The Latest on Birth Control

From why the IUD is back and more popular than ever to questions on whether it’s really safe for a woman to miss her period (oh, and WHEN IS THE MAN PILL coming out) and so much more, Breezy Mama’s favorite go-to OB Dr. Rothbart answered our questions.

I have heard of many OBs recommending IUDs now. Why is this? What’s changed from our mother’s generation when there were lots of problems?

We have come a long way from our mother’s generation of IUDs. IUDs got a bad rap in the 70’s and 80’s for causing pelvic inflammatory disease. They were made of completely different materials then, and the next generation of IUDs on the market today in this country are extremely safe and effective.

I heard there are two types of IUDs – a bronze one without hormones? And a regular with hormones? Is this right? Can you explain the different types and why one is good for one patient and vice versa?

There are indeed two types of IUDs. The Copper-T, or Paragard, has no hormones and can be left in for up to ten years, and the Mirena which has mainly locally acting progesterone in it, which lasts up to five years. The Paragard has the unique benefit of having no hormones, which is really important to many women. Women who have sensitivities with mood, weight, bleeding patterns with hormones revel in the opportunity to have contraception non-hormonally. The Paragard is also excellent for women with coexisting medical conditions where hormones are contraindicated, such as uncontrolled high blood pressure, history of breast cancer or history of a blood clotting disorder, to name a few. The main draw back to the Paragard is that it can cause a longer, heavier, and crampier period. The Mirena, on the other hand, has progesterone in it, but very little of it gets into the blood stream, i.e., it mainly acts locally in the uterus. The benefit of this IUD is that it makes the lining of the uterus extremely thin, and therefore makes a very light period that sometimes is just a few days of light spotting. In fact, we often prescribe this IUD for women with very heavy periods for a treatment option to avoid surgery. The drawback of the Mirena is that it does have one hormone in it, and that it lasts five years less than the Paragard.

In all honestly, with IUDs being all the rage again, I know of two people who have had complications and had to go back in to their Dr’s office. How common is this? What exactly happens or can go wrong that would cause a patient to have to return?

Complications with IUDs are actually very rare. Not knowing the exact nature of why those people had to go back, it’s hard to comment. That being said, the most common reason for a return visit is because of abnormal bleeding/spotting, lingering pain or just a sense that the woman doesn’t like having it in. There is a very rare complication of uterine perforation upon placement, but this usually is discovered at the time of placement.

What birth control pill is currently the favorite among the OB community?

There never really is a favorite among the community. There are over 60 pills on the market and some OBGYNs have their own favorites, and others have theirs. Some doctors prescribe pills interchangeably, and others pay closer attention to what combination of hormones are in which and would be better for an individual patient.

For those that are sensitive to the extra hormones in the pill, what new pill is out there?

There are several low dose pills on the market for those women sensitive to higher doses of estrogen.

A lot of the birth controls tout that you don’t get your periods. Is that really okay for us?

Yes! Any birth control pill can be taken continuously, without the week off, to avoid having the withdrawal bleed (period). A period only means that the woman didn’t get pregnant, and that the lining that was built up in preparation for a pregnancy isn’t needed, so it sloughs off to get ready for a new cycle. Evolutionarily, a woman was not made to have a period. Way back in the day, a woman was meant to get her first ovulation as a young girl, get pregnant for 10 months, have the baby and breast feed for a period of time, then get pregnant again. The period only means that a pregnancy wasn’t accomplished. The same effect can be achieved by taking pills continuously. The “period” during a birth control pill month isn’t a true period anyway. Its simply bleeding because of withdrawal from the hormones, and it is in no way necessary.

When is the man pill coming out? What Dr. do men go to for that?

The male pill is still not on the market and there is no set date for it to become available. Most likely general practitioners or internists will be in charge of prescribing it when and if it is made available.

What form of birth control do you recommend most often?

I am a big supporter of IUDs. It is basically like tying tubes, but completely reversible. I talk to all my patients, young and old, those with 4 children and those who have never been pregnant, about the option of IUDs. After that, I like to recommend a low dose birth control pill, usually LOESTRIN-24 because of its low dose and mild, symptom-avoiding hormones. Of course, pills are VERY trial and error and one woman’s savior pill is another woman’s nightmare.

Do your recommendations change after a woman has given birth?

My recommendations are exactly the same postpartum.

Is the sponge still around?

The sponge has been off the market for many years.

And we know about condoms. Any advice that we may not know about them? Any particular brand better than others?

Mainly, just to use them properly and EVERYTIME and from the beginning. Pregnancy can happen with “just the tip”, believe me on this one! As far as brands, there are many with different characteristics and lubricants, etc., but just make sure that they are latex, as the lambskins condoms do not prevent the HIV virus from passing through.

What other forms of birth control are out there that aren’t as commonly known?

Besides pills and the IUD, there is the vaginal ring (Nuvaring) which is a small plastic/rubber ring that goes in the vagina and stays for three weeks at a time, the hormones being absorbed through the vaginal wall. There is also the patch, which is changed weekly. Also the diaphragm and cervical cap, though these methods only offer around 90% effectiveness compared to over 98% with proper use of the pills/ring/patch and 99% of the IUD. For even longer term contraception, there is the Depoprovera injection, which is progesterone only and given every three months, as well as the newer Implanon, which is a 3 year forearm progesterone-only implant. These two methods are also good for women with medical conditions where estrogen is contraindicated. Lastly, there is old fashioned sterilization for the woman (laparascopic, postpartum or hysterscopic) or man (vasectomy) — which should always be thought of as permanent.

Listen, the hubby and I can’t handle a fourth baby, so I need the straight up truth: In your experience, what type of birth control has resulted in babies – in other words, the big OOPS – the most often (other than the “method” or “pulling out,” but actual birth control)?

Failures are most often associated with human error, i.e., condoms not put on properly or on time, pills taken at the wrong time or missed altogether, etc.

Famously flown to Namibia to deliver Brad Pitt and Angelina Jolie’s baby Shiloh in 2006 as well as appearing on Tori Spelling’s reality show, Jason A. Rothbart, M.D. is an Obstetrician/Gynecologist in Los Angeles. He attended college at the University of California at Davis, and medical school at The Chicago Medical School. He was trained in obstetrics and gynecology at the University of Southern California in the Los Angeles County Medical Center. He is back home practicing minutes from where he grew up, and has a wonderful practice with all ages, and is currently on the surgical and obstetric staff at Cedars-Sinai Medical Center.

Breezy Tip: As Dr. Rothbart mentions, what’s right for one woman may not be right for another, so please discuss any options with your own OB.

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