Get the Skinny on Weight Gain & Birth Control

Many women are worried about gaining wight on birth control. In fact, it’s something women ask us about nearly every day here at New Gen. Fortunately, it’s not necessarily true. Check out this article written for Bedsider by Jessica Morse, MD, MPH. Some of you might even remember Dr. Morse, she was a clinician here at New Gen a few years ago and she is most definitely missed!

BCM & Weight Gain

What myths have you heard about birth control??? First 3 people who leave a comment about a birth control myth they’ve heard will win a $5 gift card to Starbucks or Jamba Juice.

Gaining weight: Is it the birth control?
If those skinny jeans are feeling a bit too skinny, don’t assume your birth control is the cause.

It’s a common story. A woman starts using hormonal birth control, finds herself gaining weight, and assumes the birth control is to blame. The tricky thing is that lots of research about hormonal birth control shows that, with one important exception, it’s probably not the birth control.

A note on personal experiences vs. the big picture:
Before we lay out the evidence, we want to acknowledge the difference between looking at lots of women on average versus an individual woman. Research tells us about women on average, but not about specific women’s experiences. When we describe what happens for women on average, we are not dissing personal stories. (Bedsider has big love for personal stories!)

Here’s why the big picture is important: it sets our expectations. Being influenced by our expectations is a basic part of human nature. That’s why the placebo effect exists, and it’s why this hatpin trick is gross even though we know it’s fake.
The big picture

Researchers have looked at whether hormonal birth control makes it more likely to get bloated or hungry. They’ve also looked at women’s weight changes over time when using specific birth control methods and compared them with women using methods with no hormones. With one exception, they’ve found no direct link between using hormonal birth control and gaining weight. Here are the details.

IUDs: There are two kinds of IUDs. One kind releases a low dose of progestin hormone (Mirena and Skyla) and the other kind has no hormones (ParaGard). Both kinds of IUDs mainly work inside the uterus, so there are minimal effects on the rest of the body. Studies show no difference in weight changes between women using hormonal IUDs and women using birth control without hormones.

The implant: The implant also releases a low dose of progestin hormone. Because the implant is relatively new, there are fewer studies about it. Early studies showed that about 5% of women using the implant got them removed due to concerns about weight gain. However, the weight changes don’t appear to be different between women using the implant and women using birth control without hormones.

The pill, the patch, and the ring: Birth control pills contain both an estrogen and progestin hormone, and are probably one of the most studied medicines on Earth. Many studies show that the pill does not cause weight gain, yet concern about weight gain is the main reason why women quit taking it. The ring and the patch are similar to the pill in terms of their ingredients and dose, so are not likely to cause weight gain, either.

That important exception

The shot: Most women don’t gain weight because of the shot, but some do. Interestingly, weight gain on the shot seems to be more common in young women who are already considered overweight. Additionally, the women prone to gaining weight because of the shot will usually notice a change within the first six months. If weight gain is absolutely not okay for you, the shot may not be the best choice.

The takeaway:

Understanding all of the details that can affect weight—like diet, exercise, and genetics—can feel overwhelming. The tendency is for people to gain weight throughout their lives, so being a year older is more likely to cause weight gain than birth control. But like we said—this is on average and doesn’t take into account women’s personal experiences. If you think your birth control is affecting your weight in a way you don’t like, talk to your health care provider to find another effective method that works for you.

No matter what birth control you’re using, it’s important to get a daily cardiovascular workout. And no one says you have to leave the bedroom for that.

Jessica Morse, MD, MPH

Exercise & Eating

Thank you Bedsider and Dr. Morse for busting this common myth!

In happiness & health,

Shawna

Don’t forget to leave a comment about birth control myths you’ve heard to win a $5 gift card to Starbucks of Jamba Juice!

Health Insurance – Get Covered!

What is health insurance?

Health insurance is a way to pay for health care. It means not having to pay the full costs of medical services when you’re injured or sick (which can be VERY VERY expensive). You pick a plan based on the type of health care services you think you may need and pay a monthly fee, called a premium. In return, your health insurer agrees to pay a portion of your covered medical costs.
Each plan is different, but most plans cover preventive care, like doctor visits and screenings, as well as hospital visits, ER trips, and even prescription drugs. Some plans cover vision and dental, but you may need to pay for these plans separately.

*Many of you probably have the green Family Pact Card. That is NOT insurance. That only works in California and only covers the cost of family planning services, like birth control.

Why is health insurance important?

No one plans to get sick or hurt, but most people need medical care at some point. Unfortunately, medical care can be EXPENSIVE!!! According to Healthcare.gov, the average cost of a 3-day hospital stay is $30,000!!!! And fixing a broken leg can cost up to $7,500!!!! Having health insurance means you only have to pay a small portion of that.

So, how do I get health insurance?

Fortunately, there are now more ways to get health insurance than ever before. Some people can get health insurance where they work. However, there are many people whose jobs don’t offer health insurance or who aren’t working. It used to be that those people simply had to hope they didn’t get sick or injured but now, there is the Affordable Care Act (often referred to as Obama Care).

The Affordable Care Act means that everyone can now purchase health insurance (meaning you don’t need to have a job that offers it). Also, it doesn’t matter whether or not you have already been diagnosed with an illness. No matter what is going on in your life, you can get health insurance. There is even financial assistance for those who qualify!!

In order to get health insurance through the Affordable Care Act, you need to apply by March 31, 2014 (or you will have to wait another year before you can apply and get covered). Don’t worry, there is no reason you will be denied and remember, there is financial assistance for those who qualify so don’t let cost scare you from applying.

• For those in California, visit Covered California and fill out an application. For those outside of California, visit Healthcare.gov and fill out an application.
• Choose a health plan based on your budget and your individual health needs. Don’t worry; there are a lot of options and financial assistance if you qualify.

How do I choose the right health insurance plan?

Check on this video that can help answer that question!

For more information:
• Check out Healthcare.gov or CoveredCA.com
• Call 1-800-300-1506
You can get help from certified enrollment counselors!

I know this can be confusing but there is a lot of help out there. Go online or pick up the phone. Deadline is March 31, 2014!

In happiness & health,

Shawna

Stick It Before You Kick It! The 101 on the Birth Control Patch!

Happy 2014!!

This is the first blog of the year! Yay! It’s also the last Friday of the month! Why is that important? Well, I will now only be posting new blogs on the last Friday of the month! I may sneak additional blogs in from time to time but from here on out, you can expect to see a new post at the end of the month. Don’t worry though; you can still contact me by email anytime you have any questions – askshawna@yahoo.com

The first blog of the year is about the birth control patch. I have gotten several emails lately with questions about the patch and so I’m here to tell you all about it! And as always, feel free to comment or email any additional questions you may have.

What is the birth control patch?

T_BC_the-patchThe birth control patch is a small patch that sticks to your skin to prevent pregnancy. Like other methods of birth control, the patch includes a combination of an estrogen (estradiol) and progestogen (progestin) to prevent pregnancy. If used correctly, the patch is a very effective (meaning it works really well) at preventing pregnancy.

How does the birth control patch work?

The patch works by “telling” the ovaries not to release an egg (called ovulation). If no egg is released, there is nothing for sperm to fertilize (the fertilization of an egg by sperm results in pregnancy). However, if the patch is missed or used incorrectly, the ovaries don’t get the message (and may release an egg) making pregnancy possible if there has been recent unprotected sex (sex without a condom).

How to use the patch:

Patch How ToWear the first patch for 7 days. At the end of the 7 days, take off the first patch and apply a new patch in a different location (see below for acceptable patch locations). At the end of those 7 days, take the second patch off and apply a new one in a different location. After the end of those 7 days, take the patch off and DO NOT apply another one. Instead, leave the patch off for 7 days. That’s, 3 weeks on & 1 week off.

It’s during those 7 days of NOT wearing a patch that most women get their period (however, some women may or may not bleed the entire 7 days). Regardless of whether or not you are still bleeding, start a new patch only when the 7 days are complete. No sooner and no later.

Never go more than 7 days without wearing a patch, if you do, you may get pregnant.

Don’t use lotions or makeup on your skin near where the patch is

Don’t put the patch on the same part of your body for 2 weeks in a row – skin may become irritated. Also, don’t wear the path on your legs or breasts.

Some women experience breast tenderness when they first start using the patch. That generally goes away within a few weeks.

Before applying a new patch, think about the clothes you may wear that week and whether or not the patch may be visible.

Why some people love the birth control patch:

What to do if a patch falls off or I make a mistake?  

Issues and mistakes with the patch happen. Although the patch is designed not to come off the skin, it’s definitely possible. Also, sometimes patch users forget when to take off or put on a new patch (if you forget often, you might want to consider switching birth control methods). Knowing what to do if that happens can help prevent an unplanned pregnancy. Read the following for some general instructions on what to do if a patch mistake happens!

If a Patch edge lifts up:

Press down firmly on the Patch with the palm of your hand for 10 seconds, making sure that the whole Patch adheres to your skin. Run your fingers over the entire surface area to smooth out any “wrinkles” around the edges of the Patch.

  • If your Patch does not stick completely, remove it and apply a replacement Patch (no backup method is needed and your Patch Change Day will stay the same). Ask your healthcare professional for a replacement Patch prescription so you always have an extra Patch available.
  • Do not tape or wrap the Patch to your skin or reapply a Patch that is partially adhered to clothing

If your Patch has been off or partially off:

  • For less than 1 Day, try to reapply it. If the Patch does not adhere completely, apply a new patch immediately. (No backup contraception is needed and your Patch Change Day will stay the same)
  • For more than 1 Day or if you are not sure for how long, you may become pregnant. To reduce this risk, apply a new Patch and start a new 4-week cycle. You will now have a new Patch Change Day and must use non-hormonal backup contraception (such as a condoms) for the first week of your new cycle

How to purchase a REPLACEMENT Patch:

  • You can get a replacement Patch at the pharmacy where you filled your prescription
  • You will need a replacement Patch prescription from your healthcare professional
  • Unfortunately, Family Pact does not pay for the replacement patch. You will need to pay for the replacement Patch when you pick it up at the pharmacy.

From the Ortho Evra website:

http://www.orthoevra.com/how-use-loose-fall.html

In happiness & health,

Shawna

Reviewed by Kohar Der Simonian, MD and Andrea Raider, NP

Happy Holidays!

Happy-Holidays

Happy Holidays from all of us here at New Generation Health Center!!!

The holidays have arrived and New Gen’s gift to staff is some much needed, and well deserved, time off.

New Generation Health Center will be closed from December 24, 2013 to January 1, 2014 with the exception of December 30th in which we will be open.  However, we know that just because we are out for the holidays doesn’t mean your reproductive health needs are too. So we have come up with a plan for what to do while we are away.

Emergency Contraception (otherwise known as Plan B or Next Choice):

ec

Emergency Contraception is now available, over the counter at drugs stores such as Walgreens, without a prescription to ALL AGES!!!!

However, without a prescription it may cost around $50. But with a prescription AND a valid (non-expired)) FPACT card (see below) it is FREE!!!

FPACT Card

If you are 18 years old or older, you can print a prescription from the San Francisco City Clinic website: http://sfcityclinic.org/services/planb.asp

If you are 17 years old or younger, you can call SFGH infor at 415-206-8000 and ask for an OBGYN on-call (they can call in a prescription for you). If you cannot reach an OBGYN on-call, go to the SFGH pediatric urgent care. They are right down the street from New Gen!!!  See below for location and phone number.

Medication Refills:

If you are currently a NGHC patient and need an URGENT refill on a medication, please call 415-502-2337 and leave a message with your name, phone number, and medication needed. Although no one will be in the clinic, we will be checking messages. Remember, this is for URGENT refills only (like, you just finished your LAST birth control pack or you are having a herpes outbreak and need your Acyclovir). If it is not urgent, please call 415-502-8336 and leave a message.

Appointments:

If you need an appointment for a non-urgent matter, please call 415-502-8336 and leave a message with your name and phone number. When clinic reopens we will call you back to schedule an appointment.

Urgent/Emergency Care:  As always, NGHC refers all urgent care needs to San Francisco General Hospital Urgent Care or Emergency Room.

Urgent Care:
Location: 995 Potrero Ave., Building 80, Ward 81 South
Phone Number: 415-206-8052
Hours: We are open every day.  Doors open 8:00 AM daily and close at 9:00 PM on weekdays and 7:00 PM Saturday, Sunday, and holidays.

Pediatric Urgent Care:
Location: 1001 Potrero, 6M (Room 6M5)
Phone Number: 415-206-8376

Emergency Room:
Location: 1001 Potrero Ave., Suite 1E21
Phone Number: 415-206-8111

Okay, I think that covers it. We hope that you have a wonderful holiday. And remember, the holidays are about more than just gifts. Spend some time with friends and family, relax, read a book, volunteer your time, do something nice for some one, give thanks, and most of all, be safe and take care of yourself. I will be doing all of those above things so I will not be posting for the rest of the year. Next blog: 2014!

In happiness & health,

Shawna

xmas condom

A Pill a Day Will Keep an Unintended Pregnancy Away!

What is the birth control pill?

The birth control pill (also called “the Pill”) is a birth control method that includes a combination of an estrogen (estradiol) and progestogen (progestin) to prevent pregnancy. If taken correctly, the pill is a very effective (meaning it works really well) at preventing pregnancy. Although there a lot of different types of pills, they all work the same way. They vary by brand or by the amount of hormones in them. If you are interested in the pill, talk to your clinician about which one might be the best option for you. And if you’ve tried the pill before and didn’t like it for a reason other than forgetting to take it, talk to your clinician about the other types of pills available.

PrintThere is a pill that is progestin only – called the mini pill. The mini pill has slightly different instructions than what is listed below. If you are using the mini pill, please discuss proper usage instructions with your clinician or pharmacist.

How does the birth control pill work?

The pill works by “telling” the ovaries not to release an egg (called ovulation). If no egg is released, there is nothing for sperm to fertilize (the fertilization of an egg by sperm results in pregnancy). However, if a pill is forgotten or missed the ovaries don’t get the message (and may release an egg) making pregnancy possible if there has been recent unprotected sex (sex without a condom).

ovulation-period-920270

How to use the birth control pill:

The birth control pill is most effective (works the best) when taken every day around the same time of day – the first week is especially important. A typical pill pack has 28 pills – 21 of those pills contain hormones and the other 7 do not. It’s during those 7 non-hormonal pills that most women get their period (however, some women may or may not bleed the entire 7 days). Regardless of whether or not you are still bleeding, start a new pack only when the 7 days of non-hormonal pills are complete. No sooner and no later.

ocp_instructions

*Every pack looks a bit different. Some are round. Some are square. Some are rectangular. Make sure you talk to your clinician or pharmacist about which pills are the active pills (the pills with hormones) and which are the non-active pills (the non-hormonal pills taken during the week in which you can expect your period). Also, not everyone starts their new pack on a Sunday. Whatever day you choose to start, be sure it’s the same day every month (meaning, if you start a new pack on Tuesday, every new pack thereafter will start on a Tuesday).

What to do if a pill or two are missed:

It’s common to forget a pill from time to time (if you forget often, you might want to consider switching birth control methods). Knowing what to do if that happens can help prevent an unplanned pregnancy. Here are some general instructions on what to do if you forget a pill or two.

Forget

Number of Pills Missed

When Pills Missed

What to do …

 “Should I use condoms?

First 1 pill

Beginning of pack 

  • Take a pill as soon as you remember.
  • Take the next pill at the usual time.

(This means you may take two pills in one day.)

Yes, use condoms for 1 week.

 

1 pills

First week of pack

  • Take a pill as soon as you remember.
  • Take the next pill at the usual time.

(This means you may take two pills in one day.) 

Yes, use condoms for 1 week.

2 pills

2nd and 3rd week of pack

  • Take 2 pills 2 days in a row

For example, if you forget pills on Monday & Tuesday, you would take 2 pills on Wednesday & 2 pills on Thursday.

No

3 or more pills

Any time in pack

  • Do not finish pack. Throw away remaining pills.
  • Start next pack.*

*If you use Family Pact, you can only pick up 3 packs of pills every 3 months. If you throw away a pack and start a new one because of missed pills, you will not have enough pills/packs to last until your next refill. If this is the case, please call New Generation Health Center. We have pills on site that we can give to you.

Yes, use condoms for 1st week of new pack.

I know this was A LOT of information. If you have any questions, you are always welcome to comment, send an email to askshawna@yahoo.com, call or make an appointment at New Gen (415.502.8336).

In happiness & health,

Shawna

Reviewed by Kohar Der Simonian, MD

Happy Halloween!!!

Halloween 1

It’s Halloween and for many of you that means awesome parties! I want to give you a few tips to stay safe while still having  fun!

Transportation

2379856938_377ed25813Transportation is a HUGE piece of the going out puzzle. PLAN AHEAD about how you will get around. Public transportation is great, especially if you will be drinking (more on that next). Make sure you have enough money for the bus or for Bart and be sure to keep track of the time so you don’t miss the last bus/train (set a timer on your phone). Or stash a bit of money away for a cab at the end of the night (keep in mind; it can be tough to get a cab in the city on Halloween night). And if driving is a must, make sure that whoever is driving DOES NOT DRINK AT ALL. It only takes one drink to impair someone’s driving. I know that nobody ever thinks an accident will happen to them, but it does.  If you can, plan for someone to pick you up (parents, older siblings, friends who are not going out, etc.). Whatever you do, be extra safe. All modes of transportation can be a little more dangerous during the holidays.

halloween_1035

Drinking

The first thing many people associate parties with is drinking. Although some of you probably aren’t old enough to drink, I know that may not stop you. I could give you a million and one reasons why you shouldn’t drink (believe me, there are many) but instead I will give you a few tips about drinking as safely as possible. These tips apply to the 21 & over drinkers too!

1. Before you go out, think about and decide how much you will drink. Establishing guidelines before you go out will help you stay aware of how much you are actually drinking. Also, if you are going somewhere you will be spending money on alcohol, bring a small amount of cash rather than an ATM or credit card. Having access to a limited amount of funds will help keep both your bank account in check but also the amount you can drink.

limit 1

2. Drink a glass of water with every alcoholic beverage you have. This will keep you hydrated and slow down the rate at which you are drinking. The slower you drink, the more likely you will be able to monitor the effects of the alcohol and know when you should stop.

water

3. Also, it can be hard to say no when all your friends keep drinking – they may even be encouraging you to keep drinking too.  Although they are probably just trying to keep you in the party mood, drinking more than you are comfortable with or more than you planned is dangerous.  Peer pressure (especially from our friends) is often hard to resist. If know you are at your limit but don’t want to deal with your nagging friends, instead of giving in, have a soda water or coke with a lime or lemon in it, NO ALCOHOL. It’ll look like a mixed drink but only YOU will know it’s actually only water or soda.

Screen-Shot-2013-05-07-at-7.15.46-AMMocktails….get it?? Hehehehe

4. Never leave your drink unattended. I know you have probably heard this a million times but that’s only because it’s great advice. You don’t want to take any chances with someone being able to alter your drink by putting drugs or even more alcohol in it. You don’t want to end up drinking more than planned or become unconscious. Either one can leave you in very unsafe situations.

Buddy system

We often go out with friends so why not make a pact before heading out the door? Making a pact will mean that not only are you required to hold yourself accountable but you will also be accountable to each other. Decide if you will be drinking or not (and if so, how much), decide how you feel about meeting someone and the possibility of making out or hooking up, what you will do if you become separated, and when you should leave. Making a pact will mean that you are looking out not just for yourself but for each other.

buddy

Safe Sex

And of course, the safe sex piece. It wouldn’t be a Just Ask Shawna blog if I didn’t mention something about safe sex.  Even though you may not plan on having sex, I encourage you to bring condoms with you *just in case*. We often see patients here at NGHC who need emergency contraception (the morning after pill) because they ended up hooking up with someone even though they didn’t plan to. It’s better to have condoms and not need  them than to need them and not have them. Stop by New Gen and pick some up! Simply ask the front desk & you’ll get a bag of 40 – no questions asked!!! And if you don’t take my advice and you do end up needing the emergency contraception (the morning after pill), please DO come see us. For more information about emergency contraception and how it works, click here!

Two men wearing horse costume, waiting in dressing room

Do you have any other tips or suggestions for a safe Halloween??? If so, leave a comment and choose from a Starbucks, etsy-announces-gift-cards-0e42146f33Jamba Juice, or movie ticket gift card. If we get 5 or more comments, I will choose someone at random to win a $25 Old Navy gift card! So if you leave a comment, encourage your friends to do so too!

In happiness & health,

Shawna

Reviewed by Kohar Der Simonian, MD

happy-halloween

Dare to Bare? Shaving tips for pubic hair removal!

Pubic hair (hair around the penis, vulva, or anus) is a totally normal part of becoming an adult. However, some people (and it’s not just the ladies) would rather not have it, so they choose to shorten it or remove it all together (but if you aren’t one of them, don’t worry! Pubic hair is totally normal). The most common way of removing pubic hair is by shaving. Although shaving is meant to leave the area smooth and hairless, it can instead leave the area irritated! Razor burn and ingrown hairs are common concerns for those just starting to shave their pubic area so New Gen has come up with a few tips to help ya out.

Pubic Hair

1. If you have long hairs (usually those who have never shaved or haven’t shaved in a long time), trim the hairs with clippers or scissors first. Electric clippers are best for this purpose.

Trimming

2. The softer the hairs, the easier it will be for you to shave. Try taking a long, warm bath before shaving, or choose to shave at the end of your shower.

3. Apply shaving gel a few minutes before shaving to soften hairs. If you have sensitive skin, you might want to try a hypoallergenic or fragrance-free brand.

4. Use a sharp and or new razor. The sharper the razor blade, the better it will work and less irritation it will cause to your skin.

New razor

5. When shaving, don’t move the razor over the same area more than twice. This will help reduce skin irritation.

         On the first stroke, go with the direction of hair growth to remove most of the hair.

         On the second stroke, go against the direction of hair growth for a smooth, close shave. If going against the direction of the hair growth tends to irritate you (and for many it does, especially when they are new to shaving), then skip that and do both strokes going the same direction of hair growth.

shaving_directions

6. Clean the area after shaving with mild soap and water to reduce the risk of infection. Continue to practice clean hygiene, washing the area at least once a day to reduce sweat and oil build-up.

7. Go as long as possible between shavings to reduce skin irritation.

A few extra tips:

1. The skin around your genitals is extra sensitive. Some people can be allergic to some types of shave gel. If you have sensitive skin, you might want to try a hypoallergenic or fragrance-free brand of shave gel.

2. To reduce the risk of ingrown hairs and razor bumps after shaving, use an exfoliating brush or loofah sponge when washing the area daily.

ingrownhair razor bump

3. When the hair starts growing back, it can be uncomfortable and itchy. Chaffing is nearly unavoidable, but exfoliating the area regularly can help. Exfoliating means removing the outer most layer of dead skin cells. This can be done with a loofah or wash cloth.

Towels with Bath Spa Kit and Gladiolus

4. If you have tried shaving and you don’t like it for whatever reason but still want a sleeker look, consider closely trimming your hair instead of shaving. It provides many of the benefits of shaving without all the risks!

street_art_big_size_17

In happiness & health,

Shawna

Reviewed by Kohar Der Simonian, MD