House Call, MD: Health Carefully Explained

by Tania Houspian, PharmD 2011

Did you know that there are 13 months in a year? Maybe not true for everyone, but true if you’re a woman using birth control pills. How is that possible you ask? Let’s do the math. There are 365 days a year and 28 days worth of pills in each month’s supply of birth control, while we’re all aware that most months have 30 or 31 days. So 365 divided by 28 gives us 13. That’s right. Women have to pay for an extra month’s worth of medication. This is unheard of for any other medicine. With no medical reason to only give 28 days worth of pills when 30 or 31 would work just as well, what’s a woman to do? Maybe we can embrace this special month that only we get, by naming it. I personally like the way “Notpregnantember” rolls off the tongue. Really though, short of demanding two more pills from your pharmacist every month, a request that sadly the pharmacist can’t possibly oblige, what’s a woman to do if she’s really put off by this extra co-pay and daily pills? Women can choose to be informed consumers. There are a multitude of products out there that work just as well, if not better than, the traditional birth control pill and they don’t require us to cross days 29-31 off our calendars or make up new names for imaginary months, as fun as this may be.

Before we dive into the world of contraception, let’s do a quick recap of what birth control is and how it prevents pregnancy. Almost all birth control products in the market today contain progesterone and an estrogen component. We women are no stranger to estrogen.  It the hormone that is blamed for any slight fluctuation in mood we may experience or tear we may shed.  However, it’s actually the progesterone component of birth control that does most of the work.

What does progesterone do?

• Send a signal to the body not to develop an egg in your ovary

• Thickens the cervical mucous so the little swimmers can’t get through

• 
  

  Alters the uterine lining, making it impossible for a fertilized embryo (egg + sperm) to attach, build a house with a white picket fence, and grow.

What does estrogen do?

• Stops the uterine lining from breaking down and causing menstruation

Now that we know the key players, let’s explore the world of birth control products that don’t force us to re-invent our calendars:

Nuva Ring

• The reason for those catchy “Monday, Tuesday, Wednesday, everyday”commercials you see on TV

• Contains both progestin and estrogen

• It’s a flexible plastic ring that you insert vaginally at beginning of the month

• No, you wont feel it in there and neither should your partner

• You can remove it if you feel the need to, but for no longer than 3 hours a day

• Take it out after three weeks.  You’ll have one week of menstruation and then start a new ring the next week.

Ortho-Evra

• Contains both estrogen and progesterone that is delivered through a patch that sticks to your skin (yup, it’s a birth control sticker)

• A box of ortho-evra comes with 3 patches (a one month supply)

• You’ll apply one patch a week for three weeks and go patch free the fourth week of the month so that you get your period

Depo-Provera

• This option contains a long acting form of progesterone only (no estrogen)

• An injection is given in the arm, hip, upper thigh, or abdomen by your doctor once every 3 months

• Some women competely stop having their period after using this continually which is completely safe and sounds like great news to me

• Possible downside: it can take 3-14 months to become fertile again after stopping injections…not a good idea if you’re in a rush to start baby-making.

Mirena

• It’s a little plastic device in the shape of a T that sits in your uterus and prevent implantation of a fertilized egg

• The device contains only progesterone

• The doctor will place this into your uterus during an office visit.

• The Downside: Expect some discomfort during the procedure (be sure to ask your doc for local anesthesia to make this part much more tolerable) and some abdominal cramping for the next 24 hours after the prodecure.

• After the initial procedure, you’ll never notice it’s in there

• It can be left in for up to five years and will continue to prevent pregnancy the entire time, maintenance-free

• Once you decide its time for more kids you can have it removed and you’re ready to start the baby-making process immediately

ParaGard

• It’s a small device looks like a “T” and is about the size of a quarter

• Contains neither progesterone nor estrogen.  It’s made of copper which prevents sperm from reaching the egg.

• Yes, the small amount of copper the device releases is safe for your body.  It’s less copper than you would absorb from eating shellfish, whole grains, nuts and leafy greens.

• Like the Mirena, it will be placed in your uterus by the doctor which causes discomfort during the procedure and about 24 hours of cramping.

• It doesn’t have any hormones in it so normal menstrual cycles will continue to occur

• It can be left in for up to 10 years and will continue to prevent pregnancy the entire time

• As soon as its taken out you can go back to making babies

Implanon

• Contains only progesterone

• It is an implant a little thicker than a toothpick is placed under the skin of your arm by a doctor (Note: discomfort occurs here as well)

• Effective for 3 years

• Baby making potential returns soon after the implant is removed…exact time till conception can occur is vague, however.

No 28-day cycle needed and no need to name your 13th month.  Of course these products may not be right for every woman, so a discussion needs to happen with your doctor to decide what is the best choice for you. Until we find out who decided to add a month to a woman’s reproductive calendar and make them pay, it may be worth exploring these other options and seeing which one is best for you.  Now, you’ll have to excuse me while I go copyright “Notpregnantember”.

References

Besinque, Kathy Pharm.D, MSEd.. Class Lecture. ‘Rings and Things: Whats New in Contraception’ University of Southern California. Los Angeles, CA. October 26, 2009.

‘Birth Control: How Hormones Work to Prevent Pregnancy.’ Association of Reproductive Health Specialists. November 8, 2009.

‘Choosing a Birth Control Method.’ Association of Reproductive Health Specialists. November 8, 2009.

‘Counseling Patients on Birth Control’. Paragard. November 7, 2009

Nuva Ring Package Insert. Organa USA, Inc. November 8, 2009.

Mirena Package Insert. Bayer healthcare Pharmaceuticals. November 7, 2009.

‘What to Expect’. Implanon. November 9, 2009.