Episode Transcript
Dr. Amy Kelley:
We call it birth control because that’s what it originally was marketed for but because like more than half of people use these things for other reasons, it really is more accurate to say hormonal management.
Courtney Collen (host):
Hello and welcome to “Her Kind of Healthy,” a health podcast series brought to you by Sanford Health. I’m your host, Courtney Collen with Sanford Health News. We want to start new conversations about age-old topics, from fertility to managing stress, healthy living and so much more.
“Her Kind of Healthy” is designed to bring you the honest conversations about self-care, happiness, and your overall wellbeing with our Sanford Health experts. We’re so glad you’re here.
In this episode, we are talking about why birth control can be beneficial for teens. Dr. Amy Kelley is a board-certified OB/GYN at Sanford Health in Sioux Falls, South Dakota, and a specialist in pediatric and adolescent gynecology. Dr. Kelley, welcome. Thanks for being here.
Dr. Amy Kelley (guest):
Yeah, of course.
Courtney Collen:
Always glad to have you. If you’re a parent or if you’re caring for a teen and just aren’t sure where to start, we’re here to help you take a step back and look at the bigger picture so we can approach this topic with confidence. Birth control isn’t just about preventing pregnancy and Dr. Kelley, I’m glad you’re here to correct me if I’m wrong, but it can be used as a powerful tool to support overall health and quality of life for teens. Am I right?
Dr. Amy Kelley:
Yeah, absolutely.
Courtney Collen:
The name birth control can be somewhat misleading. So let’s start with this. What are the most common medical reasons teens would be prescribed birth control?
Dr. Amy Kelley:
Yeah. So common medical reasons would be painful periods, especially if they are interfering in a teenager’s life. They’re missing school or they’re missing their sports activities or just not feeling their best.
Also, sometimes for adolescents who maybe have really heavy periods that are hard to manage, if you have to change your tampon between every class period, there is like two to five minutes between class periods and that’s just like impossible for some people to do. Sometimes it’s just way too heavy or you’re bleeding through your clothes because you can’t change it often enough. Those are things that birth control methods can help a ton with.
Courtney Collen:
Dumb it down for me for a moment. Why would birth control help with a painful period? What is it doing in your body to help with a period?
Dr. Amy Kelley:
Yeah, so there’s really kind of two big groups of birth control. One is things that you have to take a lot, really common, like you have to take often. So pills you take every day. A patch, you change once a week. The Nuvaring, which looks like a hair tie and goes in the vagina and you change it once a month.
Those all work to give you just a little bit of estrogen and a little bit of progesterone every day. And so they actually kind of keep your hormones the same throughout the month and they make the lining of the uterus thinner so that your periods can be lighter, less heavy, less painful.
And sometimes they help with mood issues too because you’re not getting a big surge of hormones right before your period. It kind of just turns the volume down on all of that.
The other big kind of birth control is things that just have progesterone in them, like the shot, the implant, and IUDs and those things don’t have estrogen in them, but they also, progesterone kind of just turns the volume down on your period and makes the lining thinner and can really help make periods less painful and less heavy.
Photo by Sanford Health
Courtney Collen:
How often would you say you prescribe birth control for reasons that have nothing to do with preventing pregnancy?
Dr. Amy Kelley:
Oh, easily more than half the time, especially for teenagers. And honestly, a lot of times it’s for both things. I mean, and that’s particularly true for adult women is they need contraception, but also they need this to help with their period.
The other big group of reasons why we help people with their period is actually sometimes to stop their period. Especially for teenagers with extra challenges or disabilities. That’s a decent segment of what we see as well. If you have autism or have sensory issues or maybe you have cerebral palsy and it’s really hard for you to actually deal with the reality of changing a pad or you know, you’re in a wheelchair. You already have these challenges and then like you throw puberty in, a period in there, and it’s like a bomb going off. It’s too much.
Some kiddos in that situation do great with their period. They’re fine. Other kiddos not so much and other teenagers not so much. So, that’s another really big segment of what I see probably because I’m a specialist.
Courtney Collen:
That makes sense.
Dr. Amy Kelley:
Kids with complex issues that need period management.
Courtney Collen:
So we talked about how birth control can help regulate or reduce painful periods. In what ways can birth control support teens who maybe struggle with acne or hormonal symptoms?
Dr. Amy Kelley:
Yeah, so there are some side effects, and they really are kind of side effects from certain kinds of birth control that can be helpful. Already mentioned the one about helping with PMS (premenstrual syndrome), they can definitely help with some of those moods. Sometimes PMS isn’t just moods; it’s also like stomach aches or headaches. And they can definitely help with those things.
Also, acne. Helping with acne can be a side effect of some kinds of birth control and honestly, especially if acne’s way worse around the time of a period, it can really help a lot with it. So sometimes those side effects are actually one of the reasons why we choose one type versus the other. Sometimes it’s the whole reason somebody’s on it.
Courtney Collen:
Well I’m so glad there are so many options. At least you can decide what route you want to take based on the condition that you’re living with or the issue you’re having. How does birth control help manage conditions like PCOS (polycystic ovary syndrome) or endometriosis in younger patients?
Dr. Amy Kelley:
We don’t typically diagnose PCOS until people have had their period for like four years. So some teenagers can be diagnosed but some are too early in kind of their period life.
Courtney Collen:
Why would you wait to diagnose that?
Dr. Amy Kelley:
Because actually normal puberty looks a lot like PCOS and so there’s so much overlap there. And it often takes several years to really know what somebody’s period pattern is because it’s normal for it to be a little more variable for the first couple years. And a lot of things in puberty, like acne in particular, which some people know can be symptom of PCOS, is totally normal in puberty.
Courtney Collen:
How do you help teens choose the method that fits their lifestyle or their comfort level? Let’s talk through some of those options and maybe which might be best for this specific age group.
Dr. Amy Kelley:
Yeah. So I think honestly it really depends on your teenager and what their goals are. I don’t think there’s a specific birth control that’s perfect for everyone out there. I think it’s a very individual decision. I kind of have people think about usually like two or three things. One is, can you remember medicine every day or every week or are you going to forget it all the time? And that’s a little bit of a personality thing. You can work on remembering things, like it can be a skill that you learn, but some people just inherently have that skill already without having to work.
Courtney Collen:
Yes. It does not go away.
Dr. Amy Kelley:
Yeah. And some people are just really not good at that.
The other one would be what you want your period to be like. So things that have a little bit of estrogen and a little bit of progesterone in them, you do have to remember a lot, but they keep your periods really regular. So like pills, the patch and the ring. And if you really want a regular period – that’s important to you – you want to be able to move it around for like prom or something, then those can be good methods as long as you remember them.
Other methods like the shot and IUDs can actually make the lining of the uterus thin enough that you really don’t even have periods. Or if you do, they’re super, super light, but some people don’t like that and other people that is their whole goal is they’re like, yes, please get rid of my awful period. So I think those are two kind of ways to, two things to think about. Like, can I remember to take something or not? What do I want my period to be like?
And I think the last thing is do I need contraception? You know, we don’t use it just for that reason, but especially in teenagers who are maybe going off to college in a year, that might be something that they are pondering maybe they’re going to need. And so I think that that’s the other thing I encourage people to think about because there are some that are better for preventing pregnancy than others.
The best things for preventing pregnancy are the things that you can’t screw up. So what I mean by that is you’re not going to forget them. So IUDs that go in the uterus and implants that go in the arm have the lowest failure rates. They’re right along with getting your tubes removed.
So the one in your arm has a failure rate of about a half-a-person in a thousand and IUDs have failure rates of about one in a thousand. Whereas if you look at all comers for the pill to patch and the ring, it’s like 50 to 70 in a thousand. And that includes people who forget it too. So it can be better if you’re really good at remembering it, but it’s not anywhere near as effective as those other things.
Courtney Collen:
Do you find that this age group nowadays is going towards a certain method of birth control versus others? Are people going to less daily oral pill form and more, you know, something else in the arm, whatever it may be? Or is it really situational?
Dr. Amy Kelley:
I think it’s a big mix and it’s really situational. A lot of younger teens may not need contraception, but they really want good acne control and they’re going to lean more towards the ones that help more with that which is like the pill, the patch, and the ring.
And some people are like, I can’t remember to take my vitamin, there’s no way I am going to remember to take a pill. And so they lean towards doing something like an IUD. IUDs and implants are a lot more popular now than they were when I first started, you know, 15, 20 years ago. We do them a lot more, especially with teenagers. The youngest person that I’ve ever had do one for bleeding disorder was like 11. They’re very safe in teenagers and we have many different ways to help with discomfort and pain with insertion.
So I think a lot of teenagers are more likely to have heard about them and maybe be willing to talk about them, but they’re not always what they want. They’re not always like to have the side effects or have the features that are what they’re looking for.
Courtney Collen:
How would you talk with teens or maybe encourage parents to talk with teens about using birth control responsibly and consistently for those who may go with the oral or some of those that you take more regularly?
Dr. Amy Kelley:
It’s a habit. You can develop the habit. But if you aren’t consistent about taking especially pills, then it’s going to make your period really wonky. Like you’re going to have breakthrough bleeding all over the place and stuff when you miss them. And so, it’s not going to help with what you want it to help with.
So it is important to take it regularly. And some tricks that I have for people is there is a website where you can sign up and it will send you text reminders. And I think that works really well for the ring, which is monthly, or the patch, which is weekly. But I don’t think it works great for daily pills because eventually you just, we just start ignoring those reminders on our phone. Right.
Courtney Collen:
Yep. Naturally.
Dr. Amy Kelley:
So, I usually for daily things I think it’s really good to pair it up with something else that your teenager is really good at. Is your teenager really good at brushing their teeth every night? Does your teenager have a skincare routine that they’re like religious about? Well then, you’re going to put that right in with that because they’re not going to forget it if you pair it up with something that they’re really good at remembering.
Courtney Collen:
Sure. That makes sense. What noncontraceptive benefits do you think are often most overlooked?
Dr. Amy Kelley:
Probably relief from pain, decreasing the heaviness of periods. Those are probably two big ones, but birth control can be very helpful for things like mood swings around your period, acne, and honestly sometimes just with life in general.
If your periods, even if they’re technically normal, where your period is every like three to five weeks, if it varies within those three to five weeks and sometimes it’s 25 days apart and sometimes it’s 35 days apart and sometimes it’s 30 days apart. As a teenager, that can be super annoying and it can be really difficult to manage, especially in younger teens if it’s kind of all over the place. And so sometimes just the regularity of it and the predictability of it can be helpful for people’s lives.
I also think that people who have medical issues or teenagers who have medical issues like seizure disorders, diabetes, or if they’re anemic, it can sometimes help with those things. Some birth control methods actually can lower or can increase the seizure threshold. So sometimes it can actually help decrease seizures, especially if you notice more seizures around periods.
And sometimes diabetics have more issues with their period. There’s like a lot of medical things that sometimes have it being on something for birth control, hormonally managing your period sometimes can help with some of those medical things.
Courtney Collen:
That’s good to know. How do you involve parents, or guardians, while still respecting a teen’s privacy and autonomy? I bet this is a really tricky, delicate line that you’re on constantly as a pediatric and adolescent gynecologist.
Dr. Amy Kelley:
Yeah. And honestly, it can be really easy sometimes because sometimes parents are very aware of giving their teenagers some more autonomy and they’re like, yes, I’m going to leave the room now. So some parents are very aware of trying to build up their teen’s ability to deal with medical issues on their own.
And it’s not about keeping things from you about your child. That is not the point of teenagers having confidentiality. I cannot order any tests. I cannot give your child any medicines without your permission because you’re their parent. So I think that it’s important to know that.
But I do think it’s also important for your teenager to maybe have someone they can ask questions that maybe they’re just not quite ready to ask you. And usually it’s just because they’re embarrassed. It’s not because they’re trying to keep something from you or they don’t know how to ask you about something.
So it’s a very fine line to walk and I usually just am very clear about the boundaries at people’s first visits when I first meet them. I’m like, “This is the confidentiality that your daughter has with me. These are the exceptions.” And I tell the daughter and the mom when they’re both in the room. So they both hear me say that. We also do have an obligation where mandatory reporters, so if a teenager tells me that someone is hurting them or they’re going to hurt themselves, that is when I can break their confidentiality for that to get them help and help protect their safety. And so I always make sure and mention that.
But if we’re just chatting and she’s telling me some things that she doesn’t need medicine for, we don’t need to look into, just questions or things that she’s asking me, I’m not going to talk to her mom about that if she doesn’t want me to. I think that’s just part of learning how to be an adult and speak to medical providers. Like that’s a skill that everyone needs to learn.
And I think it’s also a way for her to advocate for herself but sometimes it’s tough. Sometimes teenagers and parents are on totally different wavelengths and then we have to kind of thread that needle about like, OK, so the teenager wants one thing, and the parent wants another. And sometimes it takes a couple visits or some time to do that honestly.
But I actually, one thing that I think both Dr. Miller and I are very clear about is that we will not do something against your teenager’s will. So if you are like, I want you to get an IUD, I am not going to put that in without your teenager saying that’s OK. And that doesn’t happen very often where people ask me to do that. But you know, we can’t do anything without your consent. But also I need your teenager to also consent to that because I’m not going to do something against their will except in very specific circumstances.
Courtney Collen:
Yeah, that’s fair. And this is why we’re grateful for you and for Dr. Miller, and for all specialists in this region, because it is such a learning process. Like parents are doing this in most cases, if it’s, if they’re listening to this, maybe they have, you know, their first girl or they’re caring for a teenager and this is their first journey kind of through puberty and we’re all learning together.
Dr. Amy Kelley:
I mean, me too. I’m a parent of teenagers. Now my two oldest are technically adults, you know, you’re looking surprised. But yeah, they are, they’re going off to college next year and it is like hard to navigate. And the one thing that I was most surprised about, I mean I knew it was coming, but I didn’t realize it was going to happen at 12:01 a.m. Is when your teenager does turn 18, suddenly you are, you do not have any MyChart access unless they sign something and give it back to you.
But like that’s also a really hard transition for some people, especially if you have a medical, a kiddo with some medical issues is when that summer before they go off to college or whenever they’re like right before 18. Sometimes you gotta do a little planning for that. Like how are they going to get their meds? Like are you going to be allowed to have their MyChart access so you can still help them? Are they going to take it over completely?
I think that that’s one thing I try to prepare parents and teenagers for too as they get closer to graduating is I’m like, now look, you’re going to not have access to this anymore. And that’s another reason why it’s super important for your teenager to be able to talk to their health care provider by themselves is that at some point they’re going to have to do that.
The goal with teenagers is you want them to be able to do things on their own. As much as we don’t want them to grow up, that’s the goal is like they need to be productive members of society and be able to take care of themselves eventually. And health care is part of that so that’s part of teaching your teenager to be an adult.
Courtney Collen:
But something that we probably wouldn’t expect unless we’re told, you know, we need to start. Like that’s a big like reality hitting you.
Dr. Amy Kelley:
Yes.
Courtney Collen:
I didn’t even think about having to do that and I’m sure a lot of our listeners didn’t either.
Dr. Amy Kelley:
No, even me, I was like, I thought I had a little bit of wiggle room. No, there’s no wiggle room and 12:01 a.m. It’s gone on their 18th birthday. One of my kids has chosen to let me have some access mostly because to pay bills to be honest. But that kiddo has a few more issues and my other 18-year-old is like, nope, I can do it. And has kind of taken over for himself.
So, you know, I think that it just depends on the kiddo, but yeah, that’s one. There’s a lot of stuff when you’re trying to launch your teenagers that it’s not an easy process for anybody really.
Courtney Collen:
This could be a whole separate conversation.
Dr. Amy Kelley:
Oh, it could. Just around the launch.
"I don't think there's a specific birth control that's perfect for everyone out there. I think it's a very individual decision." Dr. Amy Kelley
Courtney Collen:
Oh, Dr. Kelley. OK. What myths or misconceptions about teen birth control do you encounter most often? I do want to ask you first, do you find that birth control encourages sexual activity?
Dr. Amy Kelley:
Absolutely not. And there have been studies going back decades that show that being on a contraceptive does not increase sexual activity. Just like getting the HPV vaccine does not increase sexual activity either. There’s actually lots of data showing that.
In fact the more informed you are about your reproductive health, you’re more likely to delay sexual activity actually. So the more you know, actually the better choices you make.
I would say there’s so many misconceptions and social media has not helped in this regard. But I think one of the big ones coming up more recently is that being on contraception or hormones are bad for teenagers, like they’re bad for their health. There is no evidence that that is true. There’s lots of evidence that it’s very safe for teenagers and can really improve their quality of life.
I think the other things that I hear a lot are it’s going to make me gain weight or I’m going to be crazy when I’m on it like it’s going to affect moods. And I would say that those side effects can happen. Those side effects do happen, but they’re like in the 1% range. So that means 99% of people don’t have those side effects.
And the good thing is we have lots of different options. So if you do have those side effects with something, we can switch you to something else. It doesn’t mean that all of those options are going to cause those things for you. Every pill has a slightly different progesterone. Every method is slightly different and if one doesn’t work well for you, a lot of times another one will.
The only method of hormonal contraception or hormonal treatment that we know is associated with weight gain is the birth control shot in about a quarter of people. But all the other ones are right around the 1%. So those are like very common myths I get.
The one that moms always ask me about is “I don’t want this to affect her fertility long term.” Sure. Which absolutely understandable. And none of them do. So none of them increase the risk of infertility. There are a couple things that do increase the risk of infertility, but none (of the hormonal contraceptives) will increase the risk of infertility. They all are out of your system fairly quickly. The birth control shot can take six months to a year to wear off. So that’s one that like, it takes a long time to wear off, but it does. But I think a lot of moms and sometimes teenagers are really worried about that and there’s no evidence that it affects fertility long-term.
I think the things that do affect fertility are if you get gonorrhea, chlamydia, then it scars your tubes. And then some medical things can – endometriosis can affect fertility and actually hormonal management of endometriosis can help protect your fertility. So it’s easier to have babies later. So sometimes it actually is protective and not harmful.
Courtney Collen:
I like that we say “hormonal management” versus birth control.
Dr. Amy Kelley:
Yeah. I always try to say this is hormonal management, like lay people, we call it birth control because that’s what it originally was marketed for. But because like more than half of people use these things for other reasons, it really is more accurate to say hormonal management. Yeah.
Courtney Collen:
Makes perfect sense. Is there anything you would want parents to know or to feel reassured and ease any fears or anxieties around their teens starting this hormonal management or birth control?
Dr. Amy Kelley:
Yeah, I would just say feel free to ask questions. It’s OK if you’re worried about it. You’re just being a parent. Like we’re trying to make the best decisions we can with the information we have, so just make sure you have the information.
I think that especially some of these were not available or were not recommended for teenagers when maybe the parents were young. Like IUDs, it used to be like, no, you can’t have those until you’ve had a baby. But we have a lot, we have different IUDs now and we also have a lot more data that is very safe. So I think just asking lots of questions and being open to having a conversation is a good idea.
I also think that watching your social media consumption is not a bad idea and watching your teenagers’ social media consumption is also important because there are amazing, good things on social media. There are health care providers who have a social media footprint who are giving really, really good information out there. And there are websites that are not owned by companies that make money from birth control, that have really nonbiased stuff on there. We know that what those websites are, we can give them to you.
But I think when you’re looking like sometimes it’s really hard to know, is this person actually a doctor? Does this person actually have any criteria whatsoever to be giving me medical advice? Oftentimes the answer is no. And so I think you really have to take anything with a grain of salt, right? That’s in social media, particularly if they’re trying to sell you something or if they’re telling you just this one thing is going to fix everything. Anybody who is making money by selling you something and encouraging you to do that, and you just have to have a little bit of suspicion around that.
As a physician, we are paid because of our expertise and our time, but we don’t make any extra money because we did so many IUD placements or whatever. We don’t get money from the company that makes IUDs. We don’t get kickbacks from that or anything. We just make money based on the time we spend with people and our expertise. And so I think that’s just a little different.
And hopefully I’m not throwing anybody under the bus. They’re not like selling supplements, but I just don’t, as a physician, I just don’t think that’s actually ethical either. That’s my personal opinion, so.
Courtney Collen:
Well, I think it’s important that we clarify like what our position is here at Sanford Health and what our physicians are doing as board-certified specialists in this area and why it’s important to, if you have questions, like skip the Doctor Googles, skip the social medias, and just go straight to your trusted provider. Absolutely. When something comes up, especially if it’s, you know, for your teen, for your adolescent, for your child.
Dr. Amy Kelley:
Absolutely. I definitely recognize that people Google things. People want or maybe look at some of that stuff. But like I will give you actual websites that I feel have good information on them or that I know somebody who’s board-certified, this is their handle and I know they actually have the expertise they’re talking about. Because sometimes it’s real hard to tell.
And it’s real hard to tell who owns websites. And who’s getting paid for what on websites. And so I think that it’s also a skill to teach your teen, you know, you want, if they’re looking at those things, you want to be like, now you’re listening to this person – is this person a doctor? What credentials does this person have? That’s a skill that your teen is going to have to know too.
So I think it’s also just like a learning experience for all of us as we navigate kind of that new, not new, but like ever expanding social media presence.
Courtney Collen:
Absolutely. Yeah. Do you have any top of mind handles or websites that you want to quickly share?
Dr. Amy Kelley:
I watch a wide variety actually in different specialties just for my interest.
Courtney Collen:
Specifically on this topic of birth control for this age group.
Dr. Amy Kelley:
So the website I really like is bedsider.org because it is actually run by a nonprofit who does not make any money from hormonal management or from birth control. And so I feel like it’s really not biased. It’s very like the good, the bad, the ugly. Like it has everything in it and I think it’s really good. And it kind of is specifically tailored for teenagers actually, too.
Or like the American College of Obstetrics and Gynecology. I think those are also good places to go if you’re looking for medical information as well.
Courtney Collen:
Well thank you as always for the insight and for all that you do in this space of adolescent and pediatric gynecology and talking about birth control and all the things. We’ve had so many great conversations. This is just another one of those. Thank you for your time.
Dr. Amy Kelley:
Yeah, of course. Thanks.
Courtney Collen:
This was part of the “Her Kind of Healthy” podcast series by Sanford Health. For more, listen wherever you get your podcasts or online at news.sanfordhealth.org.
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Posted In Family Medicine, General, Gynecology, Parenting, Pregnancy, Sioux Falls, Women's
