S3_E3_Birth Control Basics: Audio automatically transcribed by Sonix

S3_E3_Birth Control Basics: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Kristyn Hodgdon:
Hi. I'm Kristyn Hodgdon, an IVF mom, proud fertility advocate, and co-founder of Rescripted.

Staci Tanouye:
And I'm Dr. Staci Tanouye, a board-certified OB-GYN striving to make reproductive and sexual health fun and empowering for all.

Kristyn Hodgdon:
Welcome to Dear Infertility. This season, we're going back to the basics. From menstrual cycle red flags to what you need to know before you start trying, we're giving you the tools you need to take control of your overall health and fertility.

Staci Tanouye:
Does birth control cause infertility? Do painful periods mean that I have endometriosis? We're here to answer all of your real-life questions and provide you with patient centric advice and support so that you can be your own best health advocate.

Kristyn Hodgdon:
Now let's dive in and talk about everything sex ed failed to fill you in on.

Kristyn Hodgdon:
Hi! And welcome back to Dear Infertility. I'm your host, Kristin, and I'm here with Dr. Staci Tanouye. Hi, Dr. Tanouye!

Staci Tanouye:
Hi, Kristyn!

Kristyn Hodgdon:
Well, welcome back, everyone, and I'm so excited today to talk about birth control. We received a ton of questions from our community about the different side effects of birth control, the different types of birth control, and does birth control cause infertility? So, excited to hop in. Dr. Tanouye, let's, let's jump in by talking about just a broad overview of what are the different types of birth control out there.

Staci Tanouye:
Yes. If we want to be specific and talk about hormonal birth control specifically, in hormonal birth control we have either combined hormonal birth control or progestin-only birth control. Combined hormonal birth control has both estrogen and progestin in it, so the two hormones in it, and that can come in either a pill form, a patch form, or a vaginal ring form. And then we have our progestin-only methods, and that has just progestin in it and not estrogen at all. And progestin forms of contraception can either be, again, pill form or it can be things like the shots or IUDs or intrauterine devices or the implants in the arm. And then besides hormonal birth control, obviously we have all the non-hormonal methods.

Kristyn Hodgdon:
Yeah, I forgot to ask about that. But can you go into that? Because I don't think I even realized that that was a popular thing.

Staci Tanouye:
Yes, yes, sure. So non-hormonal are for people who want to stay away from any sort of endogenous or outside hormones putting into their bodies. The one long-acting option you have is the copper IUD, the copper intrauterine device that has no hormones in it, and that's good for up to ten years. And then besides that, we have things like barrier methods. So condoms, external versus internal condoms, we have things like spermicide, diaphragms, cervical caps, and then or just natural family planning and cycle tracking, these are all forms of non-hormonal birth controls. Oh, and I forgot to mention like sterilization, permanent forms of birth control too. Like those are the ultimate, right, but we're not there yet, so.

Kristyn Hodgdon:
Yeah, that's amazing that the copper IUD lasts for ten years and works without hormones, it blows my mind. So what are some of the side effects of, of birth control? As someone with PCOS that has always struggled with hormonal acne, I'm always like, which, which kind of birth control should I be on?

Staci Tanouye:
Yeah. You know, side effects are kind of the toughest part of hormonal birth control, not because they're overly frequent, because in reality they're not. Most, most people will have minimal side effects, if any at all. But there is a subset of people who will have a lot of side effects who hormonal birth control just doesn't work well for. And it's going to take us a lot of back and forth to kind of fine-tune and figure out what's going to work best for them. But the most common side effects of hormonal birth control are things like nausea, breast tenderness, bloating, mood changes, and irregular bleeding patterns. Now, with these types of symptoms, usually the longer you are on that form of hormonal birth control, the better these symptoms will get. So these symptoms will usually improve over the first 3 to 4 months that you're taking or have something in place for you, because these are kind of the, the symptoms of your body really just getting used to that outside hormone.

Kristyn Hodgdon:
Yeah.

Staci Tanouye:
So they get better over the time. And I think that's what a lot of people don't really realize is that that first month I might feel a lot, but if I keep continue with this, it's going to get better and better over time. Now again, like I said, there's a subset of people who it will not get better over time, or they have more severe side effects, or they have more severe mood symptoms or depression, anxiety, severe nausea. For those who have side effects that are totally intolerable, and I can't even stand to be on this for three months, then we have to shift gears sooner and kind of figure out and fine-tune. And so birth control, hormonal birth control can be tough because it does some, for some people it does involve a little bit of trial and error to see what works best for you, because what works best for you may not have worked well for someone else. And that can be the tough part of it, is that trial and error and back and forth of figuring it out.

Kristyn Hodgdon:
Yeah. And are there typically symptoms when you come off of the pill?

Staci Tanouye:
So I think that's, that's a very popular topic right now, right? This, this like birth control withdrawal. And in general, there are not significant, there's not a withdrawal sort of symptom like there is with some other medications that you can get out there. There is some adjustment of your body getting back to its normal cycle. And so it does take some time for your body to get back, but that time period is a lot shorter than people think, okay? On average, people will get back to their normal cycles within 30 to 32 days of stopping whatever hormonal birth control that they were on. But we also have to remember that if we were on birth control because we were trying to fix something, if when we get off of birth control, that's something is still going to be there that needs to be fixed. So we might have been controlling symptoms that we wanted to control with birth control, but when we take that birth, hormonal birth control away, those symptoms might still be there because hormonal birth control is all about controlling things, it's managing things. And so that's what we have to remember, is that underlying things, it might still be there. So coming off of those hormones, our underlying bodies of whatever it was going to do is going to go back to what it's going to do. The other thing we have to remember when we come off of hormonal birth control is we're always older than when we started it, right? So people were like, oh, I was on birth control for ten years and I came off of it and this, this, and this happened. I'm like, yeah, you get ten years older, like our bodies and our menstrual cycles change significantly over our reproductive years. My menstrual cycle and your menstrual cycle is not going to be the same when you're 20 as it is when you're 30 and when you're 40. Age makes a big impact on our bodies as well, so we always have to keep that in mind too.

Kristyn Hodgdon:
Absolutely, yeah. You see a lot about like post birth control syndrome or birth control's just a Band-Aid for PCOS. But I mean, I'm someone that actually feels a lot better on birth control and my acne is lessened, my cycles are regular, and for those people, do you kind of recommend it indefinitely? Like if you're not, obviously trying to get pregnant.

Staci Tanouye:
Yes, yes! We definitely do. I always, I make the analogy because I don't like this, this movement that's going on of like, oh, it's just a Band-Aid. Well, I mean, yes and no, because what are we doing with any medication, right? What are we doing with any other medical condition? I like to, I always like to use the example of asthma, right? Someone who has asthma. What is our goal for treating asthma? Is our goal to cure the asthma? Well, no, you can't really cure asthma. It's something is always going to be there underlying. So our goal is to manage the symptoms of asthma, to manage and control them so you can feel healthy and optimize yourself. So what do we do for that? We control our environment, we decrease allergens in our environment, we optimize that, we optimize what kind of exercise we can do, and we might optimize what kind of medications help control our asthma symptoms. But if I took all of that away, am I still going to have asthma? Yeah, because we're not going to cure asthma. With something like PCOS and endocrine stuff is similar, right? There's not any definitive cure for PCOS, so we can optimize everything. We can optimize our environment to try to control and manage symptoms that way, we can control and manage symptoms with things like hormonal medications or birth control medications. But that's what we're doing, is we're trying to manage those symptoms to optimize how we feel and how we function on a day to day basis and for what our goals are, our goal is not to cure PCOS. We don't know how to cure PCOS, we have lots of ideas of how we can manage that, how we can optimize things, how we can improve ovulation, how we can improve insulin sensitivity and all that stuff that goes into it, but there is no cure. So when people are saying, oh, you're just putting a Band-Aid over it, well, no, I'm managing your symptoms so you can live your life how you want to, and we're taking into consideration your current and future goals of what you need to live, which is the same thing we do for asthma. I'm not going to say like, oh, that inhaler is just putting a Band-Aid on your asthma, you just go ahead and not breathe, that's dumb.

Kristyn Hodgdon:
That's a great point. It kind of reminds me of like the stigma around SSRIs and medication for your mental health, it's like you would take medication for your physical health, why can't you take medication for your mental health?

Staci Tanouye:
Right. I also use asthma for that example, too. Like .... You ought to just like say, oh, no, just keep struggling, breathe, trying to breathe. Like you don't need this medication, it's just a Band-Aid. You just go on huffing and puffing and not being able to breathe. No, we want we would treat it so people can live their lives and optimize their lives. Same thing with depression, same thing with anxiety if you need it, same thing with PCOS, our goal is to manage our symptoms so we can live our lives and get to the goals that we want.

Kristyn Hodgdon:
Absolutely. So the million dollar question which so many people in our community wrote in and asked, does birth control cause infertility? And why is that such a common misconception.

Staci Tanouye:
No, absolutely not. This has been studied like over and over and over again. Fertility rates, fecundity rates, everything has been studied constantly with this, the answer is unequivocally no. Birth control cannot cause infertility, it does not cause infertility. The misconception is out there again because, because of some of the stuff that we've kind of touched on already, number one, birth control can manage a lot of things, can manage a lot of symptoms, but those symptoms might be caused by something underlying, so birth control is not going to cure that underlying something, that underlying something is still going to likely be there when we come off of birth control. So if that's PCOS, if that's thyroid disorder, if whatever that something was, was us not ovulating, when we take away that birth control, that underlying condition is likely still going to be there. And so it would have been the same before birth control as it is after birth control. The other thing like we also mentioned, is we get older, and what's the biggest predictor of fertility that we have is age. Age is our biggest fertility predictor. Any time we're getting older, which is every second of the day, our fertility is declining. So the longer you are on birth control, the older you are getting naturally, and your fertility will naturally decline with your age.

Kristyn Hodgdon:
Yes, absolutely. That's a very important point. So for for those who might be considering different birth control options, what are the benefits to like an IUD versus a birth control pill?

Staci Tanouye:
Yeah, and everyone's totally different with you know, that's why we have to personalize a lot of these things and not just kind of throw the same thing at everyone. So a lot of what I do in clinic is talk to people about what their goals are, what they want, what's most important to them, what are they scared of? All of those sorts of things to try to figure out what is the best option for them. The benefits of something like an IUD or an implant in the arm is those things are what we call a LARC or L A R C, long acting reversible contraception. That means that these things are things that we put inside our bodies and we leave it. So what are those old commercials, that set it and forget it like that? That's what it is. You set it and you forget it and it's good for years. And you don't have to think about it, you don't have to do anything, you don't have to take anything, you don't have to remember anything. It's the set it and forget it, it's good for years, and because there's no user error day to day, it's going to be the most effective and reliable for us. So if you are someone who is not good at remembering something every single day, who doesn't have a predictable schedule every single day, who maybe has other health issues that make you not absorb something very well, something like an IUD or an implant is going to be a really great option for you. There's also other good side effects to things like the IU, the hormonal IUDs, it can decrease amount of bleeding with your periods or even take periods away. It can really help improve pain because it decreases bleeding so much, and that can sometimes be a more significant improvement than some other things. For pills, any kind of pill, whether it's progestin-only or combination, pills are easy to start and they're easy to stop.

Kristyn Hodgdon:
Yeah.

Staci Tanouye:
So for people who just want to kind of try something but they don't want to commit to something being inserted or implanted, then a pill is a very easy thing to try and it's also a very easy thing to say, you know what? No, this is not working, let's stop. So that's kind of the biggest benefit of the pill, but because it's easy to start and easy to stop, it's also easy to forget, which does decrease the efficacy a little bit more. So there's user error in that too. And again, different pills have different other side effects that can be beneficial. Some pills have more what we call anti-androgen effect, anti-testosterone sorts of effects that can improve things like skin and acne and that sort of thing. So there's other little subtleties in there. There's other pill formulations that might help with periods in different ways, that might help with PMS symptoms in different ways. And all of those, I try to tease out all of those questions and details from people when I'm trying to pick and help talk about which options might be best for them.

Kristyn Hodgdon:
Awesome. So this question has been coming up a lot in light of the recent Roe v Wade news, when will there be more male birth control options on the market?

Staci Tanouye:
Oh my God. Don't, like don't hold your breath. Don't, don't hold your breath. It's a really good question. There's always ongoing research on this topic, so it's constantly being researched. But to create a kind of testosterone controlling birth control for our sperm producers out there is a little more difficult because testosterone as, or any of derivatives as a form is harder to deliver in a stable form because it has a shorter half life and it's more unstable depending on the form that you're giving it in. So it's harder to create a pill form of those testosterone derivatives. It is not well funded research because of all of the very kind of typical patriarchal society, societal issues out there right now, it's easier to create things that help control a women's body. And our society wants to control women's bodies more, right? So that's why there's more push for that. It's, it's easier to control our hormones and society wants to control us. So there's two aspects of that. And we, we all know where that's gotten us. And so that's another reason why there's just not a whole lot of research or drive or funding for, for male birth control, it is being done. Lots of people are doing it. It's just not in the massive amounts that's going to make it a push to make it happen quickly. I think we'll eventually get there. But don't hold your breath.

Kristyn Hodgdon:
Yeah. Hoping for progress.

Staci Tanouye:
Yeah.

Kristyn Hodgdon:
So lastly, what would you rescript about how people understand birth control and how it relates to their reproductive health?

Staci Tanouye:
Yeah, I think again, the internet and social media is always good and bad for us. And in particular recently it has been kind of bad towards things like hormonal birth controls. There's a lot of stuff out there that really demonizes hormonal birth control, that really vilifies it. And I really, really hate that because, yes, we need to talk about birth controls limitations, birth control's negative side effects, you know, all of those things need to be a discussion, but we can't forget what birth control has done for us, for us men straighteners, for us who can have the potential for pregnancy. It gives us the freedom that we need to live our lives without pain, sometimes without periods, or sometimes preventing a pregnancy that we're not ready for. So birth control does a lot of really great things for us, and we can't forget that. But it is a conversation that has a lot of nuance to it, and that nuance changes from person to person. So all of this kind of demonising and vilifying hormonal birth control is really a disservice to men straighters and women everywhere. I hate it, I wish it would stop, I wish we could have honest conversations about the negative aspects, but also about the many, many positive aspects. And that ratio of negative positive is going to be different for every single person. And we have to understand that, yeah, there's so much misinformation out there about all of what's bad and what's good and all of that, it just drives me absolutely insane.

Kristyn Hodgdon:
Well, that's what, that's what we hope to do with this podcast to sort of rescript the narrative and with your platform and Instagram and hopefully this work will get out there to the masses.

Staci Tanouye:
Yes. So when you hear like something about birth control, like come to someone like me and ask me my, my thoughts because my goal is to give balanced answers, right? Everyone wants to think like OB-GYNs, we just push pills, we push pills, we push birth control pills, and we like pills because they can fix and manage a lot of things. But we're also honest about their limitations and what they can and can't do. And if we are good doctors, we're going to be providing both sides of that thing to help each person figure out what the right answer for them is, and that's what's most important.

Kristyn Hodgdon:
Absolutely. Well, this is awesome, as always. Thank you, Doctor Tanouye. And we'll chat next episode.

Staci Tanouye:
Thank you. I love birth control.

Kristyn Hodgdon:
Thank you for tuning into this episode of Dear Infertility. We hope it left you feeling more educated and empowered about your reproductive and sexual health. Whatever you're currently struggling with, Rescripted is here to hold your hand every step of the way. If you like today's episode and want to stay up to date on our podcast, don't forget to click Subscribe and to join Rescripted's Free Fertility Support Community, head to Rescripted.com.

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