Ashlee Williams, MD (Host): Birth control is personal, and you may find this surprising. It's not just used to prevent pregnancy. Contraceptives can help regulate and lighten periods, reduce cramps, and help control acne. No matter what your goal is, finding the option that fits your needs can allow you to take control of your future and live the way you want.

Welcome to the Healthier You Podcast. I'm Dr. Ashlee Williams. And today I'm talking with Dr. Amy Banulis, a Board Certified OBGYN at Kaiser Permanente about the pros and cons of various birth control methods, common myths, and how different contraceptives can align with your unique lifestyle and health goals. Thank you so much for joining us today, Dr. Banulis.

Amy Banulis, MD: Thank you so much for having me.

Host: Okay, so let's just start with the most popular birth control option, birth control pills. What should patients know about the pill options?

Amy Banulis, MD: So birth control pills are a kind of medicine with hormones that are taken once a day. There are two different types of birth control pills, combination pills, which have estrogen and progesterone and progesterone only pills. Depending on the pill, they work in a combination of ways by stopping ovulation, which means there's no egg for the sperm to fertilize, so pregnancy can't happen. And the pill's hormones also thicken the mucus of the cervix, which blocks the sperm so it can't swim up and fertilize an egg.

Host: So how do you choose between a progesterone only versus a combination pill?

Amy Banulis, MD: Sure. So the combination pills with estrogen are not a good option for women who have a higher risk of blood clots, for women who are smokers over the age of 35. And there are a few other conditions that estrogen would not be safe for you. So this is definitely a conversation that you want to have with your healthcare provider to determine whether the combination pill is a good option, or if the progestin only pill would be a better option for you.

I will say the combination pills do tend to have a lot of non-contraceptive benefits; like helping with acne, like regulating your periods, decreasing cramping, decreasing the amount of bleeding. So I would say in general the combination pills are a more popular option, but the progesterone only pills, again, are great option for women who are not able to take that estrogen.

Host: Got it. And you touched on this a little bit, what should women know about the side effects of birth control?

Amy Banulis, MD: Sure. So side effects are relatively common, especially in the first couple of months as your body is adjusting. So things like a little bit of nausea, some breast tenderness, some spotting in between your periods. These are all relatively common side effects that do tend to go away after the first couple of months. Certainly if you have any persistent side effects or anything more serious, you definitely want to reach out to your healthcare provider right away.

Host: Right. And then I hear there's a new over the counter birth control pill. Can you talk a little bit about that?

Amy Banulis, MD: Yeah. So the over the counter birth control pill is called Opill and this is very exciting. It is the first over the counter birth control pill that's been approved by the FDA. There are birth control pills over the counter in many other countries, but it's the first one for us here in the United States.

It is a progesterone only pill which is considered safe for the vast majority of women. And again, it's a pill that you take once a day. It is very effective, approximately 93 percent effective, as long as you take it at about the same time every day.

Host: Wow, and you should probably let your doctor know that you started this over the counter pill, correct?

Amy Banulis, MD: Yes, always a good idea to discuss with your doctor first, but for women who maybe don't have access to a physician, again, most women are able to safely take this birth control pill, it's without a prescription.

Host: That's great. So another popular option are intrauterine devices or what we call IUDs. Can you talk a little bit about this option?

Amy Banulis, MD: Sure. So IUDs are a great method of contraception. They are tiny T shaped devices that we put in the uterus to prevent pregnancy. They're long term, but they're still reversible. And they're one of the most effective methods that are currently available.

Host: That's great. And there are several different types of IUDs. Is that correct?

Amy Banulis, MD: Yes, there are several IUDs that are currently available. They broadly fall into two different types. Hormonal IUDs, which have a little bit of progesterone that goes into the lining of the uterus. Again, that thickens that cervical mucus and prevents the sperm from fertilizing an egg. There are several different progesterone only IUDs, and there's one that's non-hormonal. It's a copper IUD called ParaGuard. And again, they're both very, very effective and can last anywhere from three to 12 years. And the nice thing is they're immediately reversible. So if you get an IUD that maybe is approved for up to 10 years, but you decide you don't want to keep it in anymore, you can get it removed at any point.

Host: Okay. And there's a lot of information out there about how comfortable, uncomfortable it may be with the insertion. Can you talk a little bit about the process of getting an IUD placed?

Amy Banulis, MD: Sure. So most women do just fine with an office IUD insertion. For some women, we do recommend taking an anti inflammatory medication ahead of time. We also can use numbing medication in the cervix to make it more comfortable. So if you're concerned, definitely talk to your doctor about ways to make the procedure more comfortable for you.

The nice thing is it's very quick. It takes just a couple of minutes to insert. And most women are fine to just go right back to normal activities immediately.

Host: That's great. And what about birth control implants known as Nexplanon? What should patients know about that?

Amy Banulis, MD: Yeah, so the Nexplanon is a little thin rod. It's about the size of a matchstick. It is inserted just under the skin in the upper arm. And it releases a low dose of progesterone. Again, has the same method of action of the other progesterone methods. It's just a different way of delivering it to you.

It is a great option in terms of just the ease, very easy to insert with just a little local numbing medication. And then you don't have to think about birth control for several years. And again, reversible. If you decide you want it out after a couple of years; you can have it removed at any point and your fertility is back to normal.

Host: Yeah. And then there's some other benefits too, right? Like maybe lighter periods or less intense cramps because it is hormonal.

Amy Banulis, MD: Sure. Yeah. So most birth control methods that are hormonal do help significantly with cramping during periods. Most of them also help withmaking your periods lighter. And in fact, the hormonal IUDs, the progesterone IUDs, are FDA approved to help women who have either painful or very heavy periods because it does lighten them significantly. About 25 percent of women who use a progesterone IUD or the Nexplanon will actually stop having periods altogether.

Host: Wow. Okay, so we've talked about the pill, the IUD, implants. Are there any other options available that you would recommend?

Amy Banulis, MD: Sure. So there's a couple of other options that are prescription. One is a contraceptive patch, and that is very similar to the combination birth control pills because it does contain both estrogen and progesterone. But instead of taking the pills orally, the medication is released through the skin.

You do need to change the patch once a week for three weeks, and then on the fourth week, you take it off and that's when you have your period. So it's very similar to the combination estrogen, progesterone pills that have active hormones for the first three weeks and then inactive pills for 1 week.

So they're sort of a 1 week off. The nice thing about either the patch or the birth control pills is if you would like to skip your period, you can simply continue to take the active pills or change your patch without leaving it off for a week, and that will prevent your period. And that is safe to do periodically.

Um, definitely I recommend, you know, discussing with your physician first. But that gives you some control if you have an event coming up, or, you know, any other reason that you'd like to skip your period, it's, it gives you that nice flexibility. And I should mention the other method that is also very similar to the birth control pill, the combination pill, is a vaginal ring.

So this releases estrogen and progesterone through a flexible ring, that you insert into the vagina and then each ring it's just like a cycle with your birth control pills you leave it in for three weeks and take it out for one week and that's when you have your period. There is a newer ring that is for up to a whole year. So 13 cycles. So you just put the ring in once, and you take it out, but you use the same ring again. So you don't have to get a new ring every month.

Host: Oh, interesting. And do people find that it may be uncomfortable to keep it in?

a No, the ring it's kind of like when you use a tampon. Once it's in, you don't even feel it. You don't notice that it's there. It's a very easy method for women who just aren't very good about taking pills every day.

Okay and what are your thoughts on depo?

Amy Banulis, MD: So, Depo-Provera is an injection, and that's another good option for some women. So, it's a shot, an intramuscular shot that you get every 3 months. It contains progesterone only. And it's very safe. Um, the one thing that I do warn people about is that you're more likely to get some irregular bleeding, and some weight gain.

 There's a lot of myths out there in terms of weight gain and birth control. And with birth control pills, there really isn't weight gain associated, but with the Depo-Provera, there is an average over a couple of years of about five to 10 pounds. So if you're concerned about that, the Depo-Provera injection may not be the best choice.

But for many, many women, they really like this method because again, they don't have to remember to take a pill every day. And it is safe for the majority of women. And the longer you take it, the more likely you are to not get your periods anymore. So that's kind of a nice benefit.

Host: That sounds like a great benefit, but it also requires you to come to the doctor's office to get the injection at least every three months. Correct?

Amy Banulis, MD: Exactly. Every three months. So again, it may not be as convenient for some women. And for women who really want ultimate convenience and they don't want to think about remembering a pill or going into an office; those long acting reversible methods that I talked about, and that includes both IUDs and the Nexplanon implant; those are a great option.

Host: Great. So what options don't require a trip to the doctor's office?

Amy Banulis, MD: Yeah, so again, the Opill, the new over the counter progesterone only pill is one option that doesn't require a trip to the doctor's office. And then, of course, there are barrier methods like male and female condoms, diaphragms, sponges, spermicides. Those are all, if used correctly, those are all very good methods. They do tend to have slightly higher failure rates than the prescription methods or the Opill. .

Host: Right. And more successful if used properly, correct?

Amy Banulis, MD: Exactly. With all of these methods, if used according to the instructions, if used, you know, as planned, most of these methods are very, very effective, but the failure rate can range anywhere from a half a percent with an IUD, up to as much as 10 percent with some of the barrier methods.

Host: Right. So thank you, Dr. Banulis. You've reviewed a lot of great options. Can you give us some information about what people should consider when choosing contraception?

Amy Banulis, MD: Yeah, like you mentioned at the beginning, birth control is not a one size fits all. It's really important to think about what's going to work best both for your body and for your lifestyle. And thinking about sort of the non-contraceptive benefits of various methods is also important. So if you have very heavy or crampy periods, as we talked about; a combination birth control pill, or perhaps a progesterone IUD are going to be great options for you.

But again, it's really an individual choice. I strongly recommend that you discuss it with your healthcare provider to determine what's going to be the best method for you.

Host: All right, well, thank you for this great information, Dr. Banulas. There's so much to learn about the different types of birth control and how to choose the best option for you. To recap, one, there are several contraceptive options available to patients like pills, patches, implants, IUDs, andmore. Each option varies in effectiveness and some options, like condoms, can also protect against STDs.

Two, effectiveness is important, but so is finding a method that a patient feels comfortable using consistently. When choosing a birth control, make sure it aligns with your lifestyle and health goals.

Three, there are many options available and it may take some trial and error to find the method that works best for you. Don't be afraid to advocate for yourself and speak up if something doesn't feel right.

And four, do your research. Ask questions and have open, honest conversations with your doctor so that they can help you find the best fit for your personal goals. For more information about contraceptives from our experts and other health advice, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcasts. If you enjoyed this episode, be sure to share it with others who may find it helpful. Thank you from all of us at Kaiser Permanente. Be well.