Maggie McKay (Host): Meaningful Medicine is a Novant Health Podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future.

Today, we're focusing on contraception options with Dr. Dorothy Parsley, an OB-GYN with Novant Health. Dr. Parsley, thank you for being here today to provide an overview of all these options we have today. Let's start with oral contraceptives, which have been around for many years. What are the two main types?

Dorothy Parsley, MD: So, you're absolutely right. Oral contraceptives still are one of our most commonly used birth control methods. When we're thinking about the different oral contraceptive options, we have both combination pills, which contain estrogen and a progestin. And then, we also have progestin-only contraceptive pills.

Host: How do patients know which one may be best for them?

Dorothy Parsley, MD: That decision is usually based on if there are any other goals from a contraceptive use standpoint, whether cycle control is a consideration and certainly other medical conditions. We know that estrogen can sometimes increase risks, mainly thrombotic risks. So, we definitely like to avoid those in certain medical conditions. And sometimes it interacts with other patient medications. So, sometimes a progestin-only method, whether that's a pill or other, is recommended based on medical conditions and other family history factors.

Host: Can you share how the patch works and why some women may prefer this option?

Dorothy Parsley, MD: Sure. So, the contraceptive patch is a combination product. So, just like our combination pills, it has estrogen and a progestin, the difference is frequency of use. So while a pill is used daily, the patch is changed once weekly. So, very similar to a pill in that most women cycle once a month. But instead of having to remember to do something daily, it has the benefit that it just needs to be changed once weekly.

Host: What about the ring? That confuses me.

Dorothy Parsley, MD: Yes, I think you're referring to the NuvaRing. So, NuvaRing, similar to the patch, is also a combination product. So, it has estrogen and progestin. And it's a ring that's flexible, that's worn and inserted into the vagina by the patient. And that is changed once monthly. So, it also has the benefit of something that doesn't have to be remembered on a daily basis and can be worn continuously for a month. And women usually also have kind of a once monthly menstrual cycle with that.

Host: A longer term option is to get a birth control implant, I understand. So, how long do those typically last?

Dorothy Parsley, MD: The implant in the arm, the Nexplanon device, that is currently approved to use for up to three years. The Nexplanon is a progestin-only method. So again, very safe for most women. If current medical history or family history is a concern or a consideration, that is a progestin-only option.

Host: Does that involve surgery?

Dorothy Parsley, MD: The Nexplanon is placed quite easily in the upper arm using just local anesthesia like lidocaine. And so, we typically place these here in the office with a normal visit.

Host: And then, not to be naive, but do you have to have it taken out or does it run out, or how does that work?

Dorothy Parsley, MD: Yeah, great question. So at the three-year mark, or whenever a woman wants to have that removed, it's removed very similarly. We use local lidocaine anesthesia to numb the upper arm, make a very small incision once numb, and it should come right out very easily, because it's placed just very superficially under the skin. Also, done for most women in the office.

Host: That is amazing. These are a lot of options. It's got to be kind of hard to choose one. Can you explain the different IUD options?

Dorothy Parsley, MD: Yes, of course. So, there are also progestin-only IUDs. And then, we of course have a non-hormonal IUD. So, the progestin IUDs, there are several: Kyleena, Mirena, Liletta, which there are some, like the Kyleena, that's effective for contraceptive up to five years, and then Mirena up to eight years for contraception. They have a very similar progestin, just a little different in size, so have a little different dose that determines their length of efficacy, so to speak.

And then, the non-hormonal IUD Paraguard is actually a copper IUD. And that is effective for birth control up to 10 years.

Host: Wow, a decade. I can't even imagine. We don't even have to worry about it. Wow. So, maybe that's a good option for younger women.

Dorothy Parsley, MD: Absolutely. Or the nice benefit that there is absolutely no hormones. So for women who want to avoid hormones or need to avoid hormones for medical conditions, it is a great option.

Host: That's a good point. Well, Dr. Parsley, some women may also choose to have a tubal ligation procedure, also called getting your tubes tied. Can you talk about how this procedure is performed and the recovery time?

Dorothy Parsley, MD: Absolutely. So, getting tubes tied most commonly is done as a laparoscopic procedure. So yes, that's done in the operating room under anesthesia with a small camera that's inserted into the abdomen. And there are a lot of different ways that, you know, the tubes can be tied, so to speak. So, rings can be placed on the fallopian tubes or clips or a small portion removed.

And a lot have been moving to removing the entire fallopian tube, salpingectomy. But recovery nonetheless is all very similar. Most women are back to their normal activities and day-to-day routine within one, sometimes up to two weeks. So usually, very well tolerated with a short recovery period.

Host: We've gone over a number of options. What advice do you give patients on navigating all these options and choosing what's right for them?

Dorothy Parsley, MD: Considering contraception is very individualized. And women usually have different goals, right? Whether that is it just solely birth control? Are we talking about controlling a cycle? There are other, many, many benefits to our birth control options. Sometimes improving skin quality or mood. And so, a lot of the determination is based on some of these other goals, and also what makes sense for each person and what are their medical conditions. So, many considerations when it comes to choosing a contraceptive, and always so important to talk to your physician or your provider about what options might make most sense to each person.

Host: You brought up skin conditions, and it brought me back to many decades ago when some friends said, "Oh, I'm just on birth control for my acne." And I thought, "Really?" So, that is a thing because a lot of us said, "Uh-huh.".

Dorothy Parsley, MD: It is a thing. It is not uncommon to get a patient in at the recommendation of their dermatologist to try a contraceptive pill to help with hormonally-driven acne. Yes.

Host: Wow. I understand hormonal birth control options can carry some side effects. If they're troubling, do patients have success switching to another medication or type of contraception to lessen side effects?

Dorothy Parsley, MD: Yeah, absolutely. And there are a number of side effects, no doubt, that can be associated with each option. While most are well-tolerated, certainly if women have unwanted side effects, or certainly an issue with their contraceptive, I usually find that we are successful in getting a different contraceptive, whether it's a different pill formulation or a different method altogether based on the specific side effect that the woman is experiencing. So yes, usually able to find something that is a better fit.

Host: Well, we've covered a lot of ground today and you've given us a lot to think about. Thank you so much. Is there anything else on this topic that's important to keep in mind?

Dorothy Parsley, MD: I think it's important that women share with their physician or their provider what is important to them when choosing a contraceptive, and sharing goals, and what is the goal with using contraception, whether that is birth control or other, and partner with their provider to come up with the best plan.

Host: And just to wrap it up, Dr. Parsley, I'd love to know how this specialty became a passion of yours. What drew you to Obstetrics and Gynecology?

Dorothy Parsley, MD: Yeah. Taking care of women at all aspects of their life, from adolescence through childbearing years and menopause has been very stimulating for me. And I'm amazed at what our bodies can do. And it has been just such a rewarding field of medicine. And I'm happy to take care of women every single day.

Host: They're lucky to have you, because clearly you're very passionate and skilled at what you do. So, thank you again for sharing your expertise. We really appreciate it.

Dorothy Parsley, MD: Thank you so much.

Host: Again, that's Dr. Dorothy Parsley. To find out more, please visit nh.team/womenshealth. And to find a physician, visit novant health.org. For more health and wellness information from our experts, visit healthyheadlines.org. Thank you for listening.