Barb's Daily Dose

Contraceptive Convenience

Have you ever forgotten to take your birth control pill? What about trying to track down a condom and squinting in the dark to make sure it hasn’t expired? What about not having enough time to stop at the drug store to pick up a new pack of pills? And how many times, have you tried to remember the first day of your period so you can try to guestimate if you’re fertile?

Wouldn’t it be nice if we didn’t have to worry about birth control?

You know what? There are 2 options out there that can eliminate the day to day, month to month scrambling.

Mirena IUD – This is method that is great for women who’ve already had a baby. It’s good for 5 years and is over 99% effective. If a woman wants to get pregnant, once the Mirena is removed, she can start trying right away. There’s no delay.

No Periods?

Yes, that's right, women who are on birth control do not need to have a period every month. 

How is this possible, you wonder? Well, as long as there is balance in hormones, then there is no risk of problems. I'll explain a little further.

The menstrual cycle 

If you click on the link above you can learn more about the menstrual cycle, which will make this easier to understand.

Help, I forgot my Birth Control Pill

If I had a nickel for every time that I heard that!  This is a very scary experience, but don't fear, the answers are right here:

If you forgot 1 pill:  

Take it as soon as you remember, and use a back up method of birth control for 3 days to be safe.  You may notice some breakthrough bleeding or spotting for a few days.

If you forgot 2 pills in a row

Take 2 pills as soon as you can, and 2 more the next day to catch up. Use a back up method of birth control for 3 days to be safe. You may notice some breakthrough bleeding or spotting for a few days.

If you're always forgetting pills

Consider switching to another method of birth control.  Stay tuned, we'll talk about the options in the next few weeks.  There's:

NuvaRing

Mirena

Depo-Provera

Implanon

And my favorite, a girl's best friend, Condoms.

  

Birth Control and lowered Libido

I prescribe a lot of birth control pills and many NuvaRings for my patients. As you might imagine most women like their method and have few side effects. Women love the convenience of the NuvaRing and find it easy to use. Many providers, (myself included) like the fact that it has the lowest circulating dose of estradiol (15 mcg). The NuvaRing is a great option for women with menstrual migraines, acne, headaches, & with PMS. 

Within the last month, I have received 3 separate calls from women who wanted to stop using the NuvaRing because of much lower sex drive. One said, that she knows why it's such great contraception, because she has absolutely no interest in sex. Another found that her moods were depressed and she was much more fatigued. Another experienced hot flashes and night sweats on it. 

I searched the literature and the package insert and sure enough lowered libido is one of the side effects. This can happen with any form of hormonal birth control, not just the NuvaRing. Yet, I suspect that the lowered estrogen dose may make this more common in some women. 

The longer I practice, the more I notice individual variation among women. We can all take the exact same dose and yet, each will have a different experience.

Bottom line, if you are having side effects from any medication, give your provider a call and find a better alternative.

Breastfeeding as Contraception?

Recently I was asked whether women who breastfeed need to worry about contraception. 

The answer is:

You sure can.  If you're lucky enough to have the energy and the hots for your partner right now, even though you're probably sleep deprived and craving a little time to yourself. If you're thinking about some cuddling and some intimacy with your partner, then please be sure to use some form of birth control. Although women who are breastfeeding might not have a period, they can still ovulate and get pregnant.

So, play it safe and lubricate, lubricate, lubricate.  Most women who are breastfeeding find that their vaginas are very dry and don't stretch like they used to.  Likewise, their sexual response might be slower. This is a completely natural side effect of breastfeeding.  You see, the hormone prolactin that makes milk, inhibits the hormone estrogen which helps keep our private girl parts moist and able to stretch.  So, no matter what you use for birth control, get yourself some lubricant, and have fun. For more on breastfeeding, see my Personal Guide to Breastfeeding.

PCOS & Weight Control

A while back I started a series on PCOS. You can read parts 1,  2 &  3 and the post on treatment if you'd like. Today we'll talk about weight control, which is a challenge for many women with PCOS.

Quick Review

Most women with PCOS also have difficulty losing weight and keeping weight off, which is not their fault and completely unfair. Because of the imbalance of hormones, they also have an underlying Insulin Resistance, in simplified terms means that they are more likely to gain weight.

How this happens:

• Eating starches and carbohydrates makes blood sugar.
• Insulin helps transport blood sugar into muscle, fat and liver cells.
• With Insulin Resistance, there are lots of roadblocks to this transport.
• This leads to higher blood sugar levels.
• It also causes more fat to develop, especially around the waist area.
• This can lead to Type 2 Diabetes.

Nutrition recommendations

It's a good idea to ask your provider to check your fasting glucose level and cholesterol & triglycerides in a Lipid panel. If you can see a nutritionist, that's even better.

Most women with PCOS will be able to lose and maintain their weight if they restrict their carbohydrates with a diet much like South Beach. Some start from the beginning if they want to lose weight, others use the 2nd phase or maintenance plans to control their weight. 

My patients have found that limiting carbohydrates not only helps with their weight loss, but also improves their triglyceride & cholesterol levels.

PCOS treatment

A while back I started a series on PCOS. You can read part 1, part 2 & part 3 if you'd like. Today we'll talk about treatment.

Quick Review

Remember with PCOS, in general: 

• A woman doesn't ovulate regularly
• Her periods are irregular or absent
• She's more likely to have acne & unwanted hair growth
• It's more difficult for her to lose weight
• She may have more challenges becoming pregnant
• She has a higher risk of abnormal uterine bleeding and endometrial cancer

Treatments

Are aimed at restoring the balance of hormones in her body (estrogen and progesterone) and decreasing the unwanted side effects of acne and hair growth. It's also essential to prevent abnormal 

The Female Brain

I'm reading The Female Brain by Dr. Louann Brizendine.  It's brilliant! Each page is a revelation and explains the neuro-chemical and hormonal influences on our behavior. She manages to take very dry science and bring it to life.  This book is a must read for women and the men who love us.

The book covers women of all ages.  I read a few pages before speaking to a group of parents last week about teens and sex. It helps to have the biologic explanation for what seems to be erratic and provocative behaviors.

Women & Herpes

Women at higher risk

We know that women are 6 to 7 times more likely than men to become infected with herpes.

A new report by the WHO (World Health Organization) estimates that worldwide up to 28 % of women will be infected with Herpes by age 50! Here in the US, studies have found that in general between 20 -25% of women are infected, with 90% being unaware that they have this particular infection. 

In some areas of the US, 50% of women are infected and this compares to areas in the world where there is a higher incidence of HIV, the infection rates are up to 70% of women. 

More on Teens & Sex

A few days ago we continued our series on Talking to your teens about sex.  So many people wrote in with practical advice.  Here are a few more helpful tips:

One mom emphasized the importance of repetition.  

"The one thing that I know that works is Repetition.  Repeat yourself, even when they do not want to hear something. Say it over and over and over again. I used to think they just tune you out, but you know what?  They hear you and it sinks in. Don't yell, don’t scream or act silly.