Birth control. From diaphragms to IUDs, implants and injections to the pill, the options available to women today can be dizzying. And as we transition from one stage of life to the next—our early 20s to starting a family and then on to perimenopause—our contraception needs change. In this episode, we discuss the wide variety of contraceptives available to women, and we hear the pros and cons of various methods that may impact what you choose for yourself at different times throughout your reproductive years.
Note: Any products mentioned in this podcast are referenced by name only for the convenience of our listeners. Nothing in this podcast should be viewed as an endorsement of any particular product by Kaiser Permanente.
About the Guest
Regina Zopf, MD is an OB/GYN physician with Kaiser Permanente in Washington, DC.
Joyce Gottesfeld, MD, is an OB/GYN with Kaiser Permanente Colorado, where she’s worked 17 years. She’s a wife, proud mother of three girls, runner and blogger. Read more about Dr. Gottesfeld.
Looking for more information on contraceptive options? Check out these online resources:
- Reversible Methods of Birth Control from the Centers for Disease Control and Prevention
- Permanent Methods of Birth Control from the CDC
- Effectiveness of Family Planning Methods from the CDC
- Choosing a Birth Control Method from Kaiser Permanente
- Teens and Birth Control from Kaiser Permanente
- Getting Pregnant After Stopping Birth Control from WebMD
- Contraception: You Need it Longer Than You May Think from the North American Menopause Society
- What is Emergency Contraception? from Kaiser Permanente
DR. GOTTESFELD: Welcome to Total Health Radio. I’m Dr. Joyce Gottesfeld. Today’s show is about the basics of birth control: the choices you have, and what methods are best for different stages of your life. Joining me today is Dr. Regina Zopf, also an OBGYN with Kaiser Permanente in Washington DC. Thanks so much for joining us, Dr. Zopf.
DR. ZOPF: Thank you for having me.
DR. GOTTESFELD: So let’s just start kind of high level. Why is birth control so important?
DR. ZOPF: Birth control gives women control over their reproductive options. Additionally it’s helpful in treating many women’s health problems like heavy, irregular bleeding, endometriosis, fibroids. And I think a lesser-known fact is it can actually reduce your risk of developing ovarian cancer later in life.
DR. GOTTESFELD: So one of the highest groups or I think the highest group of unintended pregnancy is teenagers. What are some good options for birth control for teenagers?
DR. ZOPF: Well I prefer a method of birth control that I recommend for women in their teens is a long-acting reversible form of birth control like the Implanon, which is that implant that goes in your arm. Or even an IUD, in some cases. And this is because women in their teens find it difficult to remember to take their pills or they may have difficulty making it to the doctor for Depo-Provera shots on time. In the 20’s if they get a little bit better about being able to take a pill consistently, I do prefer this method. Because in their 20’s it’ll give them the added benefit of prevention of ovarian cancer later in life.
DR. GOTTESFELD: So a teenager can take the pill though if they want, and they feel like they’ll be able to remember it?
DR. ZOPF: Absolutely. Yes. If they are able to remember it and I have a lot of patients that’ll set a timer on their phone to try to remember, or they have apps that remind them, then it’s a great method for teens as well. So is the Depo-Provera, if they can make it to the doctor on time. But a lot of women in their teens may be having changes in their life situations like moving or changing insurance. And so for different reasons, it can be a little bit more difficult for them to get regular birth control pills or Depo-Provera shots.
DR. GOTTESFELD: And then one last question, and this is for any teenagers who might be listening: do birth control pills prevent sexually transmitted diseases?
DR. ZOPF: They absolutely do not and neither do any of the long-acting reversible contraceptives that we mentioned. The IUDs or the Depo-Provera. You always need to use condoms and limit your sexual partners to limit the transmission risk of STDs.
DR. GOTTESFELD: So let’s talk about the IUD. Which, by the way, IUD stands for inter-uterine device. And it is a little device that goes inside your uterus, so once it’s in there you don’t need to remember it. Tell me about why that might be good for a teenager or why it might not be good.
DR. ZOPF: So the reason why the IUD could be good is because it’s got a greater than 99 percent effectiveness rate. That means the failure rate is going to be very low. So if you really don’t want to get pregnant, that’s a great method. Some of the reasons why it might not work is if it does not fit, or if you have some other reason for not being able to have an IUD placed. Another concern could be if you have multiple sexual partners and are at risk for infection such as pelvic inflammatory disease. It might not be the best method for you.
DR. GOTTESFELD: Can you tell us, how does an IUD work, how does it prevent pregnancy?
DR. ZOPF: Well there’s two different types of IUD, and one is the progesterone IUD. And that acts by just releasing small amounts of progesterone, which is a hormone that leads to the thinning of the lining in your uterus. In some cases it can actually stop your eggs from coming out every month and in addition it can stop your tubes from moving so that the egg doesn’t reach the sperm. The Paraguard IUD, which is a non-hormonal copper IUD that’s placed and stays in for 10 years, actually creates slight inflammation in the lining of the womb. And what that does is that makes it so that the sperm can’t make their way through the birth canal or up through the cervix and into the tubes. It also stops the tubes from moving.
DR. GOTTESFELD: So the sperm can’t get through the uterus into the tubes. And so basically the egg and the sperm never meet.
DR. ZOPF: Exactly.
DR. GOTTESFELD: Okay, interesting. So is there a population of women that’s especially well-suited for IUDs?
DR. ZOPF: Absolutely. But the people that are best suited for IUDs are people that cannot take hormonal forms of birth control or people with other medical problems. Say, problems with their liver, problems with their heart. Most young women don’t have these medical problems, but also people that have certain blood clotting disorders where they form blood clots easily – the IUD would probably be a better method for them.
DR. GOTTESFELD: Okay, let’s talk a little bit about – and you referred to this before – you mentioned long-acting reversible contraceptives. I like to just call them LARCS. I kind of like that nickname.
DR. ZOPF: Yeah I do too.
DR. GOTTESFELD: So let’s just talk a little bit about, you mentioned that Implanon and the Depo-Provera. Can you tell me a little bit about what those are and how those work?
DR. ZOPF: Sure. The Implanon is very similar to the Mirena IUD. It has the same type of progesterone. The difference is the delivery method. It’s on a small silicon rod that’s placed in your arm under local anesthesia. And they just numb your arm a little bit, and then they have an applicator and they just pop it right in and it just sits under your bicep. You can feel it there but you can’t really see it. And it stays there for three years and it works much in the same way as the IUD that I explained.
DR. GOTTESFELD: Now tell us about, what is the Depo-Provera shot? What is it and how does it work?
DR. ZOPF: The Depo-Provera shot is a shot of progesterone essentially and it’s a high dose of progesterone. And basically it stops you from having eggs come out every month, it stops you from having your period, and you may have irregular bleeding on it. So that’s something to keep in mind. Another thing to keep in mind is that it is associated with a 10-pound weight gain in the first two years of use.
DR. GOTTESFELD: Well of course you gain quite a bit more with pregnancy.
DR. ZOPF: That’s absolutely true, but it is something I do like to mention.
DR. GOTTESFELD: Right, so people aren’t surprised cause I know that that could be an unpleasant surprise for some people. Let’s talk about the birth control pill. So we’ve mentioned a few other methods. Birth control pills obviously used commonly by many women. How do birth control pills work?
DR. ZOPF: Birth control pills also stop your eggs from coming out every month so that they don’t get fertilized. They also thin that lining in your womb the same way the IUD and the Implanon do.
DR. GOTTESFELD: That to me sounds like why, if you’re on the pill, maybe your period isn’t as heavy or you don’t have as much cramping?
DR. ZOPF: That’s exactly right.
DR. GOTTESFELD: You mentioned some other benefits of the birth control pill. Let’s talk about that for a minute.
DR. ZOPF: Sure. My favorite one is that women are having children later and later. So they’re ovulating a lot more than they would have maybe, evolutionarily speaking, when we were just hunter-gatherers and we were just sort of having a baby and breast-feeding for long periods of time. And essentially we probably wouldn’t have been ovulating as much as we are now. So the birth control allows you to kind of restore a natural balance that you might otherwise have if you were having children younger. I’m not saying we should go back to that. But ovulating every month probably isn’t the best thing for our health. Because again, when you’re ovulating, your cells are dividing. And cells that are dividing are at risk for mutations and mutations are changes in our DNA that can lead to cancer. And DNA is just again, the recipe we all have for how our cells should operate.
DR. GOTTESFELD: That’s interesting. So, taking birth control pills will decrease your chance of getting cancer of the ovary and cancer of the uterus, period.
DR. ZOPF: That’s exactly right.
DR. GOTTESFELD: That sounds like a headline to me.
DR. ZOPF: I don’t know why it’s not in the headlines.
DR. GOTTESFELD: And it’s not new information really either.
DR. ZOPF: No, it’s not.
DR. GOTTESFELD: So let’s talk about some other things the pill does. We talked about how it makes your period better. We talked about how it prevents cancer. What about skin, acne, that kind of thing?
DR. ZOPF: Yeah, that’s a great added benefit. The birth control pills often will improve acne in many women. The way that it does that is when you’re taking the birth control pill it actually binds up a lot of the hormones that can lead to acne and in some cases, even male-pattern hair growth.
DR. GOTTESFELD: Interesting. And I know there’s a lot of teenagers who take birth control pills for their skin.
DR. ZOPF: That’s right.
DR. GOTTESFELD: So, if you get a prescription for birth control pills for your skin or for your periods, you might not be using it for birth control.
DR. ZOPF: You’re exactly right. You may be using it for controlling acne, you may be using it for controlling heavy periods, or pain with your periods. You know, there’s a lot of different reasons women use birth control.
DR. GOTTESFELD: Excellent. So let’s talk about another life stage. When you’re maybe thinking about getting pregnant – let’s talk about, for example, those women who, you know, they’re in a relationship. Maybe they’re getting married or something and they’re going to use birth control pill, they don’t want to have a baby yet but they think maybe in a year or two, they might want to have a baby. What do you recommend for those gals for birth control?
DR. ZOPF: Well the first thing I recommend is stay on the pill, because actually you can get pregnant the month after you get off the pill. I also recommend that you start folic acid at least three months before stopping any method of birth control. And again, while it can take up to six months to start ovulating regularly after stopping the pill, or even after the Mirena IUD is removed, this is not common. And, in many cases, I have women coming to me pregnant the month after they stop their form of birth control. And that’s why I recommend that they use a pill until they’re ready to get pregnant.
DR. GOTTESFELD: I’ve seen that as well, women who never had a period off the pill. They got pregnant right away. So this whole idea about, we want to get pregnant next year so we need to go off the pill now a year ahead of time for something, is there any rationale for that?
DR. ZOPF: Absolutely not. I really don’t think that there’s any reason to go off the pill that early.
DR. GOTTESFELD: Okay so go off the pill when you’re ready to get pregnant is the bottom line.
DR. ZOPF: Yes, that’s definitely what I advise.
DR. GOTTESFELD: Okay, so she goes off the pill, she gets pregnant, she has the baby. After the baby, and she’s breastfeeding, what do you recommend for contraception during that time period?
DR. ZOPF: So after pregnancy, women are at high risk again of forming blood clots or they can be in their legs, their lungs. They’re also at higher risk of stroke. So we don’t recommend using the estrogen and progesterone containing birth control pills for about the first three to six weeks after pregnancy. Now if you were to do a progesterone-only pill, it’s not as high of a risk of this happening. So this may be an option but again this does have a higher failure rate. If a woman is breast feeding, she does get some protection. So then the progesterone only pill maybe good enough for her, but if she’s not breast feeding exclusively and she’s not breast feeding through the night, and even still you can have ovulation. Then you know you still maybe need something, if you absolutely need something after having a baby. And again, you can ovulate if you’re not breastfeeding as soon as 21 days after having a baby, and IUDs are a wonderful option that are safe after pregnancy, especially if you want to wait a little longer between children or between pregnancies. You can have it out before you have your next pregnancy. And so I think those are kind of the best options to use, right after pregnancy.
DR. GOTTESFELD: So after the baby is born, probably don’t necessarily count on being protected from pregnancy just because you’re breastfeeding?
DR. ZOPF: Exactly. It’s probably good to have another method of birth control. And again, barrier methods in the short term are okay to use as well. Most people aren’t going to start having sex until they’ve seen their doctor 4 to 6 weeks post-partum and they’ve been cleared. Most people are just going to be too tired, but if you do, it is good to have some additional protection in addition to breastfeeding.
DR. GOTTESFELD: Alright, let’s talk about the last age group which is perimenopausal women, which is probably the, second to teenagers, the second highest group of unintended pregnancies is in perimenopausal women. So you still need birth control even when you’re in your 40s.
DR. ZOPF: That’s absolutely true. Yes and a lot of women sort of think, oh well I’m getting close to menopause and they’ll go off their pill and they’ll come in with an unplanned pregnancy.
DR. GOTTESFELD: What are some of the best methods for women in this age group?
DR. ZOPF: So for women that are approaching menopause, it is safe to continue birth control pills so long as the they’re non-smokers, have no other medical problems like for example if they have uncontrolled high blood pressure or heart disease or diabetes. In general though I will, if a woman is healthy, she’s exercising, normal weight, I’ll prescribe her birth control pills. I do tend to stick to the lower dose estrogen pills just to minimize that risk of blood clot, stroke and heart attack. I think IUDs another great option in women that are near menopause that either don’t want to take the pill or the pill’s not an option because of other medical problems they have.
DR. GOTTESFELD: Right. And it probably helps perimenopausal women are notorious for other hormonal swings and fluctuations, irregular periods and whatnot. And I would guess certainly the pill would help with some of this.
DR. ZOPF: Exactly. That’s why I think- I think its perfectly fine for women to stay on the pill right into menopause, so long as they don’t have any other medical problems.
DR. GOTTESFELD: And then the other thing for perimenopausal women, I don’t think there’s any problem with asking the male partner to get a vasectomy.
DR. ZOPF: Absolutely not, as long as that’s the only person you’re having sex with.
DR. GOTTESFELD: Right, okay, well there’s that. But the woman, she can also have a tubal sterilization procedure of some kind. You know some kind of tube-tying procedure.
DR. ZOPF: Correct. And now we have a tube – it’s not really tube-tying. We have an e-sure device, which we don’t even have to do surgery in your belly for. We just go in through the cervix and these little devices can insert right into the tubes, and these are also options for women that are done with child bearing in general.
DR. GOTTESFELD: Well this has been such a great conversation. Thank you so much for all your wonderful information and for joining us today, Dr. Zopf.
DR. ZOPF: Oh thank you for the opportunity to speak.
This show is for educational purposes only. If you have specific health concerns, you are encouraged to address those with your personal doctor. And as always, if you’re having a health emergency, please call 9-1-1 or go to the nearest emergency department.