Scott Webb (Host): Today, I'm discussing birth control options for pregnancy prevention with Carrie Illg. She's a family nurse practitioner with Solution Health, and she's here today to tell us about the five categories of birth control and the pros and cons of each of them.

 This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of Solution Health. I'm Scott Webb. Carrie, it's nice to have you here today. We're going to talk about birth control options, but for pregnancy prevention versus controlling periods and that sort of thing. So, I just want to start here. How do you help individuals or how can individuals find the contraception method that sort of best suits their needs and lifestyle?

Carrie Illg: I think the best way to obtain birth control is certainly to talk to your healthcare provider. If people don't have a healthcare provider or a PCP primary care provider, there's other options out there, things like Planned Parenthood, which are often in bigger cities. Other options include things like public health centers and college campuses are also amongst places where people can get birth control, predominantly college-aged kids, but that tends to be a highlight for a lot of our 20-year-old patients.

Host: So, what are the five categories of birth control, and maybe you can explain the differences between hormonal and the non-hormonal contraceptions?

Carrie Illg: Amongst the hormonal contraceptive options, we've got estrogen and progesterone combination medications. We also have progestin-only medications, which are still hormonal. We've got non-hormonal options. We've got surgical interventions and then we also have abstinence.

Host: Yeah, we're going to kind of go through each one of these and have you drill down a little bit. So, let's do that. We'll have you walk through the estrogen/progesterone combinations.

Carrie Illg: Yeah. So, this includes things like the pill. The pill is based on a daily dosing schedule. There's lots of different options for pills. Pills are determined based on patient needs and risk factors. I would say that a pro of taking a pill is that it's on your own accord. So, you can take the pill morning or evening. It's a once-a-day medication. A lot of people are already taking supplements and vitamins and maybe even some regularly scheduled medications. So, adding an extra pill regimen for pregnancy prevention would be a pro to that. I would say the con to taking a pill is similar to the pro in that it only will work if you take it. And unfortunately, the patients have to be responsible for daily dosing. So, medication compliance is a problem for some people with taking the pill. It is a daily dosing schedule.

In addition to pills, there's also a patch option, which is actually very similar to a sticker that you apply to your skin. This is a patch that is changed once per week. I like this option for a lot of patients, because it gives you the weekly option versus the daily dosing option that is of the pill. People like this also, especially people who are intolerant to taking oral medicine or have difficulty taking pills. Downfall is this is obviously similar to the pill in that the user is responsible for medication compliance. The other con to this medication would be some skin irritation that we do see at times with the patch.

And then, the only other estrogen and progesterone combination that we have available is something called the vaginal ring. It is about the size of a half dollar. It is circular and has a big open space in it. It is a flexible rubber vaginal ring. It is inserted vaginally. This isn a insertion that is put into the vagina by the patient. It is left in place for three weeks at a time. So, I like this option because it is less often than daily and weekly combination using, and patients remove it and replace it by themselves. Again, this is a great option for people who are not great with oral-based medication. The con is that it does take a little bit of getting used to as far as insertion and removal. It's similar to a tampon application, which most of my patients are familiar with, but it does lead to some patients not wanting this option, because it is a little bit more invasive than the other two options.

Host: All right. So then, let's go through the progestin-only methods.

Carrie Illg: So, the progestin-only methods, I actually have four options for patients. Option number one is something called the Depo-Provera shot. It is an intramuscular shot that we do give in the office setting. This is given every 13 weeks in the office. It is a great option for people because it gives long-term birth control. The downfall of this is that your usage for this should be limited to two years. It does have an impact on bone health for greater than two years use. The con to this is it is an injection, so it's similar to an immunization in that it's given intramuscularly. It does involve patients coming into the office every 13 weeks. The downfall of this also is it does have a high weight gain profile to this medication, so it's certainly not for everyone.

Another option for progestin-only birth controls is something called an IUD, an intrauterine device. I've got three different varieties to offer patients as far as the progestin-only goes. This is an intrauterine device that is placed in the office. It is a set it and forget it type of method in that once it's placed, depending on which IUD patients go with, they can have three to even eight years of pregnancy prevention with no maintenance at all. The con of this is that it is a procedure. It is not the most comfortable procedure to have, but we have patients who do it every day, and we have patients who request this method.

Another method of progestin-only is back to pills. There is progestin-only pills available. These are taken once a day and similar to the estrogen and progesterone medication. These go by medication compliance, so you have to take them for them to work. This is a great option for people who can't take estrogen for a variety of reasons. And so, I like this option for people who still want a pill option but are intolerant to estrogen.

The last form of progestin-only that I have to offer is something called the Nexplanon. It's also called the implant or a rod. It is inserted in the office into the inner upper arm underneath the skin. It's about the size of a matchstick. It gets put in similar to how an intravenous would go in. It just goes right underneath the skin with a small incision. It lasts for three years of pregnancy prevention. This is also a set it and forget it type of method. So once it's placed, you have three years of birth control.

Host: Yeah. And thankfully, patients have experts like yourself to help them through this, because my head's spinning a little bit, but that's okay. You know what you're talking about. And you would help patients, obviously, to try to find the right method, as we mentioned earlier that is best for their needs and their lifestyle. Why don't I have you talk about the non-hormonal options as well?

Carrie Illg: Yeah. So, I've got a couple of options for that as well. Condoms are non-hormonal and available over-the-counter at health clinics, at schools, at college campuses, readily available. Another option would be an IUD that is non-hormonal. This is called the ParaGuard. It is actually a copper IUD. It lasts for 10 years and goes in the same way as the hormonal IUDs, except this one being non-hormonal based, is good for 10 years.

The last option I have for patients is a vaginal gel called Phexxi. It's similar to spermicide in its application, but it is non-toxic and it has food-grade ingredients. It's made actually out of lactic acid, citric acid, and potassium. It helps to maintain the vaginal pH to immobilize sperm. This is done about one hour prior to intercourse. It can be repeated. It is prescription-only, but it is non-hormonal. And I have many patients who use it.

Host: Yeah, that's interesting. I want to finish up today, talk about more permanent methods, if you will. Surgical interventions, that sort of thing.

Carrie Illg: Surgical interventions used to be considered reversible. They're really no longer considered reversible. So, we would call these surgical interventions permanent birth control methods. These are things like tubal ligations, hysterectomies, and partner vasectomy. This is when our male partners have vasectomies, eliminating our chances of pregnancy. Tubal ligation used to be called when the tubes are tied. These days, they're actually removing the tube. So, they're no longer reversible. Hysterectomy is a fancy way of saying the uterus is removed, thereby eliminating the chance of pregnancy.

Host: Yeah. Well, this has been really educational, as I said. Thankfully, we all have experts like yourself to sort through all these things and find the right option. And I'm sure for some folks, some patients, it is a bit of trial and error until they, you know, find exactly what works for them. But it's nice to know as to someone listening to this, as I'm sure our actual listeners, feeling the same way. It's nice to know there's lots of options and experts out there to help. So, thank you so much. You stay well.

Carrie Illg: Thank you!

Host: And for more information, go to snhhealth.org and search OB/GYN. And if you enjoyed this podcast, please be sure to tell a friend and share on social media. This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of Solution Health. I'm Scott Webb. Stay well, and we'll talk again next time.