Family Planning 101



Hey girlfriends! Today, we are going to discuss various birth control options. During my time as a Certified Nurse Midwife, I have encountered numerous women who fear, dislike, or are confused about birth control. When I inquire about where those feelings stem from, I always hear a story about a family member or friend’s horrible experience. Some of these women have never tried birth control for themselves and some have with significant side effects. The first thing to realize is that all of our bodies are different. How I may respond to a certain method is not how you will respond. So I always encourage women who have never tried to at least find out for themselves, if they are a good candidate. For those who have had a personal unfortunate experience, many of them had only tried pills and weren’t aware of other options. Family planning methods vary in terms of the type of hormones they include (if they even have hormones at all) and how the hormones are introduced to the body. So the second thing to consider is that your body will react differently to each method. My job is to educate, provide options, and encourage each woman to pick the method that best works for her. I’m often asked what I think someone should do. This is impossible for me to know. Only you know your lifestyle, schedule, and specific needs so if equipped with knowledge, you are more than capable of making your own decision. Class is in session!


Combination Birth Control Pills



This is the method that most of my patients have heard about and tried in the past. When I first started birth control over 10 years ago, I was placed on this and honestly not even given another option. These are called combination pills because they contain a combination of two hormones: estrogen and progestin. Both of these hormones naturally occur in your body, but the introduction of more from birth control stops you from ovulating. No ovulation = no egg to be fertilized. Progestin also thickens cervical mucus so that it’s more difficult for sperm to enter. It’s important to note that different brands insert different amounts of hormones into their pills, so your dose may need to be adjusted based on side effects.


How to Use


You take the pill everyday around the same time with the last row of the pill pack or last few pills being placebo pills. During the placebo period, your body experiences withdrawal from the extra progestin, which stimulates an artificial period. For those who desire even less periods a year, you can use brands that contain placebo pills every 3 months. Some brands even include iron in their pills.


Pros


These are great at regulating your period and are often used for this very purpose. Your periods will be predictable and often shorter and lighter with fewer cramps. If you have a vacation or special event coming up, you can also avoid your period by skipping the placebo pills. We can all agree its super helpful knowing when your period is coming!


Cons


You have to take it everyday! I personally cannot remember to take pills everyday, so I really struggled on the pill. I recommend setting an alarm or placing it next to your vitamins or other medicines. Taking the pill incorrectly can actually increase your chances of getting pregnant than if you were on nothing.


Side Effects


· Mood swings

· Spotting

· Headaches

· Breast tenderness

· Nausea

· Changes in sex drive


The most serious side effect is developing blood clots that can cause a heart attack, stroke, or pulmonary embolism. This is life threatening! Smoking, being over 35 years old, having poorly controlled high blood pressure, a clotting disorder, or a history of clots increases your risk. Consider another method if you have these conditions. If you are not at increased risk, this method is safe for you.


Progestin Only Birth Control Pills


As the name suggests, these pills only have progestin in them. These are safer for the conditions I listed above as it’s the estrogen in the other pills that can lead to the development of blood clots. These pills and other progestin-only methods are also safe for breastfeeding since estrogen can reduce milk supply. Since the progestin is there, this method still thickens cervical mucus and thins the lining of the uterus. However, ovulation is only suppressed sometimes, so it can still occur. You can take the combination pills a few hours later, but this one you must take at the same time. I tell my patients that they really have to be strict when taking these pills as they are not as effective as the combination pills. These are not utilized to regulate periods because ovulation can occur whenever (there are no placebo pills). Side effects are similar to the ones I listed above but occur less frequently.


The Patch



The patch is placed on your body and releases both estrogen and progestin through the skin into your bloodstream. It’s important to note that this method is less effective in women who weigh more than 198 lbs. So it wouldn’t be a good method for me personally. The patch also exposes you to about 60% more estrogen than a regular pill. Generally, it works the same as the pill except for how you administer the hormones.


How To Use


Place one patch on your upper outer arm, stomach, butt, or back once a week for three weeks. Each time you should place the patch on a different site. During the fourth week, do not place a patch and this is when you will receive your period.


Pros


The patch causes regular, predictable periods. You have to remember this method less than the pills; once a week instead of every day. I suggest labeling your calendar each week as “on, on, on, off.”


Cons


This method is visible and could detach from the skin. You could also experience a reaction at the site of placement.


Side Effects


· Similar to pill – see above

· Skin reaction


NuvaRing



This method is a clear ring filled with the hormones estrogen and progestin that is inserted in the vagina. Again, works similar to the pill in terms of how it affects the body, but is administered differently.


How To Use


Insert the ring inside your vagina all the way back for 3 weeks continuously. At the beginning of the 4th week, remove the ring and leave it out for 1 week; this is when your period will occur.


Pros


Only have to remember twice a month; when you put it in and take it out. Periods are predictable.


Cons


You have to be comfortable inserting and removing yourself. It can be felt during sex. If placed incorrectly, it can be uncomfortable.


Side Effects


· Similar to pill – see above

· Increased vaginal infections


Depo Shot

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