Melanie Cole (Host): While a visit with your OBGYN can be awkward for some women, especially if you have questions regarding your health, it's a necessary step to ensure you're getting the answers you need.

Whether you're visiting for gynecologic or prenatal care, we're here to help. to share part two of what questions you shouldn't be embarrassed to ask your OB GYN. Welcome to Checkup Chat with Evergreen Health. I'm Melanie Cole and we have Erin Kendall, Physician Assistant from Evergreen Health OB GYN joining us today.

And on today's episode, we're discussing birth control and wellness exams. Aaron, I'm so glad to have you join us today. There are so many birth control options available. What are some of the tried and true contraceptive options? Let's quickly break down the different types and how hormones can affect your body. For example, weight gain and acne. So start with some of the tried and true birth control methods.

Erin Kendall: Yes, thank you, Melanie, again for having me. It's very exciting to be back. birth control is going to be really close to my heart. and just before I start about birth control, I think there's kind of a misconception regarding birth control because I think a lot of people hear birth control and they think only to protect against unplanned pregnancy.

and this is not the case. Birth control is a fabulous tool for women who have very heavy periods, very irregular menses. Very painful menses. Sometimes even, terrible cyclic migraines with those menses. As well as those lovely PMS symptoms we sometimes get. And birth control can be a fabulous tool to help those women with quality of life during the menses.

it just has a lovely side benefit of protecting against unplanned pregnancy. So that's kind of a nice side benefit of it as well. So, birth controls are essentially two different types. The first ones we have are going to be the combined, which is going to be estrogen and progesterone, those options tend to be the birth control pills, the patch, or the NuvaRing, And then we move on to our progesterone only birth control options. That will be the Depo Provera shot. The Nexplanon, which is an implant that goes in the arm, as well as the IUDs, so Skyla, Kyleena, Mirena slash Lyletta. So same things, just different brands. So those are our progesterone only ones. A lot of people, you know, are concerned with birth control, being like, what is it going to do to my body regarding hormones?

How will I feel with it? and I will be very honest with you. Every woman is going to react to hormones differently in the body. Some women are very sensitive to hormones, while other women kind of like, eh, and keep on rolling through. There is usually an adjustment period.

I would say anywhere from a month to three months that the body does take to adjust to that birth control. So I like to say that up front with people, but normally side effects as you mentioned they can range from anything from nausea, breast tenderness, headache sometimes, sometimes irregular periods as well.

We have bloating. Acne, weight gain sometimes, as well as mood swings, and sometimes low libido some women feel. I will also be honest when I talk to women, I always ask them goals and things they're worried about with birth control. Because different birth controls can affect the body differently based on data.

So, if a certain patient is concerned with a certain side effect, Sometimes we can talk about other options that have a less likelihood of causing that effect for them specifically. So it's always a discussion with patients to see what is their best option. The other side effect, and I feel like I have to mention this because Full transparency is some women are concerned about blood clots, Full stop, though. When I say blood clots, people get very nervous. So to kind of bring it back in, baseline women in pregnancy actually have a higher chance of getting blood clots than you do if you're just on a birth control, So, birth control causing blood clots? is incredibly rare and low risk, assuming you have no risk factors.

And that is something as a provider, we always ask our patients, because if you do have added risk factors for estrogen specifically, that is going to be a discussion we make together to say which one is best for you and safest for you. If you have those risk factors. but birth control is a fabulous tool and can work really, really well for women if they need it.

Melanie Cole (Host): Well, thank you so much for that, Erin. You're so knowledgeable.

And I'd like you to expand for just a minute, because you mentioned right at the outset that it's not just to prevent pregnancies, but that you're seeing more ladies and younger ladies using birth control for other benefits, like acne, even though it could be a risk. for acne itself, but controlling PMS, endometriosis.

We're seeing it used for so many other things. Can you just speak about those things a little bit Yeah, so birth control, like we just talked about, can be incredibly helpful for a lot of just normal women's bodies. Young women, when our, our HPO axis is not communicating to our uterus and ovaries as it will in the future, because it's young, it's still maturing. So, women with, you know, acne, super, super painful menses.

Erin Kendall: Menses that, you know, stop them going to school because they're in so much pain or they're just like I don't want to hang out with my friends, do the things I like to do because I am so miserable during this time during menses. Birth control and all the options we just talked about can be a fabulous tool for those women so that they can continue being themselves during those times of periods.

And sometimes we use birth control to also skip menses altogether. It's not a hundred percent. It's very very difficult to actually stop the menstrual cycle 100 percent because every woman is different. But sometimes we do use that tool, that continuous use, to really help women be their best selves.

Melanie Cole (Host): Well, thank you for clarifying that. Now, as we talk about pregnancy, how soon does a woman know she's

pregnant?

Erin Kendall: Yeah, so great question and I would say any woman who's of reproductive age that is having sex, unprotected specifically, if you miss your period, I would say take a home pregnancy test. They are very, very accurate over the counter. Usually, you'll know if you're pregnant within one week of missing your period.

for some women though, it is two weeks. Okay, so it's kind of that one to two week sweet spot. I will also say that if you do miss your period and your pregnancy test is negative, sometimes that's nothing to worry about because sometimes miss our periods randomly as women and it can be Anything from lots of stress, illness, sometimes even you've started exercising a lot more, you're training for a marathon, and our bodies sometimes do skip those periods, and that is okay.

Going back to my different age of women, my women who are about 40, 45, definitely coming up on 50, if you are starting to miss your periods, that is perfectly normal and the normal process of our bodies as we hit menopause.

Because menopause is no more menses. That time of our lives is over. So, that is normal, but always, if you're worried, please come and see us. When you do miss your period, I get concerned if it becomes a pattern. So, let's say, six months, you've missed your period two to three times with a negative pregnancy test, or you haven't had a period for, I would say, three plus months, I want you to come see us.

Because we do need to talk to you, do a workup as well to make sure, we either diagnose, something and treat you. Very important. Because women who are menstruating, it is not safe for us not to have a period if we are not on some type of hormonal birth control.

Melanie Cole (Host): You are so informative and educational, and you're a great educator, Aaron, with such a soothing, compassionate voice. I just love to hear you speak,

Melanie Cole, MS: Now, what about intercourse pain? Some women have pain with intercourse. And I know there are a few conditions that can signal that, or it can just be really anatomical. Speak about that briefly for us.

Erin Kendall: Pain with intercourse can be very common. It's not normal, but it can happen. And really, again, the vagina is an exceptional organ and she's kind of like a muscle. So, those of us who are maybe not as experienced with intercourse, it might be a little bit uncomfortable. But usually, as you have a little bit more intercourse with your partner, it tends to get better.

But I also want to talk about very importantly the difference between discomfort and pain. And let me think of maybe an analogy. Let's say you are doing squats on a rack, and you're squatting, let's say 150 pounds. Beautiful technique, you do that squat and your legs are burning a little bit, they feel like they're kind of stretching a little bit, but you know you're building that muscle. Now, let's say you're doing your squats like you normally do, beautiful technique. And let's say someone dropped something to your left, weights on the floor, it's a huge noise and you turn your body and squat. And now, what you've done is you feel a burning, excruciating pain to your low back because of poor technique. That is the thing that I can think of right now for an analogy with intercourse. If you have pain like that or if you're ever uncomfortable, please talk to your partner and have them stop. It's very important to communicate with your partner. So, please keep that in mind.

I do have to mention, of course, is something called vaginismus, as well as vaginal spasms. And for women who have these disorders, please let us know. There are absolutely ways that we can help treat you for these to make intercourse more comfortable.

Some things to keep in mind regarding perimenopause and menopause, so age around maybe early 40s, mid-40s, because of the low estrogen levels, you can have increased pain with intercourse. But the good thing is if you have this as well, please let us know. We can also treat you for this.

Melanie Cole, MS: What great advice, Erin. Wow, this is so informative. As a last question, I would just like you to speak a little bit about STIs and what you're seeing in the different populations and what someone should do if they had unprotected sex with someone. They haven't gotten tested yet. What would you like them to know about protection for sexually transmitted infections? And then, any final thoughts that you have, wrap it up for us.

Erin Kendall: STI is very close to my heart, and they are preventable. So, that's the big thing. With new partners or maybe partners you don't know as well, condoms are super, super important as a barrier method to STIs. Also, of course, shared sexual toys, making sure those are clean as well, or using a condom too can also help protect you if you're unsure about where has that other sexual toy been if you have been sharing them. So, that's first one of course.

The second, please get tested. Unfortunately with STIs, a lot of people who have them do not have symptoms, so you have no idea that you have them. A lot of the times, the only reason that we know that you have them is if we test you for them. The thing to know about STIs is that some are treatable and some are not. So, gonorrhea, chlamydia, very common, very treatable. And we do need to treat those to make sure they don't wreak further havoc on the body, possibly later in life. There's also, of course, HIV, syphilis, as well as herpes. Syphilis, all these things, HIV, herpes, these are all treatable as well. They are not something that we can essentially fully treat or fully get rid of like gonorrhea, chlamydia with an antibiotic, but we can give you medications, antivirals to help suppress as well as not spread them to other partners. And let me back up, the syphilis, we can absolutely treat, by the way. It's really the HIV and genital herpes that we cannot treat, but can suppress as well as get that viral load so you can't pass it on to others.

Kind of ending this session, part two of the podcast. Again, I want to reiterate what you said, Melanie. Please, please, please, you are the best advocate for your health. If you have questions, it doesn't matter how silly you think they are or how dumb they are, there is no dumb question. Please ask us. That is what we're here to answer as providers, to answer that question, provide you support and validation.

Okay, so please ask. Thanks so much.

Melanie Cole (Host): Thank you so much, Erin, for joining us on Part 2 today. And the Women's Health Specialists at Evergreen Health are available to address all health concerns that you may have, regardless of sensitivity. To find a Women's Health Specialist, please visit evergreenhealth. com slash findadoctor. That concludes this episode of Checkup Chat with Evergreen Health.

I'm Melanie Cole. Thank you so much for joining us today.