Episode Transcript
Courtney Collen:
There’s a lot of options. (Laugh)
Dr. Amy Kelley:
Yeah, totally. There’s tons of options. And I didn’t even talk about condoms. I didn’t even talk about barrier methods, which is kind of the other group.
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 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 honest conversations about self-care, happiness, your overall well-being with our Sanford Health experts.
On this episode, we are talking about birth control, or contraception, the use of medication devices or procedures to prevent pregnancy. And there are so many different types. For a lot of us, it can be very overwhelming. Let’s bring in Dr. Amy Kelley, who is an OB/GYN at Sanford Health, and a specialist in pediatric and adolescent gynecology. If you ask me, she is the perfect person to have this conversation with. Dr. Kelly, welcome. Thanks for your time today.
Dr. Amy Kelley (Guest):
Thank you.
Courtney Collen:
So let’s start with the basics. We have a lot to get to. What exactly does birth control do physiologically in the body to prevent a pregnancy?
Dr. Amy Kelley:
It depends a little bit on what method you’re talking about, on how it prevents pregnancy. Things that are fairly common and have been around for a while, like birth control pills or the birth control patch, they work by kind of taking the job of the ovary away. So they basically give you a little bit of estrogen and a little bit of progesterone every day. And that makes you not ovulate. So it kind of takes the ovaries’ job and says you don’t have to do anything right now. And he kind of keeps your hormones basically very similar from day to day.
Courtney Collen:
So how would a young woman or women of any age know what birth control is right for them and where do they even begin?
Dr. Amy Kelley:
Well, there’s actually a few really good online resources to kind of do a little bit of looking around on your own. The one I like the most is called bedsider.org, and it’s an app as well. And I like that one because it’s not from a company. It’s actually run by a nonprofit. So you know, they’re not trying to sell you anything; they’re just trying to give you information.
But otherwise I would say going to your physician is a great place to start as well. What you do for contraception I think varies a lot depending on what stage you are in your life and what you need. Some people you know, are using contraception more because their periods are bothering them, especially in the teen years. And they may want something different than what they want maybe when they go to college and their life is busy and they have to worry more about the contraception or the pregnancy prevention part, maybe then and they also, maybe their life’s a little crazy because they’re in college and they can’t remember their pill anymore.
So I think that what you do varies a lot based on your personality and also what stage of your life you’re in.
Courtney Collen:
Now let’s talk through some of the options. Yeah, like explain some of the various types of contraceptives that are available.
Dr. Amy Kelley:
Yeah, so I kind of put things into different categories. So I put things into high maintenance and low maintenance categories because that’s kind of how I roll. I like low maintenance things.
The things in the low maintenance category are also a little bit more effective to prevent pregnancy. So that’s kind of a good category for people who are most concerned about that. It’s also a great category for people who need low maintenance options where you don’t have to think about them very often.
So the two big ones in that category are the implant that goes in your arm. And I actually have one right here. You’re probably going to be kind of hard to see it since I have just such a little screen, but it’s very small. It’s really, really tiny and it goes under the skin in your arm. And that works for about four years. And it is the most effective thing for contraception. It has a failure rate of a half a person in a thousand. So it’s like right up there with getting your tubes tied or doing something permanent.
The other one that’s very similar in effectiveness is IUDs. There’s a couple of different kinds of IUDs, but IUDs stand for intrauterine device and it’s a T-shaped device that goes in the uterus. They’re also quite small, so this is an example of one right here. They’re not very big.
Courtney Collen:
Wow. That is small.
Dr. Amy Kelley:
Yeah, they’re pretty small. And intrauterine devices come in a couple different flavors. There’s one that doesn’t have any hormones at all and that has copper in it. That works by causing some inflammation in the uterus. But it also works because copper makes sperm unable to penetrate eggs. So it actually prevents the process of fertilization. The copper IUD is good for 12 years. It’s good for a very long time. That one doesn’t really change your periods. It can make them a little heavier and more painful sometimes because it causes inflammation, but otherwise you have regular periods with it.
The two hormonal IUDs that are used the most often there’s one called Kyleena and there’s the Mirena. The generic of the Mirena is called the Liletta. And those work for five years and eight years. And hormonal IUDs have just a little bit of progesterone in them, so they make the lining of the uterus really, really thin. And some people actually don’t have periods with them because they just don’t have a lining to shed very often because it’s so thin.
So Kyleena is smaller. They’re the five year one and they’re made specifically and FDA-approved for people who haven’t had children. The Mirena and Liletta are just a tiny, tiny bit bigger and it’s good for eight years. And it’s specifically FDA-approved for people who have had children.
Now we have lots of studies that show that people, whether or not you’ve had a child, can use either one of these. But the company just hasn’t gotten FDA approval for both of them, for both kinds of people. But those are all very low maintenance options and they work really well for contraception.
The downside to the hormonal ones is that they can make your period kind of wacky. And that’s a little bit different for every person. For IUDs, a lot of people don’t have periods at all and if they do, they’re pretty light, maybe a little sporadic. For the one in your arm about one in three women don’t have any periods and then everyone else has periods and they can be kind of crazy and long, but not usually heavy or painful. But they can also just be spotting every couple of months. So it varies a lot. And that’s, those are probably the main side effects that we talk about when we talk about using those for people. But those are, those are our low maintenance options where you don’t even have to think about them. We put them in, you’re done.
Our kind of medium range options that I think are pretty low maintenance, but you have to remember more often, is Depo-Provera, a shot and you, every three months you have a little wiggle room. It’s every 10 to 13 weeks. And most people it stops their period actually. Because it’s also a bunch of progesterone. So that lining gets really thin. Depo is kind of in that medium range because you only have to remember it every three months. For some people that’s great and they remember, it’s good. Other people it’s easier to remember things every day than every three months. Everybody’s a little different. So that’s kind of a medium range option.
The most high maintenance options are the birth control pill, which you take every day. The patch which you change once a week and something called the birth control ring. There’s a couple of different kinds of the ring. And you change that once a month. So those are a little bit higher maintenance because you have to remember them more and you have to go to the pharmacy and you have to get refills on them and if you move or if you’re in college, you have to figure out how you’re going to get those refills. So those are just a little bit more like time consuming and you have to think about them a little more. Those are the only ones that keep your period really regular, too. And a lot of times they have really nice side effects. Most of them help with acne. A lot of them help with, if we feel kind of moody around our period, a lot of them help with that.
So those are pretty popular ones and they’ve been around for a long time too. Those have a much higher failure rate though. The failure rate for those is about 70 in 1,000 versus like two for IUDs and a thousand or a half a person for the one in your arm.
Courtney Collen:
There’s a lot of options.
Dr. Amy Kelley:
Totally. There’s tons of options. And I didn’t even talk about condoms. I didn’t even talk about barrier methods, which is kind of the other group. Condoms are also definitely contraception because they prevent sperm from getting to eggs. But they’re kind of the most high maintenance option really. Because they don’t work in your drawer or in your purse or in your truck. They only work if you use them every single time. But they are also the only method that helps protect you from things like gonorrhea and chlamydia. And so they’re a super important option, particularly in our state that’s really having a surge of different STI infections right now.
Courtney Collen:
And a great way to get the partner involved too. I mean it, you know.
Dr. Amy Kelley:
Absolutely.
Courtney Collen:
They’ve got to do their part.
Dr. Amy Kelley:
Yeah, I mean it is unfortunate that there aren’t very many options for males, right? At least not reversible options for males. There’s always been talk of getting reversible options for males but they just never seem to let come to fruition.
Courtney Collen:
What are some factors, Dr. Kelly, that might determine what is right for each patient? I mean does age come into play? Health history, sexual activity, maybe having had previous children? Talk through some of that.
Dr. Amy Kelley:
Yeah, absolutely. I think there’s a lot of factors that go into it. Certainly what you want after children sometimes is different than what you want before you have children, but I tend to – and everybody’s a little bit different so of course there’s lots of different factors – but I tend to try to talk to people about two big ones to try to pick what they want to do. And those two big ones would be what do you want your period to be like or what can you handle as far as your period goes and how important contraception is to you. And I try to stick with those two things because there’s just so many other factors too.
But the reason why I think those two play a big role is because these kinds of options vary a lot on how effective they are, and getting pregnant is a huge thing. Changes your whole life. And so you know how worried you are about that is a very big determining factor on what option you choose. And most of these affect your period.
Now, they usually affect your period in good ways with our high maintenance options like the pill, the patch, the ring – most people’s periods get shorter, they’re less crampy less and sometimes they’re a lot lighter as well. But you still have them every month.
There are ways to kind of skip and manipulate your period with them, but you have very regular periods and for some people that’s super important and that’s what they’re looking for. With our low maintenance options, you’re getting much better contraception, but you may have periods that are irregular and not as predictable. You might also not have a period at all. And sometimes that’s people’s goal is to not have a period maybe because they don’t like it. Like a lot of our autistic teenagers have – it’s a sensory thing that they don’t like or sometimes it’s because they’re super busy with a sport and they don’t want to deal with that period. Sometimes it’s because they miss school because it’s so painful or so heavy every time. And so we’re trying to have them have less periods.
There’s really good reasons to consider not having a period for some people. But if that’s their goal then I’m going to recommend different things than if they want regular periods or if they can handle a little bit of irregular bleeding. Sometimes that drives some people crazy. So I think knowing a little bit about how you’re going to feel is a good way to kind of figure out what might be a good option for you.
Courtney Collen:
Are there any risks that a patient should consider before choosing a birth control or any specific risks behind any of those types of birth controls?
Dr. Amy Kelley:
Yeah, so the ones that are high maintenance pills, the patch, the NuvaRing, and actually there’s more than just Nuva so I should just say the ring. But those three have estrogen in them. Estrogen does have the potential risk of blood clots. Which is, you know, a serious risk. It’s not a very common one. But there are some people who have medical conditions or who have certain genetic issues that make them too high risk to use estrogen. So there are some women who are not good candidates for those three options because they shouldn’t use estrogen.
The other ones have other risks. You know, certainly any medication has some risks. People can have things like stomach upset, headaches, nausea, but most of the time any of those types of side effects, you always have to compare them to what the alternative is too. So if the alternative is the potential to get pregnant, pregnancy has a lot of complications and side effects too. And so most birth control, if you’re comparing it to pregnancy, is much safer than pregnancy.
But there are some people who have some mood changes because with hormonal options or Depo is associated with weight gain in some people. And so those kind of side effects vary from person to person. But we always discuss that with people so that they know if they have them what to do and you know, if we think that they’re likely to have them or not.
Courtney Collen:
If an individual is planning to get pregnant but they’ve been on birth control for a period of time, be it the more high maintenance options, the pill or something more low maintenance like the ring or IUD. Is there a period of time that they would need to be off the birth control before successfully conceiving? And is it different based on the type of birth control? Can we talk through that for a moment?
Dr. Amy Kelley:
Yeah, you actually don’t have to wait at all. It’s a little bit of an urban myth that you have to wait a couple months when you go off of the pill or go off of really any birth control. I’ve had plenty of people who we pulled their IUD and they never even got a period they got pregnant instead. So it can happen rather rapidly. Almost all of our methods of birth control are once you take them out or once you stop taking them, your fertility comes back very quickly.
The exception to that is Depo-Provera, the shot. That can take six months to a year to wear off. So that isn’t a great option for people who think they’re wanting to have children soon because it can take a while to wear off. Now I’ve also had people who have gotten pregnant on it because Depo has a failure rate, so that’s not a universal truth, but it can take a while to wear off. The Nexplanon also can take a few months to wear off. But I’ve had people also get immediately pregnant with that. So it does vary a little from person to person. But yeah, that’s an urban myth that you have to wait. You can definitely start trying right away.
Courtney Collen:
Well thanks for clearing the air on that. I appreciate it. Now speaking of myths or misconceptions, are there any that you hear of about different birth controls? Either the types or things you’re seeing on social media? Any fear that you hear of? Talk about that.
Dr. Amy Kelley:
All the time. When you think about birth control is something that 90% of women take or use in their lifetime. Women make up more than 50%, you know, 50-52% of the population. It’s no wonder there’s all these myths because when so many people are using something like contraception, it’s very easy to blame contraception for lots of common things, whether it causes that or not.
One of the biggest concerns I get from parents a lot of times is: will this affect fertility in the future? There’s this myth that like you take the pill for 10 to 15 years and then when you go off of it, you can’t get pregnant anymore, or Depo or whatever it is that you’re on. And that really is very much an urban myth.
The biggest issue with fertility nowadays is actually age. So if you’re on the pill for 15 or 20 years, you’re trying to get pregnant in your thirties, maybe even your late thirties and it’s much harder to get pregnant as you get older. So I think that’s a common misperception and it really is just, it’s based on some other things. It’s not a crazy thing to think by any means. But I hear that a lot.
The other thing I hear a lot is that contraception, especially hormonal contraception, makes you gain weight or it makes you crazy. And there’s a kernel of truth to that as well because some people do gain weight with hormonal birth control and some people do think it affects their mood. But lots of other things in life do that to us too. You go to college, a lot of people gain the freshman 15. College is super stressful. People have a lot of anxiety when they’re at college, especially that first year. And so sometimes those things aren’t just from birth control, but it can be really hard to tell.
Regardless if you think your birth control is causing some of that, it’s not something that we hear very often. I would put it in the under 5% category. So if you look at all kinds of birth control, a small number of people might have those side effects. But really if that’s the case, switching to a different method usually will fix that. So it doesn’t mean you can’t have any kind of birth control if you have one that you don’t like or doesn’t work well for you. The one birth control that consistently is associated with weight gain in studies is Depo. And the average weight gain with Depo is five pounds. And about 10 to 20% of people gain weight with Depo. So, you know, if you think about that being the only one that consistently shows that, that’s kind of worst-case scenario. So really all the other ones are probably much better for most people.
Courtney Collen:
Yeah. Good to know the risks or side effects I guess before you go in.
Dr. Amy Kelley:
Yeah, absolutely. And we talk to people about those. I think that we’re very open with what people might potentially experience. On TikTok lately there’s been a lot of stuff about IUDs and how horrible they are. And so there’s quite a bit of fear around getting IUDs for some people too. And the interesting thing about IUDs is how much the experience varies from person to person. I do think that they can be uncomfortable and crampy. I myself have three IUDs and this is my third one. And I really don’t like getting them because they are kind of yucky to get, but it’s also like less than a minute. And you know, there are things we can do to make it better. There’s medicine we can give you beforehand if you’re anxious, there’s medicine we can give you that kind of helps the cervix be a little bit more open to putting an IUD in. And we even sometimes put people to sleep for IUD placements if they’re really anxious or if they have a history of trauma or for kiddos who maybe can’t cooperate with an exam like children or teens who have developmental delays and things like that.
But there are definitely things we can do to make it make it better. I had a teenager just the other day, 16, who did way better than I did with my last IUD insertion. So it does vary a lot from person to person. But most people can get through it.
Courtney Collen:
Yeah, good to know. Now how young is too young to start on a birth control and what to consider there because – and then you know, how old is too old to continue birth control? Can you talk to that?
Dr. Amy Kelley:
So really once you have your period, you could be on something for birth control.
Courtney Collen:
So as early as 11, 12 …
Dr. Amy Kelley:
You know, even nine, 10 because some young ladies do get their period as early as nine or 10, especially African American teens and Hispanic teens sometimes get theirs a little early. But there are some special considerations in young people. There’s the potential for a little bit of loss of height in that first year after you get your period. You can still grow a little bit. We don’t have great studies to prove that if you take estrogen that it makes you not grow as much. But there’s that concern. So sometimes we start out with things that don’t have estrogen in young ladies who just started their period.
But, if you’re having problems with your period or if contraception is needed, then it’s really as soon as you get your period, we can be helping you with that if it’s an issue. As far as how old you can be, it’s unlikely, but you can get pregnant all the way up until menopause. So I think it’s important for our perimenopausal women to understand that, you know, once you hit 40, it doesn’t mean you can’t get pregnant anymore. And so it’s important to still use contraception if you need it and it depends on what method you’re using.
As you get older, things with estrogen do start having a little bit more risk. But if you are someone who can still take estrogen, you can take it until menopause. You can take birth control pills until menopause. If you have a reason why we think estrogen’s not a good idea, you develop hypertension or you know you’ve had a blood clot or something, then there are other methods. There are those methods that don’t have estrogen that you can use.
Courtney Collen:
Different factors. Let’s talk through some of those that might affect the success or effectiveness of any method of birth control.
Dr. Amy Kelley:
Yeah, so there are some medications that do affect birth control and how effective it is for contraception. So it’s really mostly our estrogen containing birth control methods. So the pill, the patch, the ring that are affected by other medications. So some of those medications can include seizure medications and antibiotics.
But there’s actually only a couple of antibiotics that really affect contraception. And they’re actually antibiotics for tuberculosis. So one of them is called Rifampin. So most of your antibiotics you’re going to get for like an ear infection or strep throat or sinusitis or a yeast infection is not going to impact your contraception method, even if it is a pill, a patch or a ring. But again, there are some medications and those would be the two big ones that are common would be a couple, a handful of antibiotics and anti-seizure medications.
Courtney Collen:
How long should a patient be on any specific birth control before they might be able to switch or something’s not working out? Or are there some that are riskier to be on for a long period of time?
Dr. Amy Kelley:
The vast majority of them, it’s fine to be on for a long period of time. There is kind of this myth about Depo that you can only be on it for two years because there is a slight risk of some bone loss with Depo-Provera, however, that bone loss is not associated with broken bones or hip fractures, risk factors, anything like that. And in fact with Depo for two years you lose a little bit of bone and then it stabilizes.
So if you’ve already been on it for two years, there’s actually no really good reason to quit unless you just don’t like it or don’t want to use it anymore. And the amount of bone you lose is about the same as you would if you had a baby and then breastfed for a year because you lose some bone and some calcium from those things as well. So we don’t really consider it to be a risk that would make us not want to do it in most people.
Courtney Collen:
What are some questions that maybe a young woman and her mom or her parents or a woman and her partner should ask their OB/GYN or their provider during the appointment when they’re discussing these different options? And/or any questions that you get that you would suggest listeners consider before beginning a method?
Dr. Amy Kelley:
Yeah, I think it’s really important to be honest with the person that you’re seeing with your provider. And you know, that can be hard in front of parents specifically sometimes, like if you really need contraception, but maybe your parents aren’t aware of the fact that you need contraception. I always think it’s better to have parents involved in these conversations, but you know, it is OK to talk to your provider alone if you feel like that is appropriate and you need to in fact, most providers I think do talk to teenagers alone for at least a little bit.
We do need parental permission in South Dakota to give adolescents any medication. And that does include contraception. There are some ways around that, but in general that is required. So it, it can be a little bit of a little bit of walking a tightrope sometimes in my shoes when you’re trying to like not out a teenager that might be sexually active, but also make sure they’re getting what they need. And I feel like that’s a conversation between the parent and teenager.
My goal as provider is to be a person that can give someone information and make sure they have the information they need to make good choices for themselves. But I think that being honest is important because you want to be honest about are you at risk for sexually transmitted infections so that we can talk to you about condom use if that’s an important piece of this. And do you need contraception or really are we just trying to get your period better? Like what is your main concern and reason for contraception? I think that those are things that are really important is just being honest.
You also want to make sure that we know and are aware of all the other medicines that you’re taking to make sure that we don’t have any interactions. And also to make sure that what we’re giving you is safe and that you don’t have these risk factors that would make us not want to give you estrogen. But I think that really, there are no dumb questions. I think that if you have concerns or you’ve heard rumors about birth control and you are worried about something specifically, just ask us. I mean, that’s what we’re here for.
Courtney Collen:
Yeah. And we’re so thankful to have you and other physicians and providers and a whole care team to be there when we’re considering these big decisions. Dr. Kelley, thank you so much for your insight on this topic and all that you do for patients at Sanford Health. I appreciate you.
Dr. Amy Kelley:
Thanks so much. It was great to be here.
Courtney Collen:
Thank you.
Learn more about this topic
- Endometriosis is common, yet commonly undiagnosed
- What is preventive care and how can it keep me healthy?
- Family planning at Sanford Health
Get more episodes in this series
…
Posted In Family Medicine, General, Health Information, Healthy Living, News, Sioux Falls, Women's
