Transcription:
Sorting Out Birth Control Options: Finding the One That is Right for You

Melanie Cole (Host): There are so many birth control options available these days. There are advantages and disadvantages to each. So, it’s up to you and your physician to decide what’s right for you. My guest is Dr. Rachel Cannon. She’s an obstetrician gynecologist at Boston Medical Center and an instructor of OB/GYN at Boston University School of Medicine. Dr. Cannon, there are so many types as I said in my intro of birth control obviously to prevent pregnancy. But how else are they used? What are some of the other benefits besides preventing pregnancy?

Rachel Cannon, MD (Guest): Great, thank you and that’s an excellent question. I think most of the time when women they think of birth control, they really think of the birth control pill and there are many, many, many options for birth control and the good thing about that is that there are lots of benefits to it. So, a lot of women use birth control to prevent pregnancy and it’s one of the best benefits of it. But other benefits include really control over periods. So, a lot of birth controls affect a woman’s cycle and many times that means making periods lighter, shorter or sometimes going away completely. So, for women with heavy periods or who may have fibroids; that can be really beneficial so that they have less bleeding every month and to reduce long-term blood loss. Birth control also helps to reduce cramping associated with periods and pain with endometriosis and can reduce premenstrual symptoms or PMS symptoms, like pelvic pain, breast pain, menstrual migraines and reduction in all of these symptoms really helps to improve a woman’s quality of life. She can reduce absences from work or school, kind of allow her to do more with her life. There are some other benefits that include acne prevention. Some birth control pills help to reduce acne and some birth control pills also help to prevent ovarian cyst formation. So, there are many, many reasons to – that women use birth control and a lot of them have to do with these other benefits besides just preventing pregnancy.

Melanie: Do they protect against STDs and STIs?

Dr. Cannon: So, condoms are the only birth control method that protects against STIs or STDs. And again, that would be something like gonorrhea, chlamydia, HIV. So, we recommend that women who use any form of birth control that in addition to that form of birth control that they use condoms to help prevent sexually transmitted infections.

Melanie: So, let’s talk about some of the types that are out there Dr. Cannon, because people have heard obviously, about the birth control pill, been around a very long time and then we have heard about implants and patches and the vaginal ring and I mean the cervical cap, diaphragms, condoms, you mentioned those, IUDs, bring up some of these and just start with what they are and what they are intended to do.

Dr. Cannon: Sure. So, I think that again, like we said, birth control is more than just the birth control pill. And one way that I think about it is that there’s sort of a dichotomy you can think of, so how often do I have to remember to take a method versus how much control do I have over that method and some of things that you talked about the implant and the IUD; those fall into the category of long-acting reversible contraception. Those are the most efficacious forms of birth control and the good thing about them is that when a woman is using this, she doesn’t have to think about it. It is kind of that set and forget mentality. She has to see a doctor to have the IUD or the implant placed, but then she can go years without really having to think about her form of birth control.

On the other hand, some women might not want – or might want a little bit more control about how they use their birth control. So, something like the pill, the patch, the ring, those are methods where a woman can start it and stop it whenever she wants to but the efficacy or how well it works depends on taking it correctly. This is similar to methods like condoms or the withdrawal method of fertility awareness where a woman has more control about starting and stopping, but they might not work as well as some of the forms that are in that long-acting reversible contraception bucket.

Melanie: So, now we have also heard about things like the morning after pill. Or even men having a vasectomy, that’s a form of birth control, but that puts it in the man’s hands. So, how is a woman to decide about these kinds of things?

Dr. Cannon: So, it’s like you said, there are so many options. I think the best recommendation that I have for women is really to see a doctor and talk about it. My mentor Dr. Katherine White says that you date your birth control, you don’t marry it. So, there are so many options out there, it’s good to talk to a doctor and try one, but it doesn’t mean that you are stuck with that method. So, I feel like a lot of women sometimes feel pressured if they have an implant placed that it last for three years, but that they don’t have to keep it in for three years. They have to find something that’s right for them and so if you are unhappy with a method, it’s always worth it to try it for a few months but that you should be in constant consultation with your doctor about what works for you and what doesn’t. And again, because we talked about that birth control has all these other benefits in addition to pregnancy prevention that you want to find the right balance for you about what you value in terms of what’s important for your life in terms or your period or maybe acne or something like that that may also be a benefit from using birth control. One decision aid that we use a lot in our clinic is from a company called Bedsider.org. It’s a website and it’s really useful because they talk a lot about different types of birth control and gives some patient stories and so patients can get a little bit more information about what’s out there and then women’s personal experiences with them to help guide their decision making.

Melanie: Let’s talk for a second about some of the risks and specifically the hormonal forms of contraception. People are not sure about the risks for cancer. They hear about blood clots in the legs. They hear about all of these sorts of things. How long do you recommend people stay on these types of contraception like the pill; and does that decrease your ability to conceive if you are on there for a very long time?

Dr. Cannon: Sure. So, I think what’s really important is that side effects do not equal risks and that side effects on birth control are very common and risks are rare. And what I always try to remind patients are that the risks associated with pregnancy are always more than with any form of birth control. And so, a way to sort of frame your thinking about it. There are some women with certain medical problems where a certain from of estrogen – or a certain hormone called estrogen is contraindicated and they shouldn’t take it. But most young healthy women can tolerate most forms of birth control. Because of this, there really is no reason that you can’t be on birth control for extended periods of time. There is really no recommendation to take any breaks, that the use over time doesn’t increase any of the risks that most forms of birth control are out of your system like within 48 hours. The exception to that is the birth control shot or the Depo-Provera. So, that whenever you are ready to no longer be on birth control and thinking about having a baby, that just stopping that birth control method again within about two days, it’s really out of your system and you are – your body will start cycling normally.

Melanie: So, then Dr. Cannon, what happens if you are supposed to – like you are on the pill and you skip a pill or two. I know that if people read the instructions, but not everybody does, then what do you do?

Dr. Cannon: So, with most pills on the market, if a woman misses one pill; she can just take it as soon as she remembers. If she misses more than one pill, though she should call her doctor and then they can decide what’s the next best plan of action and most of the time, that means just using a back up form of birth control for a period of time. There is one type of pill called the mini pill, and it’s much more sensitive to the timing of taking the pill, so on that pill; if a woman is taking that pill, she should consult her doctor even if she misses just one, but again, typically with most of the pills if you miss one you can take it when you remember.

Melanie: Then there’s always the old standby of the pull-out method. Now what do you tell people, especially if teens come to see you and they are OB/GYN appointment and they say oh well, he pulled out before and what do you tell them about the risks of that and pregnancy?

Dr. Cannon: Sure. So, the pull-out method or the withdrawal method can be very effective. The issue with it is that it really only works while – you have to – it requires the patient to work really closely with her partner to make sure that they are able to be successful with it. That using another form of birth control would be more effective, but that using the withdrawal method is better than nothing. A lot of women use the withdrawal method or pulling out in a combination with another method and sometimes that can be my monitoring your cycles to see which times of the month she is the most fertile and trying to have sex on the days that she’s not the most fertile in combination with the withdrawal method. But that – the thing about the withdrawal method is that it is successful until it is not successful and so that women who are solely relying on that should have access to emergency contraception in case they come into a point where the withdrawal method didn’t work and that women are able to buy emergency contraception over the counter, a medication called Plan B or they can get a prescription for it from their doctor, so it can be on standby in case they need it.

Melanie: Can you get pregnant while you are having your period?

Dr. Cannon: So, the pregnancy happens after the egg is released from the ovary and travels through the fallopian tube and meets up with the sperm. Ovulation occurs around the middle of a cycle and so during the period, the ovulation has already occurred, and a pregnancy would be unlikely, very, very unlikely.

Melanie: I’m just trying to break up a few myths here. And would couples one of which or more people are transgender, would they need to use birth control?

Dr. Cannon: So, it depends. If a person with a penis is having sex with a person with a vagina and no one is using birth control; then pregnancy is absolutely possible. Even with some hormones that transgender individuals take to help with transitioning; those are not necessarily birth control and so transgender individuals need to be counseled that they are at risk for pregnancy and that counseled about what options they have to prevent that if that’s what they want.

Melanie: Wrap it up for us, because it’s really so important. This information is really, really great for listeners to hear. So, give us your best advice on birth control, some of your, you know the best ways to use it when you think it’s important that women start talking to their doctor about it.

Dr. Cannon: So, I think that the choice to use birth control is very individual and that we are really lucky that we have so many options for birth control so that we working at any point in your lifetime that you can talk to a doctor about what you want to do in terms of planning pregnancy and managing your period and thinking about other benefits that having effective birth control can do for you and then really understanding that if you get a method that you like; you are not stuck with that method. There are so many other choices that you have and that you can really work with your doctor to find something that’s right for you.

Melanie: Thank you so much Dr. Cannon for sharing your expertise with us today. This is Boston Med Talks with Boston Medical Center. For more information you can go to www.bmc.org that’s www.bmc.org . This is Melanie Cole. Thanks so much for listening.