On and Off the Birth Control Train

Hi Shawna,

I’ve stopped taking my pills a month ago because I wanted to try a different method but I changed my mind and want to stick to pills. I still have 3 filled packs. Is it safe if I start again tomorrow?

Questions about the Pill

PrintHi,

This is a great question!!

You can definitely restart your pills tomorrow or whenever you’d like! Just remember to use a backup method, like condoms, for the entire first week. In fact, you should always use condoms if you are concerned about STD’s or HIV. Also, your period might be slightly off for the first pill pack, but that is normal and OK. If you don’t get a period in 4 weeks, come in for a pregnancy test.

01-condom-and-the-pillpill_condom_300x300_istock_7

 

 

 

 

 

 

 

 

 

Hope this helps answer your question!

In happiness & health,

Shawna

Want more information about the pill, like what to do if you miss a pill, click here!

Reviewed by Kohar Der Simonian, MD

To bleed or not to bleed?? How to control your period using the NuvaRing!

Hi Shawna,

I am going on vacation soon and really don’t want to be on my period. I am using the NuvaRing and my best friend told me that if I kept it in, I would skip my period. Is that true?

-Anonymous

Swim-when-You-Are-on-Your-Period-Step-5

Hi,

Great question! Your friend is right!

Although I have written about the ring before, I have not written about how to use it to skip periods (which is totally safe). For those who have never heard of the NuvaRing or still a bit confused about it, check out my previous blog post by clicking here.

NuvaRing 1

It’s actually pretty simple to skip a period using the ring. Instead of taking the ring out after 3 weeks and going ring free for a week, simply leave the ring in for 4 weeks and immediately replace it with a new ring when the 4 weeks is up. This means there will not be a time in which you aren’t wearing a ring. Don’t worry; your ring is still protecting you against pregnancy during the 4th week, just don’t forget to remove it and replace it when the 4th week is up. You can do this just once or continually. And remember, it’s totally safe not to have a period, so using your ring in this way is a great option for people who hate having their periods.

grace-period-300x199
Let me know if you have any other questions!

In happiness & health,

Shawna

Reviewed by Kohar Der Simonian, MD

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!

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

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

From Bedsider: Mirena Lawsuit – Fact and Fiction!

If you haven’t noticed by now, we LOVE Bedsider here at New Gen! That’s because Bedsider provides all the information you could ever want to know about birth control in a way that is super easy to understand (go check them out by clicking here). Recently Bedsider addressed a concern that we’ve recently been hearing a lot of at New Gen. And although I couldn’t have addressed this subject any better, don’t hesitate to contact me or New Gen if you still have questions or concerns.

In happiness & health,

Shawna

P.S. The following is written entirely by Bedsider and can be found on their site (which I definitely recommend you check out) by clicking “Those Mirena Lawsuit Ads: Fact and Fiction” below the image.

bedsider_social_thumb

Those Mirena Lawsuit Ads: Fact and Fiction

The recent slew of Mirena IUD lawsuit ads are creepy. But are they true? We’re going to fearlessly wade into the scary things these ads claim, because we think the over 2 million U.S. women now using IUDs deserve the real info—without the hype.

What problems are being reported—and how common are they?

Some of the ads say 47,000 women have had problems with the Mirena. But where does that number come from? The Food and Drug Administration (FDA) scrutinizes drugs and devices for safety before they can be sold in the U.S., then continues collecting information about problems people have with drugs and devices after they’re on the market and being used more broadly.

Anyone can report problems to the FDA. Since Mirena came on the market in 2001, the FDA has received about 47,000 reports of problems with it. Many millions of women have used a Mirena over the 12 years it’s been on the market, so this number is actually a small fraction of the total—and it includes common complaints in addition to the rarer, scarier problems the lawsuit ads often focus on.

Here’s how the problems break down (and more about each below):

  • almost half (45%, or about 21,500 women) of the complaints are about IUD expulsion
  • pain during or after the IUD placement makes up 25% of the complaints (or 11,700 women)
  • complaints about more bleeding make up 21% (or 10,100 women)
  • complaints of less bleeding or no period account for 6% (or 2,800 women)
  • complaints of pregnancy with the IUD make up 5% (or 2,200 women)
  • perforation of the uterus accounts for 3% of the complaints (or 1,300 women)

Let’s look at the scientific evidence about how common each problem is and what it means if it happens to you.

Expulsion

It’s not surprising that almost half of the reported problems with Mirena were expulsion—it’s relatively common, occurring in up to 5% of women who get an IUD. Expulsion is a fancy way of saying that an IUD has been pushed out of its ideal location at the top of the uterus. The uterus is one big muscle, so this sometimes happens. In a complete expulsion, the IUD is pushed all the way out of the uterus into the vagina. In a partial expulsion (a.k.a. dislocation), an IUD is pushed only part way out and a woman may not know that her IUD isn’t where it should be.

If a woman doesn’t recognize a partially expelled IUD, it can mean the IUD isn’t working to prevent pregnancy. Signs of a partial expulsion include cramping, pain, and feeling the plastic of the IUD at the top of the strings. This is why doctors often advise checking on the IUD strings. If recognized quickly, a partial expulsion is not a big problem: the IUD needs to be removed, and a woman can decide if she wants to try another IUD or switch to a different method. After expelling one IUD, there may be a higher chance of expelling the next one.

The bottom line: Expulsion can be uncomfortable—and it’s definitely inconvenient—but it does not have lasting effects or cause infertility as some of the Mirena lawsuit ads imply.

Pain and bleeding

During insertion: IUD insertion pain is worse for some women than for others. (Even for women who experience a lot of pain during insertion, they often say it was worth the gain of hassle-free birth control.) After the IUD has been inserted, continuing pain may be a sign of a partial expulsion or another problem, so if the pain doesn’t go away within a few days of insertion, it’s definitely a good idea to check in with a health care provider.

During periods: In the long run, many women using a Mirena experience less period pain than they did before getting the IUD. About one-third of users have frequent or longer bleeding in the first three months, and about two-thirds have some spotting or bleeding between periods. After a year, about three-quarters of women have infrequent or no bleeding at all. On the other hand, some of the problems women report to the FDA are about lighter or nonexistent periods. Some Mirena users see this as a benefit, but if you’re not prepared for these possible changes, they can seem like a problem.

The bottom line: Only you know what’s normal for your body in terms of pain and periods. Learn as much as you can about how your pain and bleeding might be affected by any type of IUD before trying one. If after your IUD is inserted you have pain or bleeding beyond what you expected, talk to your health care provider.

Perforation and migration

For about 1 in 2,000 women, the IUD can get stuck in or puncture the uterus—also known as perforation. (That’s about the same chance as being hit by this satellite falling out of the sky.) Perforation only happens when the IUD is being put in. Highly skilled providers who have inserted many IUDs are less likely to have perforations. Women who are breastfeeding or have given birth within the last month are more likely to experience perforations because the muscle of the uterus is softer at those times.

What does it mean if there is a perforation? If it’s recognized immediately, the health care provider will stop the insertion. It takes about a week for the uterus to heal, and then a woman can have another IUD inserted if she wants. More than half of perforations may go unrecognized at the time of insertion. That may mean that a woman thought she had great birth control when she may not have. If undiagnosed for months, a perforation can make removing the IUD difficult, and can sometimes require surgery. Even in the worst-case scenario of an undiagnosed perforation that requires surgery, it shouldn’t have an impact on the woman’s future fertility.

Many of the lawsuit ads warn of IUDs migrating outside the uterus. Although it is extremely rare, there have been cases when an IUD has gotten past all of the thick layers of muscle of the uterus and entered the body cavity. How rare is this? So rare that even with tens of millions of women using IUDs worldwide, we can’t estimate how often it happens. We just know that there have been case reports in medical journals.

The bottom line: Perforation is rare and, if it’s recognized quickly, it’s not a major health event. Many providers will have you come back 4-6 weeks after an IUD placement to check on the strings and make sure everything is okay. If you’re worried, you can check your own strings. If you can’t find your strings, see your health care provider.

Pregnancy, now and later

Can you get pregnant with an IUD? Unfortunately, method failure is a risk with any and all contraceptives. So, yes—for a very small number of women, the IUD can fail and an accidental pregnancy can result. For the Mirena, this happens for about 2 in 1,000 women. That’s way less common than 90 pregnancies in 1,000 women using the pill—but it’s not zero.

What about getting pregnant after having an IUD? Studies have repeatedly shown that in the year after removing an IUD, over 80% of women who want to have a baby do get pregnant—exactly the same as for women who have never used an IUD. In other words, using an IUD now has no impact on future motherhood.

The bottom line: IUDs fail way less than other kinds of birth control, and they don’t affect your ability to get pregnant in the future.

Serious problems with IUDs are rare—but we understand that’s small comfort if you or someone you care about experiences them. Each person has to weigh the risks and benefits when making any decision, including about birth control, and we hope that this and our other information about IUDs helps create a more complete picture than the lawsuit ads alone.

love your body * have fun * use birth control

Period pain? Birth control can help!

This week we have an awesome article written by New Gen’s very own clinician, Meredith Warden!!! The article was originally published on Bedsider but it’s a concern we hear at NGHC all the time so we thought it was worth sharing!

WARDEN_small

Meredith Warden MD, MPH is a Family Planning Clinical Fellow and an Ob/Gyn at the University of California, San Francisco. She lives in San Francisco with her fantastic skateboarding husband and their little mini dachshund named Stretch. She loves being outside doing anything, and reading anywhere, anytime.

 

Hormonal birth control is one of the best ways to manage painful periods.

Having a painful period can mess up your day, or week—or weeks! Every woman’s period is different and the same woman’s periods are often different over time. So how do you know if the pain you have with your period is normal? And what can you do to make your periods  less painful?

For more information on periods, check out some previous blogs!

Aunt Flow’s Monthly Visit

When Aunt Flow DOESN’T Visit

My periods are really painful. Am I normal?

It’s normal for women to have some cramping, bloating, nausea, or diarrhea before their period starts each month. These symptoms can continue for a few days after the period starts, and they can be annoying—but they shouldn’t interfere with going to school or work, or with otherwise living life.

Here’s what’s not normal:

  • Moderate to severe cramps or lower belly pain with every period.
  • Periods so bad that they interfere with work, school, or life in general

crampsSo what’s the problem, exactly?

Periods like this may be dysmenorrhea—a fancy medical term for pain with menstruation. There are several possible causes of severe period pain, some of which have special treatment options.

  • The cells from the lining of the uterus may be growing into the muscles of the uterus (adenomyosis) or on other organs in the body (endometriosis).
  • The muscle of the uterus may be growing fibroids.
  • The uterus may be releasing too much of a substance called prostaglandins, causing its muscles to contract irregularly and leading to big-time pain.

The good news is that you don’t have to put up with this pain! If you’re having abnormally bad periods, talk to your health care provider about what might be causing the pain and how to treat it. There are a few things you can do to make your periods less painful, shorter, or go away altogether.

And what are the solutions?

1. Make your periods less painful. You can buy pain killers like ibuprofen (Advil or Motrin) at the drug store. Start taking them right when you first start feeling symptoms, or if your cycle is really regular, take them just before you expect your period.

3-02-11-ibuprofen2. Make your periods lighter. All types of hormonal birth control are even better at reducing pain than over-the-counter meds. The hormonal IUD, the implant, the shot, the pill, the patch, and the ring will all make periods lighter. This is because these methods of birth control make the lining of the uterus thinner. There’s less tissue in the uterus to shed, so periods are lighter. One special note on the implant and the shot: for some women, these methods cause more days of spotting or bleeding, but periods become lighter and less painful overall.

3. Have fewer periods. The ultimate solution may be to have as few periods as possible. Several methods of birth control can make periods go away for months or even years at a time:

  • One of the best ways to treat painful periods is to get the hormonal IUD Mirena. This IUD makes periods lighter and shorter for nearly all women, and many stop getting periods even after one year of use. The chance that you’ll stop getting your period increases the longer you use it. Periods should be light or nonexistent as long as you use a Mirena—up to 5 years. (Of course you don’t have to use it for all 5 years—you can have it removed anytime you want to. Your ability to get pregnant returns right after it’s removed.)

Mirena-In-Uterus

  • You can use the pill or the ring continuously. Some brands of the pill are packaged for 3 months of continuous use (e.g. Seasonale or Seasonique). But you don’t need a fancy brand: with a monophasic pill, instead of having a few days of placebo pills when you’d normally get your period, you can just start a new pack of active pills. Here are more details on how to use the pill this way. (However, this may not be an option for those using Family Pact, the little green card we give you at New Gen, to pay for their pills because Family Pact will only give 3 packs of pills every 3 months – ask NGHC for more information about this.) For the ring, instead of having the ring out for a few days when you’d normally get your period, you can just change your ring once a month and skip the week without one. After 3-6 months, you may have break-through bleeding.

endo_cont_horm_instructions

  • You can try the shot, which causes about half of women to stop getting periods after a year of use.

DMPAWhen hormonal birth control stops your period, it’s because the lining of the uterus gets so thin that there’s nothing to shed. It’s totally safe to skip periods this way, so if you suffer from serious period pain, talk to your provider about what you can do about it.

If you have questions or you are experiencing period pain, come see us at New Gen! We would love to help put an end to your period pain!

Thank you for reading,

Meredith Warden, MD