GynoFiles

How we select a pill for you to start on, and how we select the pill you should continue on is a very complicated topic. Choosing the right pill for you, however, has certain key elements. Typically women think of the pill for contraception, but it's an excellent strategy to ward off many problems. 1. Contraceptive protection is quickly established and very effective. Virtually all oral contraceptives have been thought to have identical effectiveness. If you take the pills faithfully, ovulation is suppressed, and failure rates are quite rare. Based on published data, about 2-3 women out of a hundred taking the pill for a year will become pregnant. Pills from the 70s and 80s that have published rates of only 1 person in a hundred getting pregnant is based on old studies. We have had a bit of pregnancy rate drift in the past few years, and women today have higher pregnancy rates than we used to in the past (obesity?). So, in truth gynos don’t assign pills based on effectiveness...

When a sentence begins with 'I read on the internet', the gyno takes a deep breath, and if the next clause contains a mention of one of the excellent sources of data we exhale and and smile. If the source is a chat room, or a site selling untested therapies, you can hear a few more deep breaths before we launch into a discussion of data. Of course, it's very important to get information about the consequences of any prescription therapy, and being prescribed contraceptive therapy is no exception. However, there are consequences of no therapy (in the case of contraception it's unplanned pregnancy) as well, and thus sprouts the prescriptive principal of 'risk vs benefit.' Your job is to help your provider sort out your personal risks and your personal perception of benefit. But it's important to not be weighing in factors that are truly myths.The June 2016 of AJOG has pointed out that contraceptive effectiveness is as much about chasing the ghosts of contr...

We know that women have about a 1/10,000 risk of having a blood clot known as VTE (venous thromboemoblism). When a woman takes birth control pills there is a 3-4 times greater risk of having a VTE, and this is primarily related to the estrogen in the birth control pill. Of course becoming pregnant raises one's risk of a blood clot even more, to as high as 6 or even 10/10,000. Thus the American Congress of Obstetricians and Gynecologists recommends having a discussion with your gyno to decide what your risks and benefits are and whether you should stop your pills before and after surgery for a time, as becoming pregnant is a risk for blood clotting. For women who have surgery planned, there are many factors that may increase her risk of a blood clot or other complication of the surgery. Blood flow is the primary factor: the quicker you are up and active, and the more activity you have, the less likely you are going to have a blood clot. This is in some way related to blood pressure...

When it comes to contraception we have a long history of asking girlfriends, sisters, hair dressers, and generally getting the broad strokes of over view of contraception alternatives from women's magazines. Now the social media savvy among us have all sorts of options for contraceptive advice from googling medical society guidelines, to reading published research, and getting the spin from the companies that produce contraceptives, themselves. We have had access to contraceptive specialists, gynecologic specialists, and even reproductive endocrinologists for many years now; all of whom have very detailed knowledge of the risks and benefits, and even costs and availability of contraception. When the morning after pill technology was no more than a special dosing way to take available oral contraceptive pills there was a special number to call for information and access to a physician. Although over the counter oral contraceptive prescriptions have been available in other countri...

Yes, pills are used for many healthy individuals to fight off risk, sort of like taking a vitamin. Generally speaking we think of most wellness care as eating better, exercising more, not smoking, and getting better sleep as part of  'therapeutic lifestyle changes.' But that's not enough power to fight off all the ravages of aging, genetics, and environmental damage, so perhaps turning to medication is what is going to be the most effective. The polypill is one good example of a pill for the healthy to prevent getting sick. It is directed at prevention of cardiovascular disease. And in the September 4th issue of JAMA 2013 it's back in the news, although almost two decades have passed in the efforts to get a polypill that will really work. The polypill was proposed over 10 years ago by Drs Wald and Law in a study in the British Medical Journal, when it was tested the medication included  three half dosage anti-hpertension agents, with other agents including a intermed...

Women have benefited from the ACA in many ways, and less out of pocket dollars and planning their pregnancies is an important way they have benefited from getting their contraception covered. However, the patients, their insurers, their workplaces, and society has benefited even more from the important non-contraceptive benefits that come from contraceptive use. Just to name of few that are directly a benefit from the oral contraceptive pills: 1. Control of heavy uterine bleeding and menstrual cramps (dysmenorrhea) 2. Prevention of ovarian cysts, and preventions of surgeries for these cysts 3. Lower Rates of  (endometrial cancer) 4. Lower rates of ovarian cancer 5. Less Ovarian cancer 6. Less colon cancer 7.  Less pelvic inflammatory disease 8. Healthier, planned pregnancies 9.  Less Anemia 10 .Fewer fibrocystic breast changes 11. Healthier bones 12. Less PMS 13. Less Endometriosis 14. Less infertility

Birth control risks vary according to your age. If you were safely using your pill, and now you have your 35th birthday, you may be surprised to know your gyno may view your risks in a whole different category. For most all women on oral contraception the risks are low, and it is acceptable to use your pills until menopause, and even into early menopause for some. If you smoke, if you become ill with a medical condition that is a contraindication to pill use , or have special considerations from your gynecologist, you may indeed have to be taken off the pill prior to the time of menopause, but women in their late 30s and 40s can most likely stay on a contraceptive pill that is working for them. Smokers should not be on the pill after the age of 35. The CDC talks about contraceptives and their risks in benefits in their publications, the last being in 2013 . If you have migraines you may also need to come off your combination oral contraceptive pills if you are over the age of 35. It...

Once again birth control availability takes a new twist from universal prescription coverage, to perhaps no coverage as politicians start to advocate over the counter birth control pills. The parent organization of all obstetricians and gynecologists has actually supported the idea of over the counter contraception since 2012 . But when faced with the fact that a half a billion dollar bill will land in the laps of women if that move was taken, organizations like Planned Parenthood are advocating that pills still be considered a prescription only medication. She was quoted on Medscape as saying “When health insurance doesn’t cover birth control and women have to pay out of pocket at the drugstore, it won’t expand access to birth control but shrink it,”  wrote Parenthood Action Fund President Cecile Richards in an op-ed at CNN.com. Does it seem civilized to buy your birth control along with anything else you can grab at the grocery? It does seem that way to other countries, whe...

Women are always questioning whether a recommended treatment will cause them to get fat, and the question comes up with contraceptive use daily in the life of a gyno. The causes weight gain, and the causes obesity are both similar and many, but it's not likely that you got fat from your oral contraceptive pills (OCP). Many women do believe that OCPs cause weight gain, but well controlled studies just do not back this up. Generally studies of healthy women over a period of time find that about a third of them will gain weight. The good news is that also during those studies about 1/5th of the participants actually lose weight. Birth control pills could cause weight gain due to water retention, accumulation of fat, or due to increased hunger drive followed by increased caloric intake. But these factors do not affect all women and it has mostly been found that pill users were no more or less likely to gain weight than non OCP users. However, a few studies found that OCP users ...

Thyroid hormone levels are affected by the amount produced. Estrogen, whether produced in pregnancy or ingested, as in the case of hormonal contraception, affects Thyroid Binding Globulin (TBG). This is a glycoprotein that binds the actual thyroid molecules themselves. Generally thyroid binding globulin releases T3 and T4 very quickly to the cells, and is not a detriment to thyroid function in our body, but because it is over produced when taking birth control pills the actual total amount of thyroid in the body is increased. But the amount of free thyroid, the active thyroid, is not changed. Birth control pills should not affect the TSH, or pituitary production of thyroid stimulating hormone, either. So testing the thyroid is still easy in pregnancy or when you are on birth control pills.

Contraceptive pills are very effective when they are taken. Failure rates are just a few percent, with missed pills, or lower blood levels due to vomiting or other medications the most common reasons for failure. How your gyno looks at these numbers is fairly interesting. Furthermore, the statistics always have to be adjusted as they change over time, even if the pills themselves are not changed.  Your doc will base their opinion of effectiveness on how many women are pregnant at the end of the year out of every hundred that use the method. That fact is called the Pearl index. Pearl indexes in this country has been creeping up, for some reason contraception, although used a bit more, is less likely to work. So, ,your method is more likely to fail now than if you were on the same method years ago. Contraceptive products tested in the USA now have higher failure rates than they had ten yrs ago. This drift in effectiveness rates is real, it is steady, and we don’t know th...

 Review of the risks again states that birth control pills are safe, the benefits far out weigh the risks, and that all current generations of the pills are safe. The new review puts some numbers to blood clot risks in a European population, specifically to venous thromboembolism (VTE). The baseline risk for the healthy used to be quoted at 1/10,000 and it has gone up slightly to 2/10,000. Most of the pills used are quoted in the statistics here. Table. Risk of Developing a VTE in a Year Class of Patient and CHC Risk per 10,000 Women Women who are not using a CHC and who are not pregnant 2 Women using a CHC containing levonorgestrel, norethisterone, or norgestimate 5 to 7 Women using a CHC containing etonogestrel or norelgestromin 6 to 12 ...

Ye Elaine Wang, MD, from the University of California at San Francisco. Taking oral contraceptives for more than 3 years doubles a woman's risk for glaucoma, according to a large population-based study. Dr. Wang presented the findings here at the AmericanAcademy of Ophthalmology 2013 Annual Meeting. Her data was from the NationalHealth and Nutrition Examination Survey (NHANES). The participants completed vision and reproductive health questionnaires and underwent eye exams, so the conclusions were based on very strong information. Although the eye docs want to screen women over 40 for glaucoma, especially if they have or are using birth control pills, there is no recommendation to change contraceptive use. The study builds on what we know about estrogen and eye disease protection. But the levels of estrogen, and the combination with progesterone may be the driving force behind the development of glaucoma in this subset of women.

Women expect effective cycle control as well as effective contraception on their birth control pills. A common question every gyno gets is what should I do and: why did I have unusual bleeding on my pills. Sometimes it’s a fee spots after intercourse, and that is unlikely to be a problem with the pill. Sometimes it’s just an early or late period, which we call “unscheduled bleeding,” you will probably call it 'not controlling your period.'  Most often it is what your physician calls Breakthrough Bleeding or BTB. If it’s not enough to need to use a pad we just call this bleeding during your pill pack spotting. BTB and spotting are common during the first few months of taking oral contraceptives. If you have BTB you are not at risk for pregnancy, and women should not stop their pills if they get BTB or spotting. BTB usually is caused by shedding of the lining tissue as your uterus adjusts to a new thin state in which it is fragile and thin. Breakthrough bleedi...

How we select a pill for a patient. Virtually all oral contraceptives have been thought to have  identical effectiveness. If you take the pills faithfully, ovulation is suppressed, and failure rates are quite rare. Based on published data, about 2-3 women out of a hundred taking the pill for a year will become pregnant. Pills from the 70s and 80s that have published rates of only 1 person in a hundred getting pregnant is based on old studies. We have had a bit of pregnancy rate drift in the past few years, and women today have higher pregnancy rates than we used to in the past (obesity?). So, in truth gynos don’t assign pills based on effectiveness, they will all work for you! Since the 1970s safety has driven most of the dosing and type of hormone changes in the pill, and safety is always the first concern. Again, all birth control pills are extraordinarily safe and few women cannot take OCs. But safety is enhanced by selecting the lower doses. Non-contraceptive benefits dri...

Many places in the world the birth control pill is available 'over the counter' with no more barrier to the obtaining of this popular contraceptive method than there is for treating headaches or indigestion or upper respiratory tract infection symptoms. For access to more information on where in the world oral contraceptives are already available, and issues relative to when this may be available in the US please go to Ibis Reproductive Health or the OCs OTC Working group.

Each gyno will have a plan for you as to when to start your birth control pills when first getting started on pills . "Sunday" start means that you run out of your 28 day pill pack on Saturdays, and that may be efficient for many women, but not so efficient for others. Especially if you just got your prescription and missed your Sunday start, yet you are wanting to be protected against pregnancy as soon as possible. So gynos have long been recommending "quick starts" meaning, start your pills as soon as you can, regardless of where you are in your cycle. Once you have taken 7 days of pills, you are protected against pregnancy. (By the way, the ring being a bit stronger, you only need three days of NuvaRing use to be protected against pregnancy). We have worried about causing break through bleeding when you first start pills in the middle of a pack. But all studies reviewed recently in a publication in the May 2013 issue of Contraception showed that there was no ...

Every woman who takes oral contraceptive pills has some risk of side effects and complications but the risks are generally regarded as very low for most women. For women with active estrogen-responsive cancers, such as breast cancer; or active liver disease, or actually pregnant, we say that the use of oral contraceptives is a Category 4: they should be avoided. However, there is a Category 3 that many women actually fit in to. We say that "the risks generally outweigh the benefits of the method" in Category 3 and we urge women to consider alternatives. For instance young women, ages 30-34,  with hypertension are 5-6 times greater to have a heart attack and stroke if they take birth control pills.  If you have been successfully using a birth control pill, but have one of these risk factors, most gynecologists will not automatically switch your method. It is important to put your risks in perspective. If you are not pregnant, you have a 1/10,000 risk of developing a blood clo...