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From Pimples To Desire, What Might Happen When You Ditch The Pill

(Becca Schmidt/Flickr via Compfight)

(Becca Schmidt/Flickr via Compfight)

By Veronica Thomas
Guest Contributor

So you’re thinking about going off the pill. Maybe you’ve been feeling depressed, getting headaches, or keep forgetting to pop the tiny tablet. Perhaps you’ve been experiencing some really strange stuff that didn’t happen before you started the pill—like inflamed, bleeding gums or cringing at another person’s touch.

Both personal anecdotes and research studies have linked these and other side effects, such as breast tenderness and nausea, to the pill. (One study suggested it might even make you pick the “wrong” partner by altering your chemical attraction to a man’s scent.)

Most randomized control trials haven’t actually found any real difference in the frequency of side effects among women taking the pill versus those taking a placebo.

“It’s an interesting phenomenon,” says Dr. Alisa Goldberg, director of clinical research and training at the Planned Parenthood League of Massachusetts. “Clearly some women are sensitive to the pill and experience these things, but when you try to study it scientifically on a population basis, there’s really no difference.”

Still, while four out of five American women have used the pill at some point, 30 percent have discontinued its use due to dissatisfaction—most commonly because of its side effects. The latest federal statistics on contraception use are due this fall, and experts expect trends from recent years to continue: IUD use will continue to rise, while pill use seems to have plateaued.

I tried five different formulations of the pill, but never managed to escape all the annoying symptoms.

The issues a woman experiences—or whether she has any at all—vary greatly based on the specific dosage of hormones and the unique individual swallowing them every day. Personally, along with bloating and mood swings, I got migraines with an aura, or what felt like a laser light show in my left eyeball. Twice I had to retreat to my office’s “Pump and Pray Room”—reserved for new mothers and religious employees—to lie down and recover. (What I did not know at the time was that, because of this symptom, I should not have been on an estrogen-containing pill in the first place. Women with aura migraines, along with other conditions that put them at risk for strokes, blood clots, heart disease or some cancers, should not take combination pills.)

Finally, I gave up on the pill—only to be blindsided by a whole new challenge: the unexpected side effects of going off the pill. To help others avoid similar unpleasant surprises, I spoke with three experts about what to expect when you ditch the pill for another birth control method.

Of course, just as each woman has a unique reaction to the pill, she’ll also have a unique reaction to going off. According to the feminist women’s health organization Our Bodies, Ourselves, there is “enormous variability in any individual’s response to her own hormones or any synthetic hormones she takes.” One woman’s skin may break out in pimples, while another’s clears up completely.

With this disclaimer in mind, here are eight possibly unexpected changes you might experience when you cancel your monthly refill of that crinkly foil packet:

1. Most of the side effects should disappear in a few days.

First off, while many women decide to have their period before pitching the pack, it’s safe to stop taking the pill at any point. However, you should stop immediately if experiencing any serious side effects, like headaches or high blood pressure, says Dr. Jennifer Moore Kickham, the medical director of a Massachusetts General Hospital outpatient gynecology clinic. Continue reading

Morning-After Pill Disappoints, On To Plan C: More Effective Methods

Morning After Pill

They were splashy headlines this week: The emergency contraceptive pill “Plan B” does not work well in heavier women, and appears not to work at all in women over 176 pounds.

The FDA is considering whether the pills’ labels should be changed to warn heavier women not to count on their contraceptive powers, NPR reported; the French maker of a similar pill is already planning such a warning.

But the controversial morning-after pill has a bigger problem than that. Family planning advocates have fought hard to make Plan B easier to get in order to bring down the high American rates of unintended pregnancy. But so far, on that score, it’s looking like a dud.

Plan B hasn’t made a dent in the stunning statistic that a full one-half of U.S. pregnancies are unintended. This despite its FDA approval way back in 1999 and the growing access to emergency contraception over the last couple of decades — and despite major recent victories for family planning advocates: Plan B is now available over the counter to all ages.

“While there’s a lot of data to show it can prevent pregnancy in individual women, we’ve all been disappointed that on the population level, it just hasn’t had the effect we hoped,” said Dr. Deborah Nucatola, senior director of medical services at the Planned Parenthood Federation of America. “The unintended pregnancy rate hasn’t changed at all.”

Why might that be? There are two main theories, Dr. Nucatola said: Maybe the women who most need Plan B aren’t using it when they are actually at highest risk for pregnancy. Or maybe they’re just not using methods that are effective enough, and women should shift to more effective types of emergency contraceptives.

Enter what we might call Plan C. Around the country, Planned Parenthood affiliates are launching a new campaign called EC4U to educate women and clinical staffs about two more effective methods of morning-after help: Paragard, the copper IUD, and “ella,” a relatively new pill that uses the hormone ulipristal acetate, rather than the levonorgestrel in Plan B and a similar pill, Next Choice.

Accumulating data suggest that Plan B has two main weak points. One is weight; it was highlighted in this week’s reports, but contraceptive specialists had known for many months that the pill’s effectiveness drops in overweight women and approaches nil in women with a Body Mass Index above 35. Continue reading

Should Parents Stock ‘Plan B’ At Home In Case Teens Need It?

Plan B emergency contraception (AP photo)

Plan B emergency contraception (AP photo)

I’ve been thinking lately about the sexual stupidity of my youth. The foolish chances I took. The silly expectations born of “uncontrollable passion” scenes in bodice-buster books. The deep need for approval as demonstrated by desire.

The trigger for these regretful ruminations was last Friday’s landmark ruling on “Plan B,” also known as “the morning-after pill.” A federal judge ruled that it should be available over the counter to all ages. He not only overruled an Obama administration decision to require prescriptions for girls under 17, he derided that age limit as “scientifically unjustified.”

That ringing endorsement prompted this disconcerting train of thought: “Wow, Plan B sounds amazingly safe. Wish they’d had it when I was young and stupid. Hey, wait. Does this mean that when my kids are old enough to enter the danger zone, I should stock some Plan B for them? If it’s stocked on store shelves, does that mean we should stock it on our closet shelves?”

It felt outlandish and loving at the same time. I could already imagine the speech: “Please, please, please don’t have unprotected sex. But if somehow you do, you don’t even have to face me or talk to me. The Plan B is on the top shelf in the bathroom. Use it as soon as possible. And I hope when you’re ready, we can talk.”

If it’s stocked on store shelves, does that mean we should stock it on our closet shelves?

Could that kind of tactic even make any sense? And mightn’t it encourage irresponsible behavior? And is Plan B really that safe, or does it carry even minor risks?

I called over to the contraception and sexual education experts at the Planned Parenthood League of Massachusetts, who had — unsurprisingly — heartily praised last week’s ruling.

First, their medical reassurance, from Dr. Danielle Roncari, the league’s medical director:

“Emergency contraception, we know, is safe and highly effective. We also know from multiple research studies that it’s safe for women of all ages to use, and that increased access to emergency contraception doesn’t lead to increased sexual activity, it just leads to increased use of contraception.

We also know that it’s a very safe medication. There’s really virtually nobody that this medication isn’t safe for, and we also know that teenagers are able to use it just as easily as adult women. Research backs this up.”

Two additional safety points she mentioned: Plan B will not impact an existing pregnancy, so no pregnancy test is needed; and repeated usage is not unsafe either, though it is a concern because emergency contraception is not as effective as regular contraception – Plan B is up to 89% effective at preventing pregnancy, compared to daily birth control pills, which are up to 99% effective.

So, then, I asked, is this a good idea, to keep Plan B in the house? Continue reading

Pregnancy Prevention Progress: Easier Pills, Plan B At Teen Check-Ups

Birth control pills


This looks like quite a convergence. In a country where roughly half of conceptions are still accidental, we’ve just seen two significant steps toward helping women avoid unwanted pregnancy, both coming from groups of doctors who can rule on safety as well as urgent need.

On WBUR’s Cognoscenti, writer Judy Foreman posts here today:

Earlier this month, the American College of Obstetricians and Gynecologists, the country’s leading professional group for ob/gyn physicians, recommended that oral contraceptives — on the market for more than half a century now — finally be available over-the-counter.
It’s about time.

And also last week, the American Academy of Pediatrics recommended that doctors routinely counsel teenagers about emergency contraception — better known as Plan B or the morning-after pill — and prescribe it in advance, even if the teen is not sexually active. Currently, girls under 17 need prescriptions for the pills.

WBUR’s Here & Now discusses the issue here, and the segment elicited this cogent comment:

Well how about the boys? Isn’t it time we gave them a script for the morning-after-pill to give to their partners?

Readers? Interesting scenario, isn’t it? How might that dialogue in the steamed-up car go?

Just How Nuts The Akin Rape Remark Was

Rep. Todd Akin of Missouri last week at a state fair (Orlin Wagner/AP)

You could hear the groans from coast to coast. “Welcome to the Middle Ages — or earlier,” said one email in my inbox. You’ve surely heard it all by now: Rep. Todd Akin’s unspeakably (except it wasn’t unspeakable for him) offensive remark about how woman who are the victims of “legitimate rape” can purportedly “shut down” somehow to prevent pregnancy.

Akin has been appropriately bashed and battered all over the media. The Planned Parenthood League of Massachusetts just sent over a statement from its president, Dianne Luby: “Congressman Todd Akin’s misinformed statements on women’s health are astonishing and downright offensive. For an elected U.S. Representative and Senate candidate to be so ill-informed about 51% of the country’s population is alarming and perfectly illustrates why politicians should not be allowed to decide what kind of health care a woman can and can’t have.” There are now calls for him to be removed from the House Science, Space and Technology Committee. (Yes, he was really on a science committee.)

‘There’s no biologic plausibility to that theory.’

But I wanted to hear it from a primary source: Is Akin’s bizarre statement as utterly lacking in factual foundation as it certainly seems to be? I spoke with Dr. Erin Tracy, an obstetrician and gynecologist at Massachusetts General Hospital and an assistant professor at Harvard Medical School. Our conversation, lightly edited, follows, but the short answer to my question is: Yes. Utterly lacking.

Dr. Tracy: I saw that The New York Times quotes a physician who tried to lend some credibility to the theory that there is impaired fertility in the case of extreme stress which is rape, but that is absolutely not the case. There’s no biologic plausibility to that theory and there’s no evidence that there are decreased fertility rates in that setting.

Yes, I saw that your Mass. General colleague, Dr. Michael Greene, said in The Times, “It is just nuts.”

I actually posted that on Facebook. The reality is that if someone has ovulated and the egg is sitting there and the sperm can get to it, then pregnancy is possible. So whether that sperm has arrived via a criminal assault such as a rape or from consensual sex, that woman has a possibility of getting pregnant. There’s no difference.

My one question is: We do hear a lot about how when women are trying to get pregnant, they’re told that they should try to relax and that will help their chances. Wouldn’t the corollary be that high stress hurts fertility? Continue reading

Study: IUD Cuts Risk Of Cervical Cancer In Half

The IUD may offer protection against cervical cancer

IUD’s have gotten a bad rap over the years, due to their checkered history (see: Dalkon Shield) and the fact that many women don’t want a medical device implanted their bodies if they can avoid it. But as my CommonHealth colleague Carey Goldberg has written, a newer, safer version of the IUD is currently enjoying a mini-renaissance.

Now there’s another excellent reason to consider (or reconsider) the IUD for birth control: In a study involving more than 20,000 women from different countries, researchers report that the IUD may offer protection against cervical cancer. Interestingly, they suggest that the annoying process of inserting and removing the device might be the very thing that destroys precancerous lesions or triggers a protective immune response. The study was published in The Lancet Oncology.

Here’s more from the press release:

The results show that women who uses IUD halved the risk of developing cervical cancer compared to those that had not ever used [the device]. These results are contrary to popular belief that IUD could be a risk factor of cervical cancer. Previous studies on possible effects of IUDs use on the development of this cancer have yielded inconsistent results…

IUD use did not affect the risk of HPV infection, but was associated with a significantly lower risk of cervical cancer for both major cervical cancer types —reducing the likelihood of developing squamous-cell carcinoma by 44% and adenocarcinoma or adenosquamous carcinoma by 54%. Continue reading

10 Reasons To Get An IUD, And 5 Downsides

Our recent post on why IUDs are on the rise has been going gangbusters, so for those interested in more bite-sized chunks of information, here’s a distillation:

After being out of style for decades, IUD use has been rising rapidly among American women in recent years, spurred by strong endorsements from birth-control experts. IUDs are by no means for every woman, but top women’s health authorities are saying they’re a good option for most women — unlike the old days when, because of the risk of infection, they were recommended only for women who’d already had children.
This post is not numerically balanced because birth control experts are not balanced: They argue that the IUD is under-used. But let’s start with some downsides:

1. IUDs don’t protect against sexually transmitted infections. A reader who’s happy with her own IUD points out: “An IUD is an effective form of birth control NOT a way to practice safe sex.”

2. Though current IUDs have caused nothing like the 1970s fiasco of the dangerous Dalkon Shield, complications still do arise. As Judy Norsigian of Our Bodies, Ourselves noted: ““Like every method, it has its downsides. There’s a remote risk of embedding and perforation, but it’s small. And some women have a lot of pain, others don’t. Some women expel the IUD, others don’t.”

Two IUDs are in use these days: The copper Paragard and the hormone-emitting Mirena. Each has some minuses:

3. The copper Paragard can lead to heavier periods.

4. The Mirena makes periods diminish or disappear, which some women don’t like.

5. Also, though their levels are very low, the hormones that the Mirena emits can affect some women. A friend of mine just had her Mirena pulled because of nasty, depressive symptoms. It’s a well-trodden path for women to replace the hormonal Mirena with the copper Paragard.

This is not an exhaustive list. But as our IUD-using reader said, “One great thing about needing a procedure to get this type of birth control is that it will allow you to have conversations with your ob-gyn and have an honest discussion about what kind of birth control suits your lifestyle.” That conversation should also include a run-down of the risks. A helpful IUD fact sheet is here.

Now for the upsides:

1. “Just one act“: It takes a doctor’s visit to have an IUD implanted, but then your birth control is likely set for years.

2. Effective: Once that “one act” is done, the device is close to 100% effective.

3. Cost: The IUD is also considered one of the most cost-effective forms of birth control; though it costs several hundreds dollars up front, that cost is spread out over years, and… Continue reading

Why The IUD Is On The Rise (And You Might Want One)

http://www.youtube.com/watch?v=-2oMElDcpdM

(Above: A 7-minute IUD show-and-tell by a leading expert, Dr. Eve Espey)

Full disclosure: I had an intra-uterine device implanted soon after my second child was born, and in my own experience, using an IUD for birth control is something like what Churchill said about democracy: It’s the worst system around — except for all the other ones.

My first few months with a Mirena — an IUD that emits tiny levels of the hormone levonorgestrel — were rife with unpredictable spotting. That certainly got very old very fast. But then the spotting ended, and my periods blessedly all but disappeared, a common Mirena effect. It’s been nearly seven years now, and I’ve been both problem- and pregnancy-free. I even re-upped for a second device when the first one hit its five-year limit.

So that’s my bias when I report that in recent weeks, I’ve noted a striking convergence of signs pointing to a new era of far greater popularity for IUDs. There’s even talk of an IUD “renaissance” — once all but unthinkable after the debacle of a 1970s device called the Dalkon Shield.

The "Mirena" hormone-releasing IUD

In the not-too-distant future, getting an IUD, which costs several hundred dollars, will be universally covered and co-pay-free under new federal insurance rules. The latest numbers suggest IUD use among American women has risen dramatically in the last decade. And the IUD’s safety record is looking so good that recent research finds that the devices can even be implanted right after an abortion or a birth.

“The message is finally getting out there that IUDs are a great option — that they’re highly effective, that they’re long-acting, and they provide reversible, highly effective contraception with just one act,” said Dr. Alisa Goldberg, director of clinical research and training at the Planned Parenthood League of Massachusetts. (That “one act” is having the IUD implanted, a quick office procedure.)

Among the first 2500 women who enrolled in the study, 56% — that’s right, more than half — chose to get IUDs.

“And the message is finally getting out there that the old days — the days of the Dalkon Shield — are long behind us,” Alisa, who’s also director of the division of family planning at Brigham and Women’s Hospital, said. “There are increasing amounts of data showing the safety, the efficacy and the increasing popularity of these methods.”

In a country where nearly half of pregnancies are accidental, “This could have a huge impact on public health,” she said.

No, she’s not in the pay of the IUD makers. She sounds just like many other evidence-based experts on contraception who have been pushing for greater IUD use for years. In fact, it was because I’d read some of their research that I opted for an IUD seven years ago, despite a lingering sense of past disaster.

Now the factors in the IUD’s favor are visibly multiplying. Most recently, new federal rules announced earlier this week, requiring insurers to cover women’s contraception without co-pays, will remove the upfront costs that put many women off IUDs. Continue reading

Daily Rounds: Partners Cutting Costs; The Liberal Gene; Vanishing Money And Alzheimer’s; Free Birth Control Under Health Reform

Partners planning reduction of costs – The Boston Globe The state’s largest health care system says it will redesign care for thousands of patients and reduce administrative costs as part of a major new initiative intended in part to make treatment at its teaching hospitals more affordable. (Boston Globe)

Can a 'liberal gene' determine political stance? Researchers say it's so – Los Angeles Times (articles.latimes.com) “[Researchers] reported that ‘it is the crucial interaction of two factors – the genetic predisposition and the environmental condition of having many friends in adolescence – that is associated with being more liberal.’

Alzheimer’s Warning Sign – Money Problems – Vanishing Mind – NYTimes.com New research shows that one of the first signs of impending dementia is an inability to understand money and credit, contracts and agreements. (The New York Times)

Health Overhaul May Bring Free Birth Control : NPR Fifty years after the pill, another birth control revolution may be on the horizon: free contraception for women in the U.S., thanks to the new health care law…A panel of experts advising the government meets in November to begin considering what kind of preventive care for women should be covered at no cost to the patient, as required under President Barack Obama's overhaul. (npr.org)

Birth Control Pills Not Simple

birth-control

ceridwen

Birth control pills

WBUR’s Dick Knox shares a cautionary tale today about the dangers of the blockbuster birth control pill Yaz. Ads gave many women the impression that with Yaz, ills ranging from fatigue to moodiness would float away like so many colored balloons.

These days, about 2,700 women are suing Bayer for health problems they blame on Yaz, and research has found it poses higher dangers of blood clots than other pills.
Continue reading