Season 6 Episode 6: Your Guide to Birth Control (Part 3): Permanent Birth Control Procedures

Season 6 Episode 4: Your Guide to Birth Control (Part 1): Hormonal Birth Control

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We should all have the right to choose the contraception that works for us – BUT also be FULLY informed of all the options we have available to us and the risks and benefits of those options. You are entitled to make an informed choice. 

This is where I think our medical system is falling down at the moment – the being informed part. How can you have informed consent when your doctor has to understand the problem, and then present you the options and complete a prescription in 10 minutes? They can’t and that’s why so many of us have absolutely no idea what options we have available to us and also what the risks and benefits of those options are. 

This podcast covers the hormonal options. Hormonal options always contain synthetic forms of Estrogen and Progesterone, which are the hormones that your body normally produces in response to ovulation. 

The way they work is that they mimic the shape of our own hormones and then fit into the slot- all hormones act like a lock and key. There are different ways they can inhibit pregnancy based on the action of those hormones and the amount and combination that they do. So when talking about each option I’ll explain to you how it’s believed that they work to prevent pregnancy.  

Like many things in life, there can be a bit of a tradeoff involved, in the case of hormonal contraceptives (and in fact any drugs), you’re making a trade-off between convenience and effectiveness and adverse effects. Drugs have effects, and those effects have knock on consequences. Because our body systems work together, we can’t expect to just turn one thing off and it not have any other consequences. But where it gets tricky is that the risk is not the same across all of us. This is why you’ll hear me talk about some people having a problem while others didn’t. The reason for this is probably mostly genetics, other conditions and in many cases, they don’t know. This is why it’s important for you to know the options so you can make the right call for you.  

This episode is for you if:

– You’re currently on hormonal birth control

– You’re thinking about going on a hormonal form of birth control

– You want to know more about the effects of hormonal birth control on your body

– You want a breakdown of the birth control options available to you

Some things we cover in this episode:

– The combined Pill – monophasic, biphasic and triphasic

– The mini Pill

– The Injection (Depo Provera)

– Levonorgestrel IUD (LNG IUD)

– The Mirena coil IUD

– NuvaRing

– Contraceptive Patch

– The different product names of all of these birth control methods

Resources and References:

Hormonal contraception mechanism of actions

 

– The combined pill: 

 

– According to the Centers for Disease Control and Prevention (CDC), the pill is 99.7 percent effective with perfect use: Contraceptive Effectiveness 

 

– Effects of hormonal contraceptives (not just ‘the Pill’):

 

Association of Hormonal Contraception with Depression

Negative Spinal Bone Mineral Density Changes and Subclinical Ovulatory Disturbances—Prospective Data in Healthy Premenopausal Women With Regular Menstrual Cycles

Adolescent use of combined hormonal contraception and peak bone mineral density accrual: A meta‐analysis of international prospective controlled studies

Contemporary Hormonal Contraception and the Risk of Breast Cancer (Danish Study)

The effects of hormonal contraceptives on glycemic regulation

Effects of Two Forms of Combined Oral Contraceptives on Carbohydrate Metabolism in Adolescents With Polycystic Ovary Syndrome

Comparison of Effects of Different Combined Oral-Contraceptive Formulations on Carbohydrate and Lipid Metabolism

Oral Contraceptives Impair Muscle Gains In Young Women

Effect of long-term combined oral contraceptive pill use on endometrial thickness

Return of fertility after discontinuation of contraception: a systematic review and meta-analysis

– With typical use the mini pill is 91% effective:  https://www.cdc.gov/reproductivehealth/contraception/index.htm

– Depo Provera: ex-injectable contraception users have a pregnancy rate of 77.74% which is estimated only with two studies https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055351/

– Levonorgestrel intrauterine system (LNG IUD) Typical use failure rate: 0.1-0.4% : https://www.cdc.gov/reproductivehealth/contraception/index.htm

– Levonorgestrel IUD has potentially greater risk of breast cancer than the combined pill and other hormonal birth control:  https://www.nejm.org/doi/full/10.1056/NEJMoa1700732

– Other hormonal IUD: Mirena, Skyla and Kyleena:  failure rate of just 0.2- 0.7 percent:  https://www.medsafe.govt.nz/profs/Datasheet/m/Mirenaius.pdf

Surgery Versus Medical Therapy for Heavy Menstrual Bleeding 

– 50% or women will ovulate on the Mirena: Mirena monograph. Bayer. Whippany; revision date: 2017 Jun; cited: 2019 Oct 6. Pp 1, 25

– These IUDs contain the progestin levonorgestrel: Progestin-only contraceptives: effects on weight

– One year pregnancy rate following cessation of different types of Intrauterine device (IUD) was 84.75%: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055351/

– Implanon/ Nexplanon implant: Typical use failure rate: 0.1%: https://www.cdc.gov/reproductivehealth/contraception/index.ht

– The 12 month pregnancy rate following discontinuation 74.7% of ex-implant users get pregnant within 12 months. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055351/

– Vaginal rings (Nuva ring):  Perfect use: 99% effective, typical use, 91-93% effective https://www.cdc.gov/reproductivehealth/contraception/index.htm

Complete and Robust Ovulation Inhibition With NuvaRing

Emergency contraceptive pill – the morning after pill is 100 percent effective in stopping clinical pregnancy if given prior to ovulation, but would have no effect in stopping pregnancy if given on the day of ovulation or after ovulation: 

Timing of Sexual Intercourse in Relation to Ovulation. Effects on the Probability of Conception, Survival of the Pregnancy, and Sex of the Baby

Contraceptive Efficacy of Emergency Contraception With Levonorgestrel Given Before or After Ovulation

Mechanism of action of levonorgestrel emergency contraception

– If you’re over 70kg or 154 pounds then the ECP maybe even less effective: https://www.medsafe.govt.nz/safety/EWS/2014/emergency-contraceptive-effectiveness.asp

Links to our programs:

The PCOS Protocol

Eggducated

Listen on iTunes, Spotify or Stitcher 

Some more blogs you might be interested in

Season 6 Episode 6: Your Guide to Birth Control (Part 3): Permanent Birth Control ProceduresSeason 6 Episode 6: Your Guide to Birth Control (Part 3): Permanent Birth Control Procedures

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  1. As always, brilliant podcast. I have listened to all your podcasts and find them so informative and beneficial. My daughter is currently on your protocol and the wealth of information you provide is so valuable. I am starting to notice small improvements, some things I am concerned over but I know she is on the right track with your guidance. I am 50 and still benefit from all you teach us. I just wish I had someone like you around 30 years ago! Thank you Clare x

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