Transcription:
Birth Control Benefits Beyond Pregnancy Prevention

Prakash Chandran (Host): Birth control is not just an important part of family planning and pregnancy prevention, but it can also have other benefits as well. There are lots of different long-term birth control options out there. And today we're going to learn more about what they are and why they're important. Let's talk about it today with Dr. Nirvana Manning, the Chair and Associate Professor in the Department of Obstetrics and Gynecology at University of Arkansas for Medical Sciences.   This is UAMS Health Talk, the podcast from the University of Arkansas for Medical Sciences. My name is Prakash Chandran. So, first of all, Dr. Manning, great to have you here today. Let's start with the topic of the hour. What exactly is long-term birth control?

Nirvana Manning, MD (Guest): Well, thanks so much for having me on. So, long acting birth control really falls into a category things that you hopefully do not have to remember to do every day. And ideally, when you take that element out and the user error that goes along with it, the effectiveness can increase with that. And so we have lots of different categories of those that we kind of cater to patients' needs and wants.

Host: Okay. I understand. And so when you say the user error components of it, are you saying that with most birth control, you have to take it on some sort of cadence or interval, like a daily basis and with long-term birth control, you don't?

Dr. Manning: Absolutely. So, with traditional birth control pills, you know, there's multiple different kinds. There's multiple different variations of those hormonal components, but to break it down into the simplest form, it's a pill, traditionally that you took every single day. Now, ideally you took it at the same time every day, but there's variations that occur. People and lives happen, and you forget a pill. You forget that time of day. You may have different medications you're on, you may have an illness that prevents something from happening. And so when we are not consistent with that, the efficacy and the effectiveness of that goes down tremendously.

Host: Okay, that makes a lot of sense. And so I imagine that patients prefer it because it's not something that they have to remember to do on a daily basis. Is there any other reasons that people should know about?

Dr. Manning: So, that's really one of the best proponents of it, I suppose. There's certainly lots of other benefits to birth control. But I would say for most patients, as our lives get crazier, as everything is just taking more of our time, to remember something every day and potentially at the same time of day gets increasingly difficult. The benefits regardless of whether it's a long acting birth control or a more traditional method, there are tons of other additional benefits to it besides just the birth control aspect of it.

Host: So yeah, Dr. Manning, before we get into the different types of benefits, maybe let's talk about the different kinds of birth control.

Dr. Manning: Okay, well, that sounds great. So, like I mentioned earlier, there's the traditional, you know, there's the pills. You take one every single day, they're on 28 day cycles, and then you start your next month. Some of the more long acting and from simplest or most frequent use to the least frequent use, I would say, there is a patch that you can change weekly and that can be placed on different portions of your body. There is a ring contraceptive device that's placed vaginally and that can stay in for three weeks at a time, is then removed and then you have a menstrual cycle. There is a shot component that can be given every three months, and then we go into some of the more long acting reversible, contraceptive devices that are extremely popular especially in the last decade or so. And those fall into our intrauterine devices, as well as our implant devices. And I'd say, where a lot of the concentration is being done on. The implant is a small rod that is placed into the inner side of the arm. And that one can last for three years. And then when we get into some of the intrauterine devices that are placed inside of that uterus, we have devices that can start at, that go to three years to five years, as well as six years that give off a tiny bit of hormone. And then we also have an intrauterine device that has no hormonal component to it at all. And that can last for even up to 10 years.

Host: Okay. That's pretty incredible. I had no idea that there were so many different types of birth control. And does it, the more it's implanted or the longer it's in your body is the stronger it is? How do you think about efficacy between the different types?

Dr. Manning: So, the least user error that we can have, the least flexibility in us messing it up, the better it is for long-term birth control, as well as patient compliance in keeping it in. All them have some little nuances. And so I think that's really important to kind of talk to your healthcare provider. Some of them may cause some increased bleeding during a period of time. And I think knowing that, at the front end helps with compliance in the long end. These intrauterine devices are so, so popular right now just because you can place it and not have to think about anything on any regular interval.

However, quite often, people will experience some spotting, some cramping, and if they don't know ahead of time that is a known expectation for a length of time, they may think something's going wrong and they want to have it removed. But all of those fall into our very effective category with regards to the IUDs, as well as the implant, because truly it is placed and you no longer have to think about it.

Host: Okay. Understood. So, you know, you alluded to earlier that there are benefits of these birth control measures beyond just preventing pregnancy. Maybe you can speak to those a little bit.

Dr. Manning: Sure. So some of the most popular side effects are the decrease in the amount of bleeding, as well as the frequency of their menstrual cycles. And this can occur with multiple different venues. It's not one particular one, but with regards to particular long acting birth control options, women will often experience shorter cycles, less frequent bleeding, a very large portion, depending on what, which one you pick may not have any bleeding at all.

Now for some women, that's a little more disconcerting because they worry that something is going on. Whether they're pregnant. And I do think there's a level of trust that ultimately has to be developed with some of these birth control options, where if you don't have any bleeding on your menstrual cycle, it's okay. And I don't say that often, because I want patients to know these are conversations you should have with your healthcare professional. There are patients that come into my clinic that have no bleeding and have no cycles that I am worried about that are not on any kind of contraceptive devices. But if you have one of these contraceptive devices and you experience what we call amenorrhea, which means essentially no menstrual cycles, that can very well be a normal side effect of it.

The FDA has actually approved the   levonogesterel 52 microgram IUD for patients with heavy menstrual cycles, in addition to the birth control aspect of it. So, someone could be have their tubes tied. We know that they're, you know, contraceptively covered, but still get one of these devices in order to decrease that frequency or severity of bleeding.

Host: Okay. Understood. And thanks for of those explanations around some of the benefits that a patient can get from it. I am wondering though, if there are any concerns that you normally hear with using some of these methods.

Dr. Manning: So absolutely. And I joke a lot of my patients as well in that IUDs have been around for a lot of years. The newer IUDs that are on our market are not our parents', our grandparents' IUD, they really have done a lot of work in the placement of them, the comfort level with them, as well as those bleeding profiles. But I think there is still a large portion of the population that are worried about a device that's placed within your uterus. So, I think having that discussion with patients definitely increases compliance. And like I mentioned earlier, there's a level of trust that goes into it, especially when you don't have the regular cycle to kind of validate for you that you are not pregnant. And so I think there's an anxiety level that for some people can occur with those.

Host: Right. And another piece of it is because this is hormonal birth control, I imagine that mood swings might come into the picture. And if you have something implanted in you, is that going to be something that you have to deal with for a long time, because you can't get it removed? Have you heard any concerns about that or is there a way that you can address that?

Dr. Manning: Certainly, each of these have their own little kind of side effect profile, but traditional birth control quite often, patients if they will have side effects, the most common of which are headaches, nausea, kind of breast tenderness, some will also complain of worsening depression, that is not necessarily negated with any of these hormonal contraceptive devices, some of which have a better   profile than others.

And those kind of deserve discussion with regards to, you know, this one may be slightly better for depression than others. This one may be slightly more effective with preventing headaches, but I will say the copper IUD, which is our IUD that has absolutely no hormones in it, and that lasts for 10 years is still an option. And it provides no hormonal side effects. So, for patients that really do suffer those ups and downs, that kind of occur with some of those hormonal fluctuations, and they're just real sensitive to any changes in their body; this is a wonderful option that will offer really wonderful birth control.

Host: Yeah. And that dovetails into the importance of why you should be talking to your doctor when considering these birth control options. Because it sounds like, as you've said, different ones have different side effect profiles and based on who you are and what you're trying to optimize for, they're going to make the best recommendation for you. Is that correct?

Dr. Manning: Absolutely. And of note, you know, a lot of these when they were first coming out on the market and they've been on the market, you know, most of these IUDs, like I mentioned for years, but some of these, the Mirena 15-20 years now, initially there was some apprehension with the younger population or what if you've never had a kid before, can you still do this kind of birth control and really all of national bodies, the American College of Obstetrics and Gynecology and the American Academy of Pediatrics, all of them have really come together and said, this is a wonderful birth control option for our adolescents. We still obviously want to talk about sexually transmitted infections and make sure that these girls are protecting themselves from all of that. But with regards to a birth control, this is a highly effective, highly recommended form of birth control, that works really well.

Host: Okay. Understood. So, let's say someone is considering one of these birth control options that we've talked about today. What questions should they be asking their doctor when making this consideration?

Dr. Manning: So, I think having a discussion about A. Is this for birth control or is this to control bleeding is one big question to ask one another. I think are you in between children? Are you trying to prevent children? Are you planning on getting pregnant in one, two, five years, never. I think will help us decide which route may be best for that patient. Are you willing to do an injection? Are you wanting to have a device placed in your uterus. Does that make you feel uncomfortable? I think these are very frank discussions on making this a shared decision making between that patient and the provider.

It's not a one shop fits all at all, and I think the patient has to be comfortable with it. And then I think we look at their medical history. Do they have medical history that makes me worry. Are they smokers? Do they have a family history of blood clot? I mean, all of these information should go into making that decision with the patient.

Host: Totally makes sense to me. So just as we close here, is there anything else you'd like to share with our audience just around long-term birth control or otherwise?

Dr. Manning: I mean, I think my take home message is don't feel as though if one form of birth control doesn't work for you, that there may not be other options that you would love. And I think make yourself very knowledgeable on your choices, such that when you go in there, you can make an informed decision with your provider and you guys can talk about those options at length and find what's best for you and your family at that time, knowing that those needs and wants may change in five and 10 years on down the line.

Host: Okay. Perfect. Well, Dr. Manning, I think that's the perfect place to end. I really appreciate all of your time today. That's Dr. Nirvana Manning, Chair and Associate Professor in the Department of Obstetrics and Gynecology at University of Arkansas for Medical Sciences. Thanks for checking out this episode of UAMS Health Talk. For more information on this topic and to access the resources mentioned, please visit uamshealth.com. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. for listening to this episode of UAMS Health Talk. My name is Prakash Chandran, and we'll talk next time.