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Melanie Cole, MS (Host): There are so many different forms of birth control options out there. It can be confusing and dizzying, and you don’t know which one to choose or which one is going to be the right choice for you. My guest today is Dr. Carrye Daum. She’s an obstetrician gynecologist with Women’s Healthcare PC. Dr. Daum, I'm so glad to have you with us as I am actually going through this with my daughter right now. Are you seeing more girls using birth control for other benefits like acne, controlling PMS, endometriosis, all of those things. Talk about birth control.

Carrye Daum, MD (Guest): What I usually go over when a patient comes and wants to go over birth control options is I go over the hormonal options first. We also have barrier methods, such as condoms, things like that. But typically if somebody’s coming in to ask me my opinion on birth control, they have questions about hormonal options. So for those I tend to break up my talk into a couple different categories. One of the categories of hormonal contraceptive options, they contain both estrogen and progesterone. Then the other group is progesterone only, and those are the longer acting options. I will throw in there’s also a non-hormonal IUD, which we’ll get to. But when we’re talking about hormones, we split them up into estrogen and progesterone options versus progesterone only options.

So within the estrogen and progesterone group, you have three main ways to go. One is just a normal birth control pill. That’s what most people choose to go to first. Just a daily pill that you take around the same time every day that contains both estrogen and progesterone. The others are there’s a patch, a contraceptive patch. That’s one that rather than taking a pill every day, you change the patch once a week. Then during the fourth week of the month, you don’t have the patch on. That’s when your body responds to the lack of hormones and that’s when you should expect to get your period. The third option in the estrogen and progesterone group is it’s called the NuvaRing. It’s a small ring that the patient actually inserts into the vagina and it stays there for three weeks. During that fourth week, they remove it, and, again, that’s when your body responds to the lack of hormones and has a period.

So that group of options is—Basically those are the ones that are going to let you predict your period the best. So many people, you know they come in, they have irregular periods or pain with periods, and they just want them to get better. They want them to be predictable. So if timing is an issue and you're having accidents because you can't predict when your period is going to start, going to one of those options is probably going to be your best bet because it makes everything predictable. The options within this group also tend to make your periods shorter, lighter, and less painful. So most people who come in to discuss contraceptive options as a first line will go to one of those estrogen and progesterone containing options. The easiest thing to kind of start and stop and kind of be in control of is the pill. It’s just the kind of tried and trusted one for decades upon decades. So most people do start with that.

Sometimes we encounter patients who have other health concerns where estrogen may actually be contraindicated for them. So, for example, if a patient has a history of high blood pressure, they actually can't be on any of the options that I just talked about because of other risks that it could pose to them. So for them and for people who just don’t want to have to remember to take a daily pill or take a weekly patch or have your NuvaRing on whatever schedule, then we get into the progesterone containing options or the longer acting options. So within that group, there are three main ways to go. One is the Depo-Provera shot. So it’s a progesterone shot that you get around once every 12 weeks that basically takes the daily having to remember to do something out of it.

Then we get into the implant options for contraception. So the first one that I always talk about is called Nexplanon. It’s just a little rod that is inserted just beneath the skin into your upper arm, and it slowly releases progesterone over the course of three years. Right now it’s FDA approved for three years of contraceptive benefit. It’s actually the most effective contraceptive method that’s out there, meaning the risk of pregnancy is the lowest possible with Nexplanon than with any other option including surgical sterilization. So Nexplanon is great, especially if someone comes in after an unplanned pregnancy and they need the best contraceptive method for these upcoming years. Nexplanon is a great option in that case.

Then we have the progesterone IUD. IUD is intrauterine device. So in most cases they're just a little plastic T that contain progesterone. Those have to be inserted by an OBGYN. So that’s something that does require and office visit. Depending on which one you get, the ones that are most popular now are the five year options. The Mirena IUD is actually also approved to decrease period flow as well. So that’s another reason, just beside contraception, that a lot of people end up going to a Mirena IUD. Then we have the copper IUD or the Paragard, and it is actually a 10 year option. So for people who have certain health issues where they just cannot have any kind of excess hormone in their body, the Paragard is a great option. So, again, it’s copper. It works for 10 years if you want it to, and it does require an office visit to be inserted.

So that’s kind of my overview that I give patients just of the basic categories of contraceptive methods out there. Of course, there is also tubal sterilization. If someone knows that they are done childbearing or does not desire to bear children, the option that has come into favor most recently is actually called a salpingectomy, which is where we remove the entire fallopian tubes. It used to be you get your tubes tied. We still do some of that just depending on the patient’s anatomy. But if we can get to the whole tube, it’s actually now preferred to just take out the tube. The reason for that is it’s thought that the origin of some ovarian cancers actually starts in the tube. So if you're done with your tube and you're not gonna be using it for fertility anymore, just take it out. So that is a same day surgery. It’s something that we do laparoscopically with just three little incisions on the belly, and we call it a laparoscopic bilateral salpingectomy, or using our little incisions and camera to actually remove the entire fallopian tubes.

Host:   What a great explanation. What a great educator you are Dr. Daum. So let’s talk a little bit—We don’t have a lot of time, but let’s talk a little bit about framing the conversation for parents. Also do birth control methods, the ones that you’ve described, protect against STDs and STIs? Do you discuss that, especially with your teens, but with your patients?

Dr. Daum:   I do discuss that. So nothing that I've talked about will help protect against STDs. So that is why we also recommend basically duo contraception. So any of the contraceptive methods that we've talked about, but also a barrier method of protection. So, for instance, condoms to decrease your STI—sexually transmitted infection risk as well. So yes. The contraceptive methods that I've talked about are great, but they will not protect against sexually transmitted infections. So it is very important to double up when you're protecting yourself.

Host:   I think one of the questions that many women have when they're looking at birth control options is the worry that if they're one birth control for a certain amount of time that it will decrease their ability to conceive. Is that a myth? Is that true? As we wrap up, how do we choose which method is correct for us?

Dr. Daum:   Great question. The only birth control method that actually prolongs—We call it your return to fertility. So once you stop the method, how long does it take your body to kick back in? The one option that has been shown to actually do that is the Depo-Provera shot. So that is something that I always talk about with my patients. I mean you could be 16 years old coming in my office having the first talk about contraception. But what if you start Depo-Provera and you love it and you stay on it for 10 years, and you expect to come off of it when you're in a situation that you want to conceive, and your body does flip back on right away? So that is something that I talk to everyone about is the return to fertility issue.

So with anything else I talked about—with the pill, the patch, the NuvaRing, the Nexplanon, or the IUDs—those all have an immediate return to fertility, but the Depo-Provera shot is the one that actually can have even up to an 18-month delay for some people. So I think what this all boils down to is you need to have a conversation with your physician about what is best for you. If someone comes in with terribly irregular periods—they can't predict anything about them—I would really probably go to one of the estrogen containing options for that person. just so that—It just depends what you want. If you want predictability, then yes. Go to that class of medicines. If you want something long-term that you don’t have to think about, then an implant may actually be more appropriate for that patient. So I really do think it just boils down to you have to have a conversation with your doctor about what you're looking for and what is most appropriate for you.

Host:   Wow, great advice. Wrap it up for us. Your best advice about choosing that best birth control option for you and learning about those options so that you're making the best decision and being your own best health advocate.

Dr. Daum:   So I would say my best piece of advice is this is all a very individualized decision. It depends what you're looking for. It depends what fits in with your life. There are some people who have a crazy day to day schedule where their shifts are different for work. Or school and activities may be interfering with their ability to take a daily method where a longer acting may be better for them. There are people who have terribly heavy periods where they come in wanting not only contraception, but also better periods. So for them, either one of the estrogen containing options or the Mirena IUD ends up being a better way for them to go. My point is it’s all very individualized and it comes down to educating yourself through a conversation with your doctor and deciding what is the best for exactly what you're looking for.

Host:  Great advice for women to hear so that they can make informed choices because that’s really what it’s all about. Thank you so much Dr. Daum for joining us today and really giving a great explanation of all of the different forms of birth control out there. That wraps up this episode of the Women’s Hospital, a place for all your life. To schedule an appointment with Dr. Carrye Daum, please call 812-858-4600. Or you can always head over to our website at deaconess.com for more information and to get connected with one of our providers. If you found this podcast as informative as I did, I'm a mother of a teen and we’re looking at all of these options. Please share with other people that you know, with other women that you know because that way we all learn from these experts together. This is Melanie Cole. Thanks so much for listening.