Birth Control Choices-- Laura Corio, MD-- 12/10/03
By Laura Corio
WebMD Live Events Transcript
From barriers to shots, pills to implants, there is a wider selection of over-the-counter and prescription birth control choices than ever before. And more contraception methods are on the horizon. We sorted through the selections with ob-gyn Laura Corio, MD.
The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Moderator: Welcome to WebMD Live, Dr. Corio. What's the latest news on birth control?
Corio: Here's what's going on right now:
- The patch, which is called Ortho Evra, is a series of patches that a woman wears three weeks out of the four-week cycle. She changes it once a week. It comes with three patches, so one week, the second week, the third week, then one week she's off of it and she'll get her period. The reason women like this is because some women are not great at taking pills, and so all they have to do is worry about changing the patch once a week.
- The Nuvaring is also new. The woman wears it in her vagina for three weeks straight then takes it out for a week, and during that week she has it out she gets her period. Both the patch and the Nuvaring are releasing hormones, just like the birth control pill releases hormones.
- There is a new birth control pill that allows a woman to menstruate only once every three months. She would take the pill 21 days, 21 days, 21 days, and then break for seven. She would only get a period once every three months.
There's also an IUD called Mirena that releases progestins, and after a year of this IUD -- you wear it for five years -- most women don't have their period any longer. Not only is it good for birth control but it also is good for women who have heavy periods.
- As far as birth control pills, the newest pill on the market is Yasmin, which has a new type of progesterone that acts as a diuretic and therefore decreases bloating and PMS and weight gain, and a lot of young girls like it and a lot of older women like it.
- Then we there's the morning after pill; Preven is one type; Plan B is another type. They have to be taken within 72 hours of unprotected intercourse to prevent pregnancy. They're approximately 75% effective. Usually it's two pills, then two more pills 12 hours later.
Moderator: What advantages do you see to using some of the newer methods of birth control?
Corio: I would say that because they have now manufactured different means by which one can get hormones, such as through the skin and through the vagina, not just orally, it allows the woman more choices.
- Some women may prefer to go through their skin and bypass their liver.
- Some women may prefer to do something vaginally and not have to think about it for three weeks.
- Some women, every time they get their period they may have terrible symptoms. So going on this birth control method of having your period once every three months may be very acceptable to a woman who has very tough periods.
Member question: I read that after a year of Depo you can lose your period completely. How is this safe?
Corio: First of all, I would say Depo-Provera as a form of birth control is probably going to go off the market, because it can affect your bones and your heart.
Yes, it is true that after a year on Depo you can lose your period, because the continuous release of progestins affects the hormones in your brain and stops you from menstruating. I would caution against using that form of birth control. When you finally stop using it, it can take 18 months to get back normal periods and fertility and, like I said, it's not great for bones or your heart.
Member question: I take Ortho Tri-Cyclen, but was recommended to take Depo because of migraine headaches.
Corio: You can still get headaches with Depo. The problem is that with Depo you get a shot every three months, and if you get headaches with it, it's in your system for three months. So I wouldn't think that is a great choice for someone who has migraines.
Member question: How easy is it to use the ring? I never could get the hang of a diaphragm.
Corio: The ring is much smaller and much easier. When you use the diaphragm it has to go under your pubic bone; it has to cover your cervix, but with the Nuvaring you just push it back into your vagina as deep as it can go. There's no special place for it, so it's a lot easier.
Moderator: Do the patches give the same amount of protection as the pill? What about the ring?
Corio: Yes. It's a personal choice.
Moderator: What do you see as the advantage of the ring?
Corio: Some women would never want to put something into their vagina and walk around for three weeks with something in their vagina. Some women choose this method because they don't have to worry about taking a pill or wearing a patch; they just put it in for three weeks.
Member question: Do you think that IUDs are underutilized in this country? My basis for that are higher usage rates in other parts of the world. If yes, what do you feel are the reasons for this?
Corio: Well, the IUD got a bad name in this country, so once it got the bad name for pelvic inflammatory disease, which is called PID, it frightened women and therefore no one wanted to use it any more. In my practice the perfect candidate to use the IUD is the woman who:
- Has been married a long time
- Has her family
- Never wishes to get pregnant again
- Is monogamous
Member question: I'm curious about your experience with patients who have IUD's (Mirena or ParaGard). Do you suggest this as a long-term method of B/C for people w/no children (I'm 30) and what have you found as the No.1 complaint about them (if any), i.e. expulsion, pain, can feel it during intercourse, etc.?
Corio: IUDs, like I said, I would rather it be used by married women who have their family already. I do not think it's a good choice for a young girl who's 30 who doesn't have a family yet. In my practice I've found the reasons that we take an IUD out early, earlier than the 12 years it's supposed to stay in, is because abnormal bleeding, meaning heavier, longer bleeding.
If it's uncomfortable to the partner, a lot of times you can cut the string shorter, and if someone's having pelvic pain or a pelvic infection, the IUD may have to come out.
Member question: My husband and I want to have kids. However, we're both in college right now and I still have a year left. I had been on the pill since I was 16. I stopped taking it when I got married. I'd like to get back on it, but I heard that the pill causes bad side effects if taken over a long period of time. I also heard that when you get off the pill, it takes a long time for you to conceive. Is any of this true or have I been completely misinformed?
Corio: I don't think that's true. I don't think that being on the pill long term you have an increase in your symptoms. I've had patients on the pill 10 years before they were ready to have children. Theoretically the pill should not affect fertility.
Member question: Is it possible for the pill or the patch to be the culprit for decreased lubrication? I am 31 years of age.
Corio: Yes. The pill can affect the secretion in the vagina. Women constantly complain of vaginal dryness on the pill. Women have used lubricants, such as Astroglide, to help with lubrication.
Member question: In your experience, have you had any patients where you believe oral contraceptive use has led to a significant increase in blood pressure to hypertensive levels? If so, how often have you found that to resolve after discontinuation of oral contraceptives?
Corio: I have seen where women were on birth control pills and they developed high blood pressure, and either they ended up on blood pressure medication while staying on their birth control pills, or going off the pill. Sometimes the blood pressure resolves, but sometimes the blood pressure is elevated and stays elevated, and they were developing high blood pressure.
They may have had a family history, or they may have had other risk factors, and I always have a conversation with the patient and the internist about the blood pressure issue and staying on birth control pills.
Member question: One of my friends is taking birth control shots, and it looks like she is gaining weight from the shots. Could the shots make you eat more? I have heard that if you take the birth control pills it will make you gain weight but if you get the shots it won't make you gain weight. What are the facts?
Corio: Totally incorrect. According to the research, the Depo shots can make a woman gain 10 pounds in a year, and according to the literature, birth control pills are not supposed to increase weight gain.
Member question: I am on the pill and I have gained 15 pounds. I am not careful enough to use condoms. What are my options so that I am able to lose the weight?
Corio: I think you should go back to your gynecologist and ask him or her about the new pill, Yasmin. In my practice the women on Yasmin tell me they don't feel they're taking any kind of hormones and have not gained weight.
Member question: I had to take fertility medicine (Clomid) in order for me to get pregnant due to irregular periods. After the birth of my twins, I want to get on some kind of birth control but I do not want it to have any effect on me trying to get pregnant again eventually. What type of birth control would you suggest I use?
Corio: It sounds like you may have polycystic ovarian syndrome (PCOS). Because of your irregular periods and needing Clomid to get pregnant. The best form of birth control for you is birth control pills, because:
- They give you a period every month
- They will decrease hair growth
- They will help you keep your weight down
- May even help after you get off the pill to allow you to get pregnant spontaneously
Member question: I need to change my cycle. I am still breastfeeding. What form of birth control should I use?
Corio: If you're still breastfeeding you can use a barrier method, such as a diaphragm or condom. You could use birth control pills that only have progestins in them, but not anything that has estrogen in it.
Member question: How do you rank various birth control methods in terms of effectiveness?
Corio: Sterilization, permanent sterilization, is like 99.9% effective, as are birth control pills with estrogen and progestins in them. IUDs are approximately 97% effective. Diaphragms and condoms are about 95% effective.
Member question: I know women who have never had children and who have no desire to have children. When they speak to their doctor they do not feel like they are being taken seriously. What advice do you have for women in this situation to go about discussing tubal ligation with their doctor?
Corio: It's a very interesting question, because there are women who may be 30 years of age and they may be saying to their doctor, I want to have a tubal ligation. Understand it is irreversible, and five years down the line Prince Charming could walk into your life and you could say, "Oh my god, I want to have babies with this man." One in three women who are sterilized regret their decision. Therefore, you can understand the doctor's reluctance to doing the procedure.
On that note, though, there's a new type of sterilization through the vagina that can be done in a doctor's office, so there is no general anesthesia. They go through the vagina, through the cervix, and into the uterus, where they can place pellets into the openings where the fallopian tubes begin. Doctors are being trained right now in this procedure.
Member question: Speaking of sterilization, how do you feel about the new Essure procedure? (A polyester fiber implant is inserted into the fallopian tubes and causes scarring around the implant that blocks the tube) Do you recommend this procedure as opposed to the tubal ligation procedure?
Corio: I think it's a great procedure, but you have to go to a physician who has been trained in this method.
Member question: What is your view on the use of a backup method when using antibiotics and oral contraceptives? Do you feel it is only necessary to use a backup when using certain antibiotics or do you recommend using a backup when using any antibiotic?
Corio: No, I would say using a backup method with certain antibiotics, such as tetracycline and penicillin would be a good thing to do when you're on oral contraceptives, because it can affect the efficacy.
Moderator: I just saw the new Diane Keaton/Jack Nicholson movie. In a funny scene, when they are about to have sex for the first time, Jack's character asks Diane's character, "What about birth control?" She responds, "Menopause!" How do you know that it's OK to stop all other birth control methods and just count on your own body?
Corio: Well, they say after you've gone a full year without a period and you've confirmed that this is menopause by blood test that you can stop using birth control.
Member question: I recently saw on MSN that there was a new male birth control when I went back to get info on it I could not find it. Do you have any info? Thanks.
Corio: I constantly see questionable new forms of male birth control come out, but I've yet to see them be FDA approved and out on the market. They talk about a male patch, they talk about pellets under the skin, but nothing has been FDA approved that I know of as of yet. All we have are vasectomies and condoms.
Moderator: Let's talk about the morning after pill. What is your feeling about it potentially being made available over the counter?
Corio: I don't feel it should be over the counter, because it's not something you want to use as a form of birth control. Women who smoke should not use it; women who have high blood pressure shouldn't use it. You are taking a very high amount of hormones in a very short period of time. It can make you nauseous and you can vomit, and therefore it should really be used as an emergency form of birth control.
I think it's very important to educate women that it is available, because condoms can break or we can have one of those hot nights where we just forgot about birth control, and of course it would be a good thing to be able to prevent pregnancy 75% of a time if a pregnancy is not wanted.
Moderator: How do you respond to those who say that women have a hard time obtaining a prescription for the drugs within the three-day window of opportunity, therefore making them useless?
Corio: You can go to an emergency room if you can't get your doctor on the phone. If you call your doctor it should be given as an emergency. I still don't feel it should be over the counter.
Member question: How do you feel about the practice of taking birth control pills continuously to manipulate menstruation and reduce the number of periods?
Corio: I have patients that have migraines on birth control pills and I have patients with endometriosis who have very painful periods, and I've put them on continuous birth control pills for three months to take a break every three months. I don't see it as a problem. I don't think there are any medical facts about the belief that women have to have a period every single month on birth control pills, but I would do it more for medical reasons than for convenience.
Moderator: Thanks to Laura Corio, MD, for being with us today. For more information on birth control, please check out the resources on WebMD.
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