Contraceptives are devices, drugs, or methods for preventing pregnancy either by preventing the fertilization of the female egg by the male sperm or by preventing implantation of the fertilized egg.
Choosing the appropriate contraceptive is a personal decision.
Listen in as Peggy Groeneveld, pharmacist with Aspirus Keweenaw Hospital, discusses questions to consider when selecting a birth control method.
Selected Podcast
Birth Control Options for Women
Featured Speaker:
Peggy L Groeneveld, PharmD
Peggy Groeneveld is a pharmacist at Aspirus Keweenaw Hospital. Transcription:
Birth Control Options for Women
Melanie Cole (Host): There are many types of contraceptives available today that allow individuals to choose the type of birth control that best fits their lifestyle and budget. My guest today is Peggy Groeneveld. She’s a pharmacist at Aspirus Keweenaw Hospital. Welcome to the show, Peggy. So, give us a little working definition of many different types of birth control methods that are out there and available for women today.
Peggy Groeneveld (Guest): Okay, Melanie. Well, the first and most common type of birth control is the oral contraceptive commonly known was the pill. That is available in many different formulations. It can be a continuous cycle where the woman wouldn’t have her period at all or could just have it four times a year. Many women find that to be convenient, especially those that have heavier, painful periods. Then, there’s what’s called the conventional cycle where you do have a period every month. You have a week during the month when you’re off the pill or taking placebos. The pill has a failure rate of less than 1% if used in the theoretical world. In the real world, it’s closer to 2-3%, but it’s still a good choice for many women. For those who don’t want to have to remember to take a daily pill, there are other methods of reversible contraception such as the IUD which can be left in place for five to ten years, depending of the type of IUD. There are also contraceptive implants which are the newer form. Those are implanted in the upper arm under the skin and those last for three to five years. There’s also a Depo-Provera injection that’s given every three months. Those are all good for women who want a long-term contraception but don’t want to have to remember to take a daily pill. For women who want contraception only on an occasional basis or those who are worried about STD’s, the only contraception that provides protection from STD, of course, is a condom. Both male and female versions are available over the counter. They are not as effective in preventing pregnancy but they do protect from STD’s and can be a good choice for occasional contraception. Other barrier methods are the diaphragm which requires a prescription or a cervical cap. Those can be good choices for women who don’t want to take a hormonal form of contraception. The only difficulty some women find with that is that you have to have it handy before intercourse and be able to insert it within an hour or two before intercourse. There’s also natural family planning for women who don’t want to use other forms of contraception or who can’t for medical reasons. Those are good forms for women if they have a provider who’s trained in those.
Melanie: Are you talking about like ovulation kits that show you what your cycle is so that you can plan that way?
Dr. Groeneveld: Not necessarily a kit, but there are OB’s and family practice doctors who help you take your temperature. So, you have to be committed to those sorts of natural family planning methods. But right; it’s based on ovulating and avoiding unprotected sex when you do ovulate. So, those are for women who are committed to keeping a careful track of their cycle because they cannot use other forms of birth control.
Melanie: So, let’s speak about IUD’s and implants for a minute because the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists are recommending IUD’s and contraceptive implants as a first line option for sexually active teens as well. So, what is an IUD? Who puts that in? How long is it in?
Dr. Groeneveld: An IUD stands for an “intrauterine device” and there are two forms commonly used in the United States. The first one is a copper form and the second one is one that has Levonorgestrel, a form of estrogen in it and it releases that. So, the second type, the Levonorgestrel-releasing one does have a hormonal component, so it would have side effects similar to a hormonal birth control pill. The copper one has no hormone but the copper prevents implantation. Both IUD’s have high rates of effectiveness, less than one percent, like .02% or something, of unplanned pregnancies. They have to be inserted by a practitioner, so inserted in the doctor’s office. If a patient desires continued contraception and there are no difficulties, they can remain in place for five to ten years.
Melanie: And, now, people have been hearing about the morning-after pill or emergency contraception, speak about that.
Dr. Groeneveld: The morning after pill is exactly what you know. The sooner it’s used after unprotected sex, the more effective it is. It is now available over the counter, so you can go to a pharmacy and get it over the counter. You don’t even have to, in most states, go up to the pharmacy counter and get it. It is without a prescription in every state. There are two different forms. One is a one-dose and one is a two-dose. And all the instructions are right on the packet. The biggest side effect with that, because you are getting a large pill of hormone, is nausea and vomiting and there are instructions right on the packet. If you vomit it up soon after taking it, you’ll have to take another dose. But, otherwise, it’s pretty self-explanatory and it is available over the counter.
Melanie: With all of these types of contraceptive devices that you’ve been speaking about, how does somebody decide, Peggy? And when people ask you which one might be right for them, how do you tell them which one to look at?
Dr. Groeneveld: Right. Well there’s no one best method, of course. So, you have to kind of get to know the person and their lifestyle and their personal preference and also if they have any individual health concerns. For instance, oral contraceptives can help with painful periods or endometriosis. So, if someone has one of those conditions, I would stir them towards an oral contraceptive but it also depends on their personal preference. Are they concerned about STD’s? Do they need a method that would help protect from that? Are they the kind of person who’s very routine and could remember to take a pill daily? So, it’s highly variable and we need to talk with their pharmacist and their health practitioner to determine the best choice for them.
Melanie: So, there’s a lot of myths and questions regarding oral contraception. So, first, do they make you gain weight? People would like to know if they lose their sex drive from using these and that some medications might interact. Can you answer those?
Dr. Groeneveld: Right. Those are all common concerns with oral contraceptives. So, first, gaining weight: that’s a common belief among practitioners and patients and there’s some basis for that but long-term studies have shown that they can’t rule out a small weight gain with contraceptives. But, studies have looked at thousands of women both on oral contraceptive and not and looked at their weight gain over years and there’s no statistically significant difference between the weight gain, between the contraceptive- and the non-contraceptive-using women. The pill can make you sometimes retain fluid, especially during the time of the month where you’re off the pill if you’re not on the continuous, where you’re on the placebo. So, that fluid retention or bloating can make you feel like you’re gaining weight but there’s no evidence that large weight gains are caused by being on the pill. For interactions, there are some interactions people need to be aware of. A lot of people think of antibiotics as interacting with birth control but studies have shown that the only antibiotic that really lowers the effectiveness of birth control is Rifampin which is very rarely used. So, most antibiotics that are prescribed, they all come with that little sticker on the bottle that says, “May reduce the effectiveness of birth control” but studies have shown there really is no significant decrease with those. A couple of drugs, though, do significantly decrease birth control and patients need to be aware of those. Most of those are anti-seizure medications such as Dilantin, Topamax. Patients who are on anti-seizure medications, we usually recommend they use a different form of birth control rather than oral contraception. Also an over the counter herb sometimes used to treat depression called “St. John’s Wort” also decreases the effectiveness of birth control. So, patients using that need to be aware. That could cause them to maybe need to look at a different form of birth control besides the pill. And, finally, sex drive: that is another common what I think of as a myth because most studies have shown, one thing: it’s really hard to weed out all the different factors that affect our sex drive. But, generally, women report an increase in their libido when they’re using reliable contraception. However, there are some reports of women who find that their sex drive is decreased on an oral contraceptive and there’s a reason. The oral contraceptives lower women’s testosterone level. That testosterone is really important to our sex drive. So, there are different contraceptives that lower the testosterone more or less. So, if you do find that your sex drive is lowered when you start the pill, after a couple of months and you’re able to rule out other reasons for that, talk to your provider about switching to an oral contraceptive that has a higher androgen content and would decrease your testosterone level less. That may take care of the decreased sex drive.
Melanie: What great information. Wrap it up for us if you would, Peggy, with your best advice for people that have so many questions about contraception options out there today.
Dr. Groeneveld: Well, my first advice is talk to your provider. Have a primary care provider that you’re comfortable with and can bring all your contraception and sexual health questions to. Also, talk to your pharmacist. We are knowledgeable about contraception, so we’re happy to answer any questions that you have on that. But, your health care provider or your primary provider has all your health information and can recommend a best option. Also, if the option you’re using, if it’s not convenient or if you have side effects you don’t like, don’t be afraid to come in and talk to your provider and let them know. There are many options out there so don’t be afraid to try several different contraceptive options until you find the one that’s right for you.
Melanie: Thank you so much for being with us today. It’s great information. You’re listening to Aspirus Health Talk. For more information, you can go to www.aspirus.org. That’s www.aspirus.org. This is Melanie Cole. Thanks so much for listening.
Birth Control Options for Women
Melanie Cole (Host): There are many types of contraceptives available today that allow individuals to choose the type of birth control that best fits their lifestyle and budget. My guest today is Peggy Groeneveld. She’s a pharmacist at Aspirus Keweenaw Hospital. Welcome to the show, Peggy. So, give us a little working definition of many different types of birth control methods that are out there and available for women today.
Peggy Groeneveld (Guest): Okay, Melanie. Well, the first and most common type of birth control is the oral contraceptive commonly known was the pill. That is available in many different formulations. It can be a continuous cycle where the woman wouldn’t have her period at all or could just have it four times a year. Many women find that to be convenient, especially those that have heavier, painful periods. Then, there’s what’s called the conventional cycle where you do have a period every month. You have a week during the month when you’re off the pill or taking placebos. The pill has a failure rate of less than 1% if used in the theoretical world. In the real world, it’s closer to 2-3%, but it’s still a good choice for many women. For those who don’t want to have to remember to take a daily pill, there are other methods of reversible contraception such as the IUD which can be left in place for five to ten years, depending of the type of IUD. There are also contraceptive implants which are the newer form. Those are implanted in the upper arm under the skin and those last for three to five years. There’s also a Depo-Provera injection that’s given every three months. Those are all good for women who want a long-term contraception but don’t want to have to remember to take a daily pill. For women who want contraception only on an occasional basis or those who are worried about STD’s, the only contraception that provides protection from STD, of course, is a condom. Both male and female versions are available over the counter. They are not as effective in preventing pregnancy but they do protect from STD’s and can be a good choice for occasional contraception. Other barrier methods are the diaphragm which requires a prescription or a cervical cap. Those can be good choices for women who don’t want to take a hormonal form of contraception. The only difficulty some women find with that is that you have to have it handy before intercourse and be able to insert it within an hour or two before intercourse. There’s also natural family planning for women who don’t want to use other forms of contraception or who can’t for medical reasons. Those are good forms for women if they have a provider who’s trained in those.
Melanie: Are you talking about like ovulation kits that show you what your cycle is so that you can plan that way?
Dr. Groeneveld: Not necessarily a kit, but there are OB’s and family practice doctors who help you take your temperature. So, you have to be committed to those sorts of natural family planning methods. But right; it’s based on ovulating and avoiding unprotected sex when you do ovulate. So, those are for women who are committed to keeping a careful track of their cycle because they cannot use other forms of birth control.
Melanie: So, let’s speak about IUD’s and implants for a minute because the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists are recommending IUD’s and contraceptive implants as a first line option for sexually active teens as well. So, what is an IUD? Who puts that in? How long is it in?
Dr. Groeneveld: An IUD stands for an “intrauterine device” and there are two forms commonly used in the United States. The first one is a copper form and the second one is one that has Levonorgestrel, a form of estrogen in it and it releases that. So, the second type, the Levonorgestrel-releasing one does have a hormonal component, so it would have side effects similar to a hormonal birth control pill. The copper one has no hormone but the copper prevents implantation. Both IUD’s have high rates of effectiveness, less than one percent, like .02% or something, of unplanned pregnancies. They have to be inserted by a practitioner, so inserted in the doctor’s office. If a patient desires continued contraception and there are no difficulties, they can remain in place for five to ten years.
Melanie: And, now, people have been hearing about the morning-after pill or emergency contraception, speak about that.
Dr. Groeneveld: The morning after pill is exactly what you know. The sooner it’s used after unprotected sex, the more effective it is. It is now available over the counter, so you can go to a pharmacy and get it over the counter. You don’t even have to, in most states, go up to the pharmacy counter and get it. It is without a prescription in every state. There are two different forms. One is a one-dose and one is a two-dose. And all the instructions are right on the packet. The biggest side effect with that, because you are getting a large pill of hormone, is nausea and vomiting and there are instructions right on the packet. If you vomit it up soon after taking it, you’ll have to take another dose. But, otherwise, it’s pretty self-explanatory and it is available over the counter.
Melanie: With all of these types of contraceptive devices that you’ve been speaking about, how does somebody decide, Peggy? And when people ask you which one might be right for them, how do you tell them which one to look at?
Dr. Groeneveld: Right. Well there’s no one best method, of course. So, you have to kind of get to know the person and their lifestyle and their personal preference and also if they have any individual health concerns. For instance, oral contraceptives can help with painful periods or endometriosis. So, if someone has one of those conditions, I would stir them towards an oral contraceptive but it also depends on their personal preference. Are they concerned about STD’s? Do they need a method that would help protect from that? Are they the kind of person who’s very routine and could remember to take a pill daily? So, it’s highly variable and we need to talk with their pharmacist and their health practitioner to determine the best choice for them.
Melanie: So, there’s a lot of myths and questions regarding oral contraception. So, first, do they make you gain weight? People would like to know if they lose their sex drive from using these and that some medications might interact. Can you answer those?
Dr. Groeneveld: Right. Those are all common concerns with oral contraceptives. So, first, gaining weight: that’s a common belief among practitioners and patients and there’s some basis for that but long-term studies have shown that they can’t rule out a small weight gain with contraceptives. But, studies have looked at thousands of women both on oral contraceptive and not and looked at their weight gain over years and there’s no statistically significant difference between the weight gain, between the contraceptive- and the non-contraceptive-using women. The pill can make you sometimes retain fluid, especially during the time of the month where you’re off the pill if you’re not on the continuous, where you’re on the placebo. So, that fluid retention or bloating can make you feel like you’re gaining weight but there’s no evidence that large weight gains are caused by being on the pill. For interactions, there are some interactions people need to be aware of. A lot of people think of antibiotics as interacting with birth control but studies have shown that the only antibiotic that really lowers the effectiveness of birth control is Rifampin which is very rarely used. So, most antibiotics that are prescribed, they all come with that little sticker on the bottle that says, “May reduce the effectiveness of birth control” but studies have shown there really is no significant decrease with those. A couple of drugs, though, do significantly decrease birth control and patients need to be aware of those. Most of those are anti-seizure medications such as Dilantin, Topamax. Patients who are on anti-seizure medications, we usually recommend they use a different form of birth control rather than oral contraception. Also an over the counter herb sometimes used to treat depression called “St. John’s Wort” also decreases the effectiveness of birth control. So, patients using that need to be aware. That could cause them to maybe need to look at a different form of birth control besides the pill. And, finally, sex drive: that is another common what I think of as a myth because most studies have shown, one thing: it’s really hard to weed out all the different factors that affect our sex drive. But, generally, women report an increase in their libido when they’re using reliable contraception. However, there are some reports of women who find that their sex drive is decreased on an oral contraceptive and there’s a reason. The oral contraceptives lower women’s testosterone level. That testosterone is really important to our sex drive. So, there are different contraceptives that lower the testosterone more or less. So, if you do find that your sex drive is lowered when you start the pill, after a couple of months and you’re able to rule out other reasons for that, talk to your provider about switching to an oral contraceptive that has a higher androgen content and would decrease your testosterone level less. That may take care of the decreased sex drive.
Melanie: What great information. Wrap it up for us if you would, Peggy, with your best advice for people that have so many questions about contraception options out there today.
Dr. Groeneveld: Well, my first advice is talk to your provider. Have a primary care provider that you’re comfortable with and can bring all your contraception and sexual health questions to. Also, talk to your pharmacist. We are knowledgeable about contraception, so we’re happy to answer any questions that you have on that. But, your health care provider or your primary provider has all your health information and can recommend a best option. Also, if the option you’re using, if it’s not convenient or if you have side effects you don’t like, don’t be afraid to come in and talk to your provider and let them know. There are many options out there so don’t be afraid to try several different contraceptive options until you find the one that’s right for you.
Melanie: Thank you so much for being with us today. It’s great information. You’re listening to Aspirus Health Talk. For more information, you can go to www.aspirus.org. That’s www.aspirus.org. This is Melanie Cole. Thanks so much for listening.