uniquely affects women using contraceptives. Spoiler Alert: Antibiotics and other medications can impact your birth control’s effectiveness!

Many birth control options contain estrogens. Some antibiotics cause the liver to increase the breakdown of estrogen and can drastically decrease estrogen levels in the body and ultimately decrease the effectiveness of birth control. These antibiotics are SUPER rare and not often used in daily medical interventions.

So what’s the deal? Why do so many people believe antibiotics cancel out birth control? Well, illness and sometimes new medications cause vomiting and diarrhea, which means you might not be able to absorb your full dose of birth control before you get sick again. Without your full dose this can lead to unplanned pregnancies.

So what should you do? Once you finish with your antibiotic (that you took in its entirety), it can take 7 to 10 days for your birth control to become effective again. So, use backup methods such as barrier methods until you know that you’re safe from accidental ovulation. Antibiotics are often necessary, and we do no discourage the use of any antibiotic. However, we encourage the power and knowledge to protect yourself and your body from unintended consequences.

Here are some tips for the next time you are on birth control and prescribed antibiotics:

Ask your healthcare provider if that particular medication can impact your birth control.
If birth control is the only contraceptive: always allow at least 7-10 days of regular birth control use after the end of your antibiotic prescription.
Consider backup contraceptives. Female condoms are often covered by insurance and provide you with control.

Want to learn more about how antibiotics can impact your birth control? Visit:

https://www.ncbi.nlm.nih.gov/pubmed/12436822

What is birth control and why do some experience side effects?

Published on December 16, 2019 by admin

What is Birth Control and Why do Some Experience Side Effects?

Birth Control (also referred to as hormonal contraceptives) comes in several forms, shapes, and sizes. Some are ingested, others are applied to the skin (the patch), while some are inserted like the shot or ring. Although there are plenty of options out there, they all influence women’s hormone levels and try to prevent a mature egg from being released to get fertilized. Many women will experience side effects from birth control; after all, birth control is a type of steroid. Birth Control is a hormone, and it will always change hormone levels.

Understanding WHY side effects can happen is essential in understanding birth control. Throughout your body is tons of hormone receptors, think of these like puzzle piece edges. When your body’s hormones naturally release, if it fits together with another piece, it will bind there. Have you ever noticed that during a period your: mood, sleep, appetite, acne, or energy level might change? This unwanted reaction is because your natural hormones teamed up with some of the puzzle pieces that you wish they had not. The same goes for birth control. Please understand that if your natural hormones caused a reaction such as acne, it doesn’t mean birth control would create a similar response. This is precisely why pharmaceutical companies made SO many options. More options mean more puzzle piece options.

If you are not new to birth control, you’ve probably heard, “Let’s try you on this and see how you do over the next three months.” *Sigh* the Guinee Pig Game. Although it is sometimes necessary (especially for new contraceptive users), shouldn’t more science go into prescribing birth control? We believe, yes!

Your birth control should change with: age, weight, BMI, environmental choices, and family planning goals. It is a medical fact that as the average female ages or gains weight, they create more estrogen. The good news is that pharmaceutical companies have created a lot of options. So if you know you do well with a particular pill and progestin (puzzle piece type), a great option is to get a lower estrogen version of that pill. Estrogen is a blessing and a curse in birth control. It helps alleviate breakthrough bleeding and reduces many unwanted, annoying side effects, but it also increases the risk of heart attack, blood clots, and stroke. When you answer medical questions at a doctor’s office, they are ensuring that you are the right candidate for birth control, and the medical benefits out way your risks.

Here are some tips for your next appointment:

Be honest and know your contraceptive past! Tell your medical healthcare provider what worked well for you or caused deal-breaking side effects. Know the names of your old prescriptions. A pill is just a pharmaceutical recipe; if you know one of the ingredients doesn’t make you feel well, tell somebody. That way, you get a pill with different ingredients.
What works for your friends or family may not work well for you. If you ask for a particular pill and are eligible to receive it, most healthcare workers will honor your wishes. If you aren’t sure what you should take, ask, don’t guess.
Go in with realistic expectations. Some people do well with hormonal changes; others do not. The longer you are on the same birth control, the longer your body gets used to and reduces your side effects. Don’t allow yourself to suffer, but know that side effects are common and usually decrease over time. Decide what your tolerance level will be, and what side effects are a deal-breaker.

Want to learn more about the chemistry of birth control? Visit https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827491/