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...

How do you know if your condom broke? Did you do it right? Can your condom prevent you from getting an STD? Will you still have fun with sex?! Maybe you haven't tried enough brands to know what you like! Maybe we can help you with the right lubricant for you and your condom use! A WebMD quiz can help you sort through all of this!  I’ve been reading about this in the journal Contraception, thinking about how and if the condom broke was a big topic. Yes, unfortunately, exploded pieces laying around in the bed after sex, that’s a pretty good sign. So yes, most often, not a trick question at all. But scientific researchers with their headlamps, their magnifying scopes, and their swabs have a whole different take on the question. So what do they test for? PSA. Prostate-specific antigen. It only occurs in men. If found in the vagina after sex protected by a condom, you guessed right: LEAKAGE! Now with the female condom, slippage, invaginating (sort of folding inward), or the p...

Ring IUD seen in 3-D Ultrasound inside the womb IUDs come in many varieties, some of which do not have strings, such as this IUD. Since it does not have a string to check the position we can use ultrasound. This ring was developed in Germany by Dr. Ernst Grafenberg. It was originally made of silver, but there was some copper contamination of most of their silver which was felt to help it be effective. Now most are stainless steel, and very few women would ever have an allergic reaction to the metal. The stainless steel was origninally made in Shanghai and this the IUD also is called the 'Shanghai Ring.' Although it is shaped like a small coil which forms a solid ring , when placed in the uterus it conforms to the fundus of the uterus which helps it's effectiveness. It is difficult, but not impossible to remove, and many women will select this device because they plan to no longer have children and it can safely be left in the uterus for 20 years or longer

The NICHD priorities for studying contraception, Selected research topics include (but are not limited to): Studies of the ability of progestin- and testosterone-based topical gels to reduce gonadotropin levels and reversibly inhibit sperm production (spermatogenesis) Studies of a progesterone receptor modulator, CDB-2914, as an emergency oral contraceptive when taken within 72 hours of unprotected intercourse Studies of the efficacy of a novel female condom for preventing both pregnancy and sexually transmitted infections Studies of progestin-based compounds that can prevent pregnancy without increasing the risk of blood clots and other venous thromboembolism-type conditions, especially in obese women Studies of the use of a novel progestin- and estradiol-releasing vaginal ring for effective contraception without increasing the risk of blood clots and other venous thromboembolism-type conditions, especially in obese women

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...

Uterine fibroids and what method of contraception you choose are two separate gynecologic issues, but if you have both there are many pros and cons to discover. The IUD first has to be inserted and there are some cases of  uterine fibroids take up some space in the cavity of the uterus and it's possilbe that the IUD would be expelled after insertion. Typically we say that only about 2% of all IUDs are expelled in the first year after insertion. With uterine fibroids that expulsion rate could climb to over 10%. Your Mirena IUD can shrink your fibroids.It is known that the IUD can shrink the overall size of your uterus. Women who suffer from uterine fibroids need to get to their gyno and evaluate their reproductive plan. In a September 2010 issue of  Contraception it was reported from Jiangsu, China that they have discovered that the progestin component, the levonorgestrel, may actually both suppress the growth and cause death of uterine fibroid cells! WoW! It is importa...

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...

Long acting reversible contraception(LARC)  is effective and cost effective because women can use it for a long time, however side effects like bleeding can make a woman give up years before the contraceptive expires. LARC is a term that is applied to any method that is designed to be used for a long time: IUDs, DepoProvera, or the Nexplanon are what is usually (in the US) refered to as LARC. However, if you discontinue the LARC we may say you have now made it into "Short-acting reversible contraception or 'SARC." The Nexplanon implantable rod is designed to be used over 3 years. Patient contraindications for Nexplanon are similar to the contraindications for other progestin methods of contraception. Specifically you should not be pregnant, have a clot or clotting disease, have disease of the liver, or breast cancer. If a woman has irregular bleeding, it should be diagnosed and treated before getting the device. Those contraindications aside it is a terrific method for...

Women have had more and more choices when it comes to contraception, and the new news is that many women can successfully use their contraception even past the FDA approved duration with continued great success. We have found that both the Nexplanon implant, and the IUDs are both very effective, and a 2015 study published in OBSTETRICS and GYNECOLOGY  they have been shown to be effective for two extra years after their expiration date. The data is very good for longer effectiveness, but questions remain before actually recommending that our patients depart from standard recommendations! And... if the condom breaks, or you have not yet gotten effective longer term contraction and have had unprotected sex and want to prevent pregnancy it is important to know that you can use either of the approved medications for up to 5 days after having sex, and that a ParaGard IUD insertion is a viable method of emergency contraception as well.  But even the WHO  says that about 1/...

 Hormonal contraception provides ovulation suppression and eventually this correlates with overall hormone control and normalizing the menstrual cycle. Knowing that these methods are extremely effective, 'will I gain weight' remains the top question women ask their gyno before selecting a contraceptive. The issue of weight gain on contraceptives is complicated by the fact that many young women are beginning on hormonal contraception as they give up sports and physical activities for extra studying in college or as they start a new job that likely is more sedentary with travel or just desk time required. But contraception might have the ability to affect weight, affect weight gain, affect weight loss and cause fluid shifts that ultimately shouldn't alter the scale. In general we counsel patients that neither oral contraceptive, patches, rings, medicated IUDs, nor Nexplanons should cause weight gain. DMPA (you may know this as Depo Provera) is associated with 10-15 po...

Condoms have been the primary defense against sexually transmitted diseases. Spermacide has also been shown to have protection, if used in the right amount and frequently enough, to achieve an effective concentration to be able to kill bacteria and viruses before they can infect a woman. And gradually we have seen other products being developed that would be both spermacidal (kill sperm) and microbicidal (kill bacteria) . Two research studies on a vaginal ring that would contain a medication that would be able to inactivate the HIV virus are underway. The trial is called ASPIRE    A Study to Prevent Infection with a Ring for Extended Use with investigator Jared Baeten, MD, from the University of Washington in Seattle with his team, and  Annalene Nel, MD,head of the international branch of the study in South Africa called the International Partnership for Microbicides. This medication is not a contraceptive and would have to be used with a contraceptive, and is not t...

Each year we re-discuss the risks and benefits of contraceptive pills and hormonal contraception. Vaginal rings produce slightly higher levels of hormone and there have been questions about the cardiovascular effects of the extra hormone levels. The newest study, including the Transatlantic Active Surveillance on Cardiovascular Safety of Nuvaring study proved that vaginal rings and combined oral contraceptive pills have about the same cardiovascular risks. The newest contraceptive revolution is to customize your contraception to your lifestyle, your physiology, and your pregnancy plans. More Birth Control pills are on the market today than ever before, and new ones are coming. In fact at Women's Health Practice we are recruiting for a contraceptive ring contraception study, if you are interested call 217-356-3736 for a free consultation appointment. So what do you think, has the contraception revolution changed again? We can think back to the start of the revolution. Russell...

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

When are you going to have a baby is the first step in planning your pregnancy. In Mexico the average age of first pregnancy is just over 21, in the UK it's closer to 29 on average, in the US we are something between those two, so think over your reproductive life plan, how are you going to fit baby into your school, job, or marriage plans if any. Then get physical and get ready to do what it takes to get ready for the conception, prenatal days, the birth and the life with baby. Planning your pregnancy by some simple tests to insure your health, and relatively simple steps is more likely to result in getting pregnant more quickly and having a healthier baby and pregnancy. A new study says that preconception care has potential for return on investment. Women with chronic illnesses have the most to gain from planning their pregnancies, and yet they the least likely to plan their pregnancy according to this new study, and thus enter pregnancy less likely to maximize their chance for ...

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...

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 ...

Starting a new medication? Don't forget to google it... or Yahoo, or wherever you normally look... but what you really want to do is always check the actual website for your medication, virtually all branded products have a webpage! Pharmaceutical branded websites offer excellent patient information about your medication, and many also offer coupons to lower co-pays and medication costs. Patients forget that if they want excellent information, their gyno , their pharmacist, the package insert, are all excellent sources of accurate risks and benefits for your medications. However for cost savings, and updates on your particular medication, and should be checked when you are on medication. Many women are currently on oral contraception LoLoestrin or Minastrin , and here are their links as just two examples. And remember, if you think you read something that contradicts or confuses you about your personal gyno's advice, be sure to check with her to clarify; and always make your ...

HPV exposure is almost universal, but even without vaccination, not everyone exposed tests positive and not everyone who tests positive will go on to develop abnormal pap smears or cancers. Other factors will determine whether you will test positive for HPV, and the list is mounting as to what these factors are. Smoking, menopause, poor immunity, frequent exposure to the HPV virus are just a few of the factors that have been associated with a positive HPV test.  Birth control pills have effects on the cervix and the uterus, and these effects have been well studied and discussed in many forums, they cause an enlargement of the sensitive t-zone area of the cervix that might make picking up an HPV infection easier. One group that has been particularly active in this research has been the International Agency for Reseach on Cancer . This group feels that taking birth control will increase your risk for cervical cancer by about double. But whether this directly is ...

From Female Condom Website What! Reuse of a Condom, is that sensible, possible? For Female Condoms, the manufacturer has given Dr. Steven Nakajima, of the University of Louisville School of Medicine the official guidelines from the World Health Orgnanization (WHO) their guide to washing the female condom . It's that official, so I pass the info on to readers who may be using the Female Condom: You need a weak bleach to kill viruses and bacteria, even chlamydia, gonococcus, the HIV virus and other more common bacteria. The bleach can be 1 part bleach and 20 parts water, and you need to soak your female condom in it for one minute. Rinse, at dry, store in a dry place. It's not recommended to clean more than 5 times. Female condoms used to be made of polyurethane, the walls were thin and odorless and transmitted body heat, but some assembly was required at the manufacturing plant, now the newest condoms, called FC2 are actually of a softer synthetic latex, and they are more a...

1. Controlled high blood pressure 2. Gestational Diabetes or actual Controlled Diabetes 3. Migraine headaches without aura 4. Uterine fibroids 5. Elective surgery 6. Seizure disorders 7. Liver disease or jaundice in pregnancy 8. Sickle cell disease 9. Gall bladder or liver disease 10. High cholesterol 11. Smoking 12. Mitral Valve Disease 13. Systemic lupus erythematosus