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

Staying Safe All Summer Long

Ahh summer… a time for picnics in the park, fun in the sun, and summer romance! With school getting out and summer in full swing many people will have a lot more time for a summer lovin’!

summer-love-sunflower

That being said, this week’s blog is all about how to keep yourself safe and protected from unintended pregnancy, STDs, and HIV.

First tip, consider stopping by New Gen (or your local sexual health clinic) to get some routine STD testing. All that is required is that you pee in a cup! The urine will then be tested for chlamydia and gonorrhea – two very common infections. These infections are passed from one person to another through female vaginal fluids and male ejaculatory fluids (cum and pre-cum) of people who are infected. Although it is most commonly passed through sexual intercourse (penis in vagina or penis in anus), it can also be transmitted (passed from one person to another) orally (mouth on penis/vagina/anus). Unfortunately, people with these infections don’t always know they have them because they often don’t have any symptoms. We recommend this test about once a year (under the age of 25) or if you have had any new partner(s) since your last test. The good news is that both infections are completely CURABLE with antibiotics (meaning after you complete the quick and easy treatment, it’s like you never had it in the first place). So why not take some time now to make sure you are tested and treated before any summer flings?

P.S. Want to know more about chlamydia? Click here! And I just realized I haven’t written about gonorrhea yet. Perhaps that’ll be the next post – unless there is something else you are dying to know about first. Let me know!!!

Okay, so although chlamydia and gonorrhea are totally treatable, they are also totally preventable (along with other sexually transmitted infections). You guessed it: condoms! Remember that condoms require special care in hot weather. Condoms need to be stored at room temperature away from direct sunlight to prevent the breakdown of the latex. For this reason, you should not store a condom in your wallet and definitely not in a hot car. Ideally you would carry your condoms in a bag or backpack but you can also keep a condom or two in a front pocket short-term without any keys or other items that may puncture the condom. If you haven’t used the condoms by the time you get back home, put them back in a cool, dry storage space. You can also buy a condom case or reuse items like mint tins (like the Altoids container) for this purpose.

altoids caseWhat about birth control? Well, many of you will have totally different schedules in the summer. For those of you using the pill, patch or ring, you may have to put some extra effort into remembering to take your pills or to change your patch or ring. If you usually take your pill in the morning before school, now you might need to set an alarm instead. Another option is to sign up at Bedsider.org/reminders to set up an email or text reminder to take your birth control. There are even apps for smartphones that will remind you– “myPill” and “Ring Timer” are some examples.  It’s important to keep on schedule with your birth control because if you don’t, it is less effective and you become more at risk for pregnancy.

bedsider_reminder

Summer is also a time that many people go on long trips. Pill, patch, or ring users need to make sure you have enough birth control to get you through your trip. You can call your pharmacy and see how many refills you have, and if you’re on your last refill, call the clinic to see about getting your prescription renewed. If the Depo shot is your birth control of choice, you will want to make sure that your next shot appointment isn’t scheduled when you are going to be out of town. If it is, give New Gen (or your shot provider) a call and see if they can schedule the appointment before or after your trip, so that you stay covered!

Summer Heart

To all the ladies with an Implant or IUD, you’re all set for the summer!  You have a low-maintenance form of birth control and don’t need to stress about it until your 3 years (Implant), 5 years (Mirena IUD), or 10 years (Paragard IUD) are up! Safe summer lovin’ y’all!

In happiness & health,

Shawna & Angela

Reviewed by Andrea Raider, NP

When Aunt Flow DOESN’T Visit….P.S. There is a chance to win something in this post!

periods

Why is my period sometimes irregular?

If you miss your period and have had unprotected sex, the first thing to check for is pregnancy.  You can take a pregnancy test at home or come into to New Gen! Why would missing a period be a sign of pregnancy?? Leave a comment with the answer for a chance to win a $25 gift card to Old Navy!!!!

symptoms-300x300

Different pregnancy tests need different amounts of time after a sexual encounter to show pregnancy.  At our clinic, at least 10 days need to pass after a missed period.

That being said, when a pregnancy test comes back negative, many girls wonder why they would have missed a period or why they only get their period a few times a year without being pregnant.  Almost every woman misses a period at some point in her life, for many reasons:

188_1period

Age: For the first few years after a woman starts menstruating (in her teens) and for a few years leading up to her last period (in her 40’s or 50’s), it is common for periods to be irregular.  This has to do with the body’s adjustment to having a menstrual cycle or not having a menstrual cycle and changing hormone levels.  

Birth Control: Many birth control methods  can impact your cycle. Check out the list below to see which methods do what to your period.

  • The pill, patch and ring:  These methods usually cause very regular periods, happening during the fourth week of the method when there are no hormones.  Usually the periods are lighter, and shorter.  Women sometimes have some spotting at other times in the first month or two of starting this method
  • The Depo shot:  Bleeding can be very irregular at first, but will likely get lighter and lighter and possibly disappear entirely.
  • The Implanon:  Tends to make women’s bleeding irregular.  This could be many months of no bleeding, bleeding or spotting at irregular times, or spotting throughout the month.
  • The Mirena IUD (hormonal, 5 year): bleeding can be very irregular at first, but tends to get lighter and usually stops entirely.
  • The Paragard IUD (copper/non-hormonal, 10 year):  Women usually have a period in the same pattern as when using no hormonal birth control method (whether that is every month or not), but it is slightly longer, heavier and crampier than their normal periods.
  • Many women worry if they aren’t getting their periods that their bodies may be “clogging up” — but don’t worry, if you are not having your period because of a birth control method  it means that your body is simply not creating the uterine lining (hormones are what control the uterine lining development).
  • Missing a pill or patch – you can get unexpected bleeding or spotting for days afterward.
  • Stopping the shot – you can have several months of no bleeding or irregular bleeding before your normal period returns.
  • Taking the “morning after pill” can cause a little bleeding a day or two after you take it, and make your next period come a little earlier or later.

Stress/Changes:  If your period is usually regular, stress can cause a delayed period.  Perhaps you are feeling tired, worried, or dealing with a big change in your life.  For whatever reason your body may decide it is not a good time to get pregnant.  Over-exercise, poor nutrition, and sudden weight loss can all be kinds of “stress.”                        

Medical Problems: There are a couple medical problems that can cause skipped periods, including ovarian cysts, polycystic ovarian syndrome or amenorrhea.  If you are not getting your period and are not sure why, check with your doctor or make an appointment at New Gen.

As you can see, this is a complicated issue! Periods can be as different as women’s bodies are, and many, many life factors can have an effect on our cycles. We recommend using a calendar to keep track! There are many free menstrual calendars online as well as many popular phone apps!

period-planner-

If your cycle ever changes or you simply have questions about your periods, come see us!

Next Week:  Pads and tampons aren’t the only options when it comes to managing your period!!!

-Barbara Haupt, AmeriCorps Member

Reviewed by Debbie Davidson, NP

When Plan A fails, there’s a Plan B (and then some)!

EC Pix

When Plan A fails, there’s a Plan B (and then some)!

What is Emergency Contraception?

Emergency Contraception (sometimes called EC or the ‘morning after pill’) is a pill (or two depending on brand – Plan B, Next Choice, Ella) you can take up to 5 days AFTER sex in order to prevent pregnancy if you think your birth control failed, you didn’t use contraception (including condoms), or you were forced to have sex.

ec

How does EC work?

Emergency contraceptive pill(s) prevent pregnancy by delaying or preventing ovulation.  Remember, ovulation is when your ovaries release an egg and is the time you are most likely to get pregnant (usually the time between your periods). No egg = no pregnancy!

There is no evidence to suggest that EC has any effect if an egg has already been fertilized (meaning it does NOT cause an abortion and is NOT the same as the abortion pill).

How well does EC work?

This is a very good question.  Honestly, it depends on the brand of EC.  Here at NGHC we dispense Next Choice.  According to Next Choice, it reduces your risk of pregnancy by 88%.  However, that’s only if taken within 3 days of unprotected sex.  It drops down to 50-60% if taken 5 days after unprotected sex.  That means, the sooner you take EC after unprotected sex, the better it works.  And no emergency contraceptive is as effective as using condoms or birth control correctly!

Where can I get EC?

We are lucky here in the state of California.  EC is available over the counter at any pharmacy without a doctor’s prescription if you are 17 years old or older.  It can range between $35 – $65 but is FREE if you have an active Family Pact card (the green card given to you from most reproductive health clinics).

If you are younger than 17 or you do not have an active Family Pact card, you can always see us here at New Gen (no appointment necessary for EC).

FPACT Card

What else should I know about EC?

EC does NOT protect against STD’s or HIV.  If that is a concern, please talk to us here at New Gen or your doc.  Also, some women may experience nausea, headache, cramping, breast tenderness and/or changes in their menstrual cycle.  But don’t let that scare you away.  Not everyone experiences that and for those that do, it only lasts a day or two.  And honestly, those possible side effects are way easier than dealing with an unplanned pregnancy.

BUT WAIT!!! THERE IS MORE! THERE IS SOMETHING MORE EFFECTIVE THE EMERGENCY CONTRACEPTIVE PILLS!!!

The Paragard IUD!!!!

Paragrd

The Paragard IUD (also called the copper IUD) is the MOST effective form of emergency contraception.  It is more than 99% effective at preventing pregnancy within 5 days of unprotected sex.  And better yet, it also acts as birth control that lasts up to 10 years.  Seriously, how cool is that? EC AND birth control in one??? Want to know more about the Paragard? Click here or come into New Gen (p.s. you can get the Paragard IUD even if you don’t need it for EC).

For more information about the various brands of EC, including the Paragard, click here!

In happiness & health,

Shawna

Reviewed by Kohar Der Simonian, MD

1 Shot, 2 Prevent Pregnancy, every 3 months!

Hey Shawna,

I heard about a birth control method you only have to take 4 times a year!?!? Is that for real?

-Anonymous

Whoop whoop! There sure is!

What it is: The Depo Provera, more commonly known as the ‘shot’. The shot contains progestin, a hormone that prevents your ovaries from releasing eggs. It also thickens your cervical mucus, which helps block sperm from getting to the egg in the first place. Don’t remember or understand all this talk about ovaries, eggs and cervical mucus? Click here!

How to use it: It’s a shot given in the arm or butt area every 3 months by a medical provider.

The Good Stuff:

• Only have to take it 4 times a year!

• No daily pill to remember or weekly patch to change or even monthly ring to remove and reinsert!

• No one knows you are using it!

• Can be used while breastfeeding (unlike most pills, the patch & the ring).

The Not so Good:

• You have to go to a hospital or clinic every 3 months (but it beats going to pharmacy every month).

• It can change your period. Some women bleed more often (in between periods and/or heavier periods) and others don’t have periods at all. The irregular bleeding usually becomes more regular the longer you are using the shot. And for the women, who don’t have their periods at all, some love it and others don’t. Just know that not having your period due to being on Depo is totally normal and not bad.

• Some women report weight gain. However, others report weight loss. Many report no change in weight at all. Unfortunately the only way to know if Depo has an impact on your weight is by trying it.

• The Depo shot can lower your bone density but don’t worry, this isn’t dangerous and your bones will return to normal after stopping the depo. Definitely talk to your clinician about this if you have concerns.

• And like all birth control other than condoms, the shot does not protect against STD’s or HIV.

In happiness & health,

Shawna

Reviewed by Koher Der Simonian, MD

Birth Control Bullies: When He Wants Your Method to Fail

So I was doing some research for this week’s post and came across an awesome article on birth control sabotage.  To my surprise,  it was written by none other than the Medical Director of New Generation Health Center Grace Shih!  Birth control sabotage “means someone is bullying or intimidating their partner into sexual situations that put them at risk for an unwanted pregnancy.”  This wasn’t what I had originally set out to write about for this week’s post but knowing how important and serious this issue is,  I didn’t think it should wait.

Birth control bullies: When he wants your method to fail

Messing with a partner’s birth control is abuse—and it may be depressingly common.

by Grace Shih, MD, MAS

When I was training to become a doctor,  one of my patients was a 25-year-old woman.  She already had one child and didn’t want to get pregnant again.  She’d been using the birth control patch,  but came to me because the patch wasn’t working for her.  When I asked her “why not?” she said,  “Because when my boyfriend sees it,  he pulls it off me.”

That was my first encounter with birth control sabotage.  Birth control sabotage is a form of reproductive coercion, which is a fancy term for a simple but disturbing idea… It means someone is bullying or intimidating their partner into sexual situations that put them at risk for an unwanted pregnancy.  It could mean that a partner is sabotaging a woman’s birth control,  like my patient.  It also includes a partner threatening violence or threatening to leave if a woman doesn’t get pregnant.

Reproductive coercion is abuse—and it may be depressingly common.

There is evidence that birth control sabotage is common,  although we need more research to understand exactly how common.  Birth control sabotage can take many forms.  For example,  women have reported:

  • Partners poking holes in condoms or taking condoms off during sex,
  • Partners hiding or throwing away birth control pills, and
  • Partners removing the ring , or even an IUD.

We do know that all types of reproductive coercion are more common in relationships that have physical or sexual violence.  In the U.S.,  approximately one in four women have experienced physical or sexual violence with a partner at least once during their lifetime.

So what can you do?

If your partner is controlling your birth control,  it is a sign of a larger relationship problem.  All women should be able to protect their bodies from an unwanted pregnancy without threats or sabotage.  You deserve to be with someone who respects you and your plans for the future—including when or whether you want to have a baby.

  • If you want support to get out of a violent relationship,  call the National Hotline anytime 24/7 at 800-799-SAFE, or talk to your healthcare provider about local resources.
  • If you have friends who can help keep you safe,  connect with them privately using the Circle of Six app on your smart phone.
  • There are also online projects like Know More, Say More that are designed to help stop birth control bullying and other types of reproductive coercion.

In the meantime, try tamper-proof birth control.

Ideally your partner should support your birth control choices,  but if you find yourself involved with someone who you suspect wants to get you pregnant against your will,  there are some methods your partner can’t mess with.

The Shot (a.k.a. Depo-Provera): Once you get the shot,  there is no way a partner can change or mess with it—or even know you’ve had it if you don’t tell them.  Each shot lasts for 3 months, so you have to be able to get to the clinic regularly if you want to keep using it.

The Implant: It sits just under the skin on the inside of your upper arm,  so your partner wouldn’t notice it unless he went looking for it.  If your partner does,  he might find it since insertion leaves a bruise for a few weeks.  The implant can last for up to three years,  so it could be more convenient than the shot.

The IUD:  It’s placed in your uterus,  where it should be discreet and difficult to tamper with.  It has small strings that can be tucked behind your cervix when the IUD is placed so that a partner won’t notice them during sex.  If you want an IUD but you’re concerned about a partner finding the strings,  talk to your doctor about possible solutions.

In a bind, there’s emergency contraception:  Actually, the most effective form of EC is the ParaGard IUD.  It is over 99% effective in preventing pregnancy up to 5 days after unprotected sex and it goes on to provide up to 12 years of protection from pregnancy.  The other forms of emergency contraception are pills like Plan B,  Next Choice,  and ella. You need a prescription for ella, but you may be able to get Plan B or Next Choice at your local pharmacy without a prescription depending on your age and where you live. (Insert from Shawna:  You can get Next Choice from us here at NGHC – no appointment necessary! As well as the above mentioned methods).

Grace Shih, MD, MAS, is an Assistant Clinical Professor in the Department of Family and Community Medicine at the University of California, San Francisco. She has a family medicine practice at the San Francisco General Hospital’s Family Health Center. When she’s not seeing patients, you can find her cooking, hiking, or salsa dancing.

Birth Control Myths DEBUNKED

Hey Shawna,

My sister wants to start birth control but is afraid of the side effects.  Is it true that women gain weight when they are on hormonal birth control?  Can you still get pregnant afterward?

Thanks

-Anonymous

Hi,

Those are very very VERY common concerns.  There is so much information on birth control out there that it is hard to know what is true and what isn’t.  Here I debunk 5 of the most common birth control myths I have heard!  What others have YOU heard???  Let me know!  Oh,  and I should mention that hormonal birth control only protects you against pregnancy.  It does not protect you against STDs/HIV.  Aside from not having sex at all,  condoms are your best option for preventing STDs/HIV.

Myth #1:  “I can’t get pregnant on my period!”

Fact:  Not true!  Although you are most likely to get pregnant in the middle of your cycle (right between your periods – when your ovary releases an egg),  you CAN get pregnant any time throughout your cycle.  There are a number of reasons for this.  First,  not everyone has a regular cycle (a regular period).  Not having a regular cycle makes it really really difficult to know when you are ovulating  (that’s what it’s called when your ovary releases an egg).  Also,  sperm can survive in a woman’s body for up to a week!  So even if you have sex a week before you ovulate,  sperm can be there waiting for the egg.  So if you are not trying to get pregnant,  it’s really important to use a birth control method.  Using a birth control method is WAY easier than trying to figure out when you are ovulating  (remember,  that’s when the ovary releases an egg and happens between periods).

Myth #2: “Birth control makes girls fat!”

Fact:  Not true.  Most women do NOT gain weight on birth control.  For those who do,  it is only a small amount.  Some girls even report losing weight on birth control.  If you gain weight you need to think about lifestyle changes that may be to blame – like not exercising,  eating junk food,  driving instead of walking,  and just getting older.

Girls often focus on side effects and overlook all of the good things about hormonal birth control like lighter periods,  less PMS,  less acne,  lowering your chances of getting cancer of the ovaries and uterus.  And most importantly – not getting pregnant!  It’s also important to remember that the weight gain you fear from birth control doesn’t compare to the weight you would gain from pregnancy!

Myth #3:  “I tried birth control and didn’t like it – which means I should not try anything else!”

Fact:  There are many different kinds of birth control,  and different women have different responses.  Many women have to wait a few months to let their body get used to birth control (this goes for all medications).  You may also have to try different kinds before finding one that works best for you.

One common thing that happens is that a friend or family member tried something and didn’t like it,  which makes you think it won’t work well for you.  But that’s not true.  You are a different person – with a different body,  likes and dislikes, and lifestyle.  Many of these myths are told to us by people who care,  but unfortunately they may not know all the facts. Always get your sex information from a trained health educator or clinician.  Call and make an appointment at New Gen to get your questions answered.  Everything is free and confidential.

Myth #4:  “IUDs  (a method that is placed in the uterus) are only for older women or women who have children already.” 

Fact:  Again,  not true!  IUDs are great for young people.  I have one!  The best thing about IUDs is that they last for years.  They don’t require you to take a pill every day or get a shot every 3 months.  It’s really safe and effective,  not messy,  it is easy to use,  and it is something you don’t have to think about.  Seriously,  once it’s placed you almost forget you even have it!

Myth #5:  “Using birth control will make it harder to get pregnant later.”

Fact:  Not True.  Hormonal birth control works by stopping you from ovulating  (when the egg leaves the ovary).  When you stop using your birth control you start ovulating again.  That is why many women get pregnant right after using a birth control method.  That means that taking a “break” from your birth control also puts you at risk  (by the way,  the body does not need a “break” from birth control).  How many of you know someone who stopped taking the pill because they broke up with a boyfriend and then they got back together …just once…and they got pregnant… or they forgot to use a condom…just that one time?  It is very easy for young women to get pregnant;  birth control only works when you are using it.  That’s why you should be using a birth control method,  especially a long acting and reversible birth control method  (like an IUD, implant or Depo),  even if you are between partners or you are not having sex regularly.

In happiness & health,

Shawna

Reviewed by Andrea Raider, NP