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What are the different types of IUD’s, and which one is best for me?

10/15/2019

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An IUD or intrauterine device is a little t- shaped device that is inserted into the uterus to provide birth control.   They are a great form of birth control because they are very effective and hassle free.  Once placed in the uterus they last for 3 to 10 years based on the one you chose to have and that’s it!  You don’t have to take a pill every day or remember to replace your Nuvaring.  No hassles or worries.  So, what are the different IUD’s, and which one is best for me?  The two types of IUD’s available are the copper IUD and the progestin-based IUD. 

​The copper IUD (tradename is Paraguard) has a plastic t-shaped frame with copper wire coiled around it.  The copper IUD releases copper ions which is toxic to sperm movement and egg fertilization. It also produces an inflammatory reaction which interferes with implantation.  It is 99% effective at preventing pregnancy and lasts for ten years.  This really is the best bang for your health care dollars.  This device costs about $1000 and is covered by most insurances.  If you use it for ten years- this comes out to about $8 per month for birth control.  Considering that most insurances cover it at a 100%, it likely won’t cost you anything.  However, there are some potential undesired side effects.  Because the copper IUD prevents pregnancy by producing an inflammatory reaction in the uterus, many women experience more painful periods and heavier bleeding than usual.  For some women these symptoms do improve over time, but this can take up to a year to notice improvement.  However, many do not notice any improvement over time, and for those women the only option is to remove the IUD. 

The progestin-based IUD (tradenames include Mirena and Liletta, among others) also has a plastic t-shaped frame that contains a progestin hormone.  Progestin is similar to the hormone progesterone which our bodies make naturally.  This type of IUD will last 5 years.  The progestin in the IUD prevents pregnancy by thickening cervical mucous which affects sperm motility and it thins the lining of the uterus preventing implantation.  Because the progestin acts locally in the uterus, many side effects that women experience with oral birth control like nausea, breast tenderness and mood changes are not experienced with the progestin- based IUD.  Also, it also does not affect breast milk supply if you are breastfeeding.  While copper IUD’s can worsen menstrual bleeding and cramping, most women with the progestin- based IUD experience less bleeding and 20% of women never have any bleeding while the IUD is in place.  Because of these non-contraceptive benefits, many women with heavy menstrual bleeding will use the progestin-based IUD just to control their bleeding.  However, some women can have irregular bleeding or spotting with the progestin-based IUD. 

So, this blog helps provide a basic framework about the differences between the copper and progestin-based IUD.  That being said, given your individual medical history, one of the options may be more effective or appropriate for you than the other.  Be sure to talk to your provider about your contraception goals, and together you can find what can work best for you. 

Dr. Pam
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Does the birth control pill make me fat, crazy and infertile?

2/14/2017

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The birth control pill has revolutionized the way women lead their lives.  It allows us to control our lives and decide when it is best to start a family.  The birth control pill can also help control symptoms of heavy bleeding and pain during the menstrual cycle.   Unfortunately, hormonal birth control pills can also cause all sorts of unpleasant side effects.  They include nausea, breakthrough bleeding, decreased libido, breast tenderness...the list goes on and on!  The most common questions I get from patients are: Does my pill make me fat? Crazy?? What about infertile???  Let's explore these below. 

1.       Does the birth control pill make me fat?  No.  Multiple studies have found no evidence that the birth control pill can cause you to put on extra fat or affect your metabolism. Now, can the pill make you bloated? Maybe.  The pill can cause some water retention associated with fluctuating hormone levels.  However, any weight gain from this is minimal and goes away within two to three months.  Talk to your gynecologist about this.  If you remember from my last blog, all pills are different.  Some pills contain a mild diuretic that can help with fluid retention if this has been a problem for you.  Now, while the pill and the IUD have not been associated with weight gain, the Depo Provera shot (birth control shot that you receive every three months) can cause 20% of women who are on it to gain weight.  If you feel that you are gaining weight and constantly bloated on the pill, we strongly encourage you to talk to your provider and make sure that you are on a regimen that will help with those symptoms.

2.       
Does the birth control pill affect my mood?  Depression and mood swings are commonly reported side effects of the pill and the most common reason that patients stop taking the pill.  However, studies have been unable to prove or disprove a link between depression and the pill.  If you experience depression while on birth control pills, you should stop taking the pill and talk to your provider about other options.  Again, the Depo Provera shot (birth control shot that you receive every three months) has been linked in studies to worsening symptoms of depression in women with pre-existing depressive symptoms. 


3.       
Will the birth control pill affect my fertility?  No.  There is no evidence that shows that long term use of the birth control pill interferes with fertility.  In fact, 20% of women who discontinued the pill became pregnant within the first month and 80% within the first year after discontinuation!  These numbers were similar for women who were not using any contraceptive method. These numbers were also similar for users of the IUD, the patch, and the ring.  Again, for users of the Depo Provera shot, studies did show a delay of up to eight months after stopping the shot.  Also remember, the pill is used to treat conditions like endometriosis which if left untreated can lead to scarring and lead to infertility. 


For many women, the birth control pill can be a great reliable and reversible contraceptive option.   Even for those women who are concerned about side effects, there is generally a pill that can minimize those side effects due to the large number of formulations available.  If you have any questions about the birth control pill, be sure to discuss these with your doctor to find out if it might be a good choice for you.

​Dr. Pam

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Are All Birth Control Pills the Same?

1/31/2017

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The birth control pill has been on the market for more than 50 years.  It has really allowed women to take control of their lives and decide when they are ready to start a family.  It also helps many women control their symptoms of heavy bleeding and pain during their cycles.  However, there are literally hundreds of different types of birth control pills out there.  So how do I know which pill will work best for me?  First, let's talk about the different types of pills: There are combination pills and the mini-pill. 

1.       Lets start with combination pills They contain two types of hormones: estrogen and progestin.   They prevent pregnancy by preventing ovulation, thickening cervical mucous and thinning the lining of your uterus, thus preventing a pregnancy from implanting there. The patch and the nuvaring have both hormones and so are essentially comparable to the pill. Different types of combination pills have different types of estrogens and progestins and at different dosages. 

2.       Let's further break it down: There are two major types of combination pills: monophasic pills and triphasic pills.  Monophasic pills have the same amount of estrogen and progestin in their active pills. Triphasic pills vary the amount of hormones every week.  The marketing guys for triphasic pills claim that they are trying to mimic the hormonal changes that happen during the cycle.  However, there is no evidence that says that triphasic pills work better or have any other benefit.

3.       Di
fferent combination pills have different amounts of estrogen. Is a low dose estrogen pill better for me since it has less hormone?  Not necessarily.  Some women are very sensitive to the effects of estrogen, and higher doses can cause worsening nausea or breast tenderness.  For them, a low dose estrogen pill may help with these symptoms.  However, low dose estrogen pills are notorious for causing breakthrough bleeding.  So while your breasts may be less sore, you may be bleeding a lot more.  I guess it's pick your poison, huh?


4.       
Different combination pills have different types of progestins.  Some progestins may be less androgenic than others.  What does that mean? Essentially some progestins may help decrease acne or affect unwanted hair growth. 


5.       
What if I can't take a combination pill?  For some women, the combination pill can worsen preexisting health problems. If you are over the age of 35 and a smoker or have high blood pressure, diabetes, history of blood clot or have migraines with aura, you may not be a candidate for combination birth control that includes estrogen and progestin.


6.       
So what is the mini-pill?  The mini-pill only contains progestin.  It thickens cervical mucous and thins the lining of your uterus, but does not necessarily prevent ovulation.  The mini-pill is usually a great option for women who are not allowed to use the combination pill because of certain medical conditions or if they are breastfeeding.  The estrogen in the combination pill can decrease milk supply and so for breastfeeding women, the mini-pill is recommended.  With the mini-pill, you must take it at the same time every day to prevent pregnancy.


​So back to which pill is best for me.  It's not that easy, is it?  It is best to have a discussion with your provider.  Based on your medical history and goals of treatment, together, you can come up with a plan to best suit your needs.  Keep following for a follow-up blog:  Does the birth control pill make me fat and crazy?!

​Dr Pam



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