Posts tagged ‘gynecology’
Learn more about Minimally Invasive and Robotic Surgery
I’d like to invite you to my website www.MinimallyInvasiveGYN.com
I’m a strong believer in laparoscopic and robotic surgery for a single, simple reason. It’s better for the patient. Minimally invasive surgery, a catch-all term which includes laparoscopy, hysteroscopy, and robot-assisted surgery, has proven benefits.
The benefits of minimally invasive surgery, compared to conventional “open” surgery include:
• less post-operative pain
• reduced need for pain medication
• faster return of normal appetite and bowel function
• smaller incisions
• less scarring
• faster recovery and return to work
Robotic surgery in particular has advantages which allow the surgeon to perform more complex procedures via a laparoscopic approach than might otherwise be possible. The robotic system gives the surgeon the benefits of:
• greater magnification with the laparoscopic camera
• 3 dimensional (3D) vision
• greater range of motion for laparoscopic instruments
• increased comfort, which may reduce a surgeon’s fatigue during long procedures
• reduction of biologic hand tremor
The robot doesn’t bear much resemblance to what we’ve come to expect from science fiction. It doesn’t have artificial intelligence and it cannot operate independently. In fact, the robot is just another instrument. It is controlled by the surgeon who sits at a console next to the patient.
The Da Vinci Robotic Surgical System
The robot has arms whose attachments are miniature versions of conventional surgical instruments (i.e. scissors, clamps, needle and suture-holders). These tiny instruments mimic the surgeon’s movements at the console (but on a much smaller scale). This allows the surgeon to perform surgical procedures with extraordinary precision.
Laparoscopy revolutionized surgery by making many major surgeries into outpatient procedures. Robotic surgery is revolutionizing laparoscopy by broadening the range of surgeries which can be performed with a minimally-invasive approach.
Take charge of your health by learning more about minimally invasive and robotic surgery. An educated patient is an empowered patient!
So, you think you have heavy periods?
Whenever I ask a patient “do you have heavy periods?” I feel like I deserve the kinds of answers I receive. I’m just as likely to hear “Yes. I have to change a panty liner every few hours.” As to hear, “No. I only go through one box of super-overnight maxi-pads per day now. It used to be two boxes.” Which is to say that every woman perceives whether or not her periods are heavy through the filter of her own personal experience.
So, what exactly is a heavy period? Well, the standard definition is a period that lasts longer than 7 days or in which a woman loses more than 80 millileters of blood. The first definition is easy. You just count the days on a calendar. The second is much more difficult to determine. (Unless you go wringing your sanitary products into graduated cylinder flasks. In which case, maybe you need a psychiatrist, not a gynecologist.)
So, how is the average woman to know what constitutes a truly heavy period? If you’re saturating your pad or tampon every hour, it’s a good bet your period is heavier than average. Similarly, if you tend to bleed through your tampon, onto your pad, and soak your pants, you probably need to see a doctor (and a good dry cleaner).
There are lots of reasons why women get heavy periods. The medical term for them is menorrhagia. Heavy menses aren’t just an inconvenience. They’re a real medical problem which can result in anemia (a reduced blood count) and fatigue. They can also be a sign of other serious medical conditions.
Adolescents and teens may have heavy, irregular periods as they begin to establish their menstrual cycle. These natural fluctuations in the menstrual cycle are often temporary, and usually resolve when monthly menses begin over the next few months to years. Adolescents and teens with very heavy menses, or whose cycles do not become lighter on their own, may need to be evaluated for bleeding disorders, such as von Willebrand disease.
Women in their reproductive years may have heavy menses or irregular cycles because of hormonal conditions, such as polycystic ovarian syndrome (PCOS), which can cause irregular menses and heavy menstrual bleeding on the rare occasions when menses take place. Another hormonal condition which can case heavy menses is an underactive thyroid gland (hypothyroidism). Both of these conditions can cause excess weight gain. Being overweight (even in the absence of other medical conditions) can worsen heavy menstruation. This is because adipose (fat) tissue produces excess estrogen, thickening the lining of the uterus. When the lining is shed at the end of the menstrual cycle, heavier bleeding occurs.
Hormonal conditions may be suspected on the basis of a physical exam, history, blood tests, ultrasound (sonogram) or a combination thereof. A combination of medication and dietary and/or lifestyle changes may be helpful in regulating the menstrual cycle and reducing bleeding.
Certain medications can lead to heavy menses. Blood thinners (Coumadin, Lovenox) and Non-steroidal anti-inflammatory medications (Motrin, Advil, Ibuprofen and Aspirin) can increase menstrual bleeding. Missed doses of oral contraceptives can also lead to heavy menses or irregular cycles.
Some women have heavy menses due to abnormalities of the uterus and its lining. An endometrial polyp is a growth of tissue in the lining of the uterus. Because polyps have a rich blood supply, they can cause heavy bleeding either during or between menses. Uterine fibroids can also cause heavy menses. Fibroids are benign muscle tumors which can impinge on the lining of the uterus, causing heavy menstrual bleeding. They can also cause other symptoms (such as pain, pelvic pressure, frequent urination, miscarriage) which likewise bring them to a doctor’s attention. Both endometrial polyps and uterine fibroids are readily diagnosed by an ultrasound (sonogram). Bleeding due to polyps and fibroids can often be managed with the use of minimally invasive surgical techniques (such as hysteroscopy and laparoscopy).
The most serious cause of heavy menstrual bleeding, especially in women who resume menstrual-like bleeding after the cessation of normal periods (menopause), is endometrial cancer. This type of cancer is rare in women under the age of 35 and is much more common after menopuause. Endometrial cancer may be suspected on the basis of an ultrasound (sonogram). It can be diagnosed by a biopsy or by a surgical procedure called a dilatation and curettage (D and C). Endometrial cancer is often responsive to treatment when caught early.
In summary, heavy menses are very common. They may represent a normal variation in a healthy woman’s cycle, or they may be due to a medical condition which requires treatment. Attention from a skilled healthcare provider can help determine whether additional care is needed.
A Good Resource:
ACOG Guide to Abnormal Uterine Bleeding
One Last Cartoon:
Buyer Beware – Suspect Supplements and Hurtful Herbals
As an obstetrician/gynecologist, one of the things I do is take care of pregnant women. And, while this blog is dedicated to gynecology, I thought I’d share with you a cautionary tale about my recent care of a woman in her first trimester of pregnancy.
She was asked to try a remedy for morning sickness. The remedy is described on its own website as “a safe, non-addictive, FDA registered natural remedy containing 100% homeopathic ingredients formulated to relieve nausea (morning sickness) during pregnancy.”
I was asked to look at the product to determine if it was safe for my patient. At the bottom of a website with abundant testimonials and positive reviews, I found a list of ingredients. 5 of the 7 ingredients were safe and nontoxic. These were:
- Mentha pip (Mentha piperita– Peppermint oil)
- Ferrum phos (Iron phosphate — a nontoxic iron salt)
- Zingiber (Ginger)
- Nat mur (Natrium muriaticum, also known as sodium chloride, or table salt)
- Sucrose (Sugar)
Two ingredients posed serious potential health risks (regardless of pregnancy status). These were:
- Nux Vom (Nux Vomica– derived from the Strychnine tree). That’s right, I said strychnine. As in the stuff they use in rat poison and gopher bait. While very small doses of strychnine cause an increase in bowel motility, which can releive nausea, larger doses can cause neurological toxicity, seizures, and death.
- Nat Phos (Sodium Phosphate — another salt) Oral phosphates were widely used in bowel preparations for colonoscopy. They have been withdrawn in the United States because evidence suggests that sodium phosphate causes serious kidney damage, a condition called phosphate nephropathy.
I told my patient that I had serious concerns about the safety of the ingredients listed on the website. I told her that, although the remedy is very unlikely to cause injury in the small amounts in which it is administered (it is sprinkled on foods throughout the day), I could not recommend that she take it when safe alternatives exist.
And, just to clarify, I am not recommending for or against the use of this (or any other product) on this blog. I am sharing this anecdote to remind you to share with your healthcare provider ANY vitamins, nutritional supplements, herbal or traditional medicines you desire to take.
That’s because only a medical professional, who is familiar with your medical history and has an inventory of the other medications you may be taking, is qualified to help you determine whether a particular product is safe for you. He or she can determine whether the product interferes with other medicines you may be taking . Your healthcare provider may also have valuable instructions on how to take the product safely (i.e. on an empty stomach, not with grapefruit or acidic juices, etc.)
Vitamins and nutritional supplements are not governed by the same strict set of rules which regulate drugs and medications. While an herbal remedy, supplement or nutritional product may be registered with the FDA, this should not lead you to believe that a particular product is safe for you (or anybody else).
And, as for morning sickness, my advice to the patient was that peppermint tea, ginger ale, and ginger candies were likely just as effective and by no doubt safer than many of the specialty products marketed to relieve the gastrointestinal suffering of pregnant women. I also recommended small, frequent meals of bland, starchy foods.
As for over-the-counter treatments, I often recommend vitamin B6, which is safe and non-toxic. I often recommend this in combination with doxylamine (found in Unisom), an antihistamine which can alleviate nausea (especially when combined with vitamin B6), although it does cause drowsiness.
If that’s not enough, I said, call me for a prescription.
What happens in Vegas stays in Vegas (Sometimes)
I recently went to Las Vegas for a medical conference. Everywhere I went, I saw signs with the slogan “What happens in Vegas stays in Vegas!”. This led me to joke to one of my gynecologist friends– “Sure. Except if it’s herpes.”
I guess I thought that was funny at the time. But it occurred to me that it’s dangerous to propagate the idea that acting out (sexually or otherwise) is without consequences.
It’s not that there’s anything wrong with Vegas. And I’m not one to knock bachelor/bachelorette parties and a night of cocktails. But if being forewarned is being forearmed, then using a condom is some food for thought you won’t find at the $19.99 dinner buffet. And I’d like to give you, gentle reader, the skinny on a few souvenirs you don’t want to bring home with you.
Some sexually transmitted diseases can be cured with antibiotics. These include gonorrhea, chlamydia, syphillis and trichomonas. All of these can be diagnosed with simple tests available in your doctor’s office. Treatment of sexual contacts is important, and should occur for both partners at the same time. All can be prevented with the use of latex condoms.
Gonorrhea and chlamydia are often lumped together when discussing sexually transmitted diseased (STD’s). They are distinct diseases caused by different microbes, but are often found together in co-infections. Both can be asymptomatic. When symptoms occur, they often show up 2 to 3 weeks after infection. Common complaints include
- A yellow vaginal discharge
- Painful or frequent urination
- Burning or itching in the vaginal area
- Redness, swelling, or soreness of the vulva
- Pain in the pelvis or abdomen during sex
- Abnormal vaginal bleeding
- Rectal bleeding, discharge, or pain
Gonorrhea and chlamydia are diagnosed by laboratory analysis of samples taken from the cervix using a cotten swab. Timely treatment of gonorrhea and chlamydia can prevent infertility, which can be a complication of advanced infection. Treatment is usually oral medication or a combination of oral medication and a shot (like a flu shot) given in the arm. Advanced infections may need to be treated in a hospital with intravenous medication.
Syphilis first appears as a painless genital sore called a chancre (pronounced like “shank-er”). It lasts 10 days to 6 weeks after contact with an infected partner. Swollen lymph nodes in the groin m ay also occur. A rash on the palms and soles (of hands and feet) occurs durng a second stage of infection 1 week to 3 months later. Flat warts or a flu-like illness may occur at this time. Syphillis can be diagnosed with a combination of physical exam and blood tests. Early treatment is important to prevent long-term problems including birth defects in children of infected mothers. Treatment usually consists of antibiotics given as a shot (in the arm or buttocks) and may need to be given more than once.
Trichomonas vaginitis is a microscopic parasite that is spread through sex. Many people have no symptoms of trichomonas. When symptoms do occur, they include discharge from the vagina and vaginal itching and redness. Trichomonas can be diagnosed on a vaginal exam (sometimes in combination with testing samples of vaginal fluid). Treatment usually consists of oral antibiotics or an antibiotic gel which is placed in the vagina.
Some sexually transmitted diseases can’t be cured. Usually, these are due to viruses.
Human Immunodeficiency Virus (HIV), Human Papilloma Virus (HPV), Herpes Simplex Virus (HSV), and Hepatitis B and C can all be sexually transmitted. All can be treated with medication, but none can be cured.
Human Immunodeficiency Virus (HIV) is the virus that causes AIDS (Acquired Immunodeficiency Syndrome). Transmission can occur during intercourse. It is possible for transmission can occur through orogenital (oral) sex too. Anal sex is particularly risky. Transmission rates can be significantly decreased with the use of a latex condom. It can be diagnosed with a blood test and is treated with antiviral medications. Untreated, it can cause compromise of the immune system, illness, and death.
Human papillomavirus (HPV) is one of the most common STDs in the United States. There often are no signs of genital HPV. However, a few types of HPV cause warts. These can appear on the vulva, vagina, cervix, and anus. In male partners, they may occur on the penis, scrotum, or anus.
Sometimes warts go away on their own. If they do not, there are several treatments for warts available at your doctor’s office. Treating yourself with over-the-counter wart medications (compound W etc.) is NOT recommended.
Even after the warts have cleared up, the virus may be present. The virus can remain in the body for weeks or years without any symptoms.
Certain types of the HPV virus are associated with an increased risk of cervical cancer. HPV also may be linked to cancer of the anus, vulva, vagina, penis, head, and neck.
Some types of HPV infection and pre-cancerous changes in the cervix are detected with a Pap Smear or Pap Test. So while your Pap Smear doesn’t test for sexually transmitted diseases per se, it can diagnose HPV-related conditions.
If abnormalities associated with HPV are found on your Pap Smear, your doctor will discuss diagnosis and treatment options with you. You may also want to discuss the HPV vaccine, which prevents several types of HPV infections, and can be given to most girls and women aged 9-26 regardless of whether they have had an HPV infection in the past.
Herpes Simplex Virus (HSV) causes herpes. It also causes “cold sores” on the face and mouth. Although people sometimes refer to the HSV 1 virus as “oral herpes” and the HSV 2 virus as “genital herpes”, both viruses can cause lesions in both areas, so this distinction isn’t particularly useful. The best description is to say that genital herpes is any herpes ocurring on the genitals, regardless of virus subtype (1 or 2).
The most common symptom of genital herpes is a sore on or around the genitals. These sores are often multiple, usually red or blister-like, and may be itchy or exquisitely painful. The sores can last from a few days to a few weeks. Herpes can be diagnosed by a combination of physical exam, viral culture of open sores, and blood tests.
The symptoms go away by themselves, but the virus remains in your body. The sores may come back at any time, usually in the same place they first occurred. Treatment can help heal the sores and reduce the number of future outbreaks, but it cannot kill the virus.
A person who has herpes can transmit the virus even in the absence of symptoms. If you or your partner have oral or genital herpes, avoid sex from the time of first symptoms until a few days after the scabs have gone away.
The Hepatitis B and C viruses can also be transmitted by sexual intercourse. Hepatitis may occur with limited or no symptoms, but often leads to jaundice, anorexia (poor appetite) and malaise. Hepatitis is acute when it lasts less than six months and chronic when it persists longer. Chronic hepatitis may be asymptomatic, but can cause cirrhosis (scarring of the liver), liver failure, liver cancer, and death. Hepatitis B and C can be diagnosed by blood tests. Treatment is directed at reducing symptoms and slowing the progression of the disease.
The Hepatitis B vaccine reduces the risk of contracting hepatits and is widely available. It is recommended to all children and to high-risk adults (those with multiple sexual partners, who use intravenous drugs, or who are in occupations which may involve exposure to blood or other bodily fluids). There is no hepatitis C vaccine.
Hepatitis A, by the way, is not sexually transmitted. It is food-borne and does not result in chronic infection. It causes an acute gastrointestinal illness and is often contracted by eating undercooked shellfish. So, You can still get it in Vegas. You’re welcome.
So, remember, there are some souvenirs nobody wants to bring home from vacation (or any other encounter). If you have a new sexual partner or have any other reason to think you may be at risk for sexually transmitted infection, visit your heathcare provider for simple tests.
And since I started this post with a poorly conceived joke, I’ll end with one. Practice safe sex: Use your head (and use protection when giving it)!
How do I find a good gynecologist?
I always ask new patients, “How did you find me?” The answers I get are fascinating. Some patients see me because their friend is my patient and they were told I am a good doctor. Others are referred to me by their primary care providers or other specialists. Some patients picked my name out of a register of providers in their insurance network. Still others found me on the internet.
It all seems so random. There are so many doctors out there and so many ways to pick from among them. But (besides getting a recommendation from a doctor, friend, or family member you trust) what’s the best way to pick a doctor? And once you’ve selected one, how can you check-up on the person who does your check-ups?
The importance of finding a good gynecologist can't be understated!
There are certain things I look for when choosing a doctor. For one thing, I’d like somebody who takes my health insurance. If you don’t have coverage for out-of-network providers, it can be a burden to pay “out-of-pocket” for health services. (It may be worth paying extra to see a doctor with special training or qualifications, but that depends on your healthcare needs and your ability to cover the cost.)
The website for your health insurance company probably lists covered providers in a database that can be searched by specialty and location. Always call the doctor’s office to find out whether a provider is in your network (or will accept your out-of-network benefits). Online lists may be out of date and include providers who are no longer in network and may not include providers who have joined more recently.
If you don’t have health insurance, you can call a doctor’s office to inquire about his or her fees before the visit. Also ask about additional fees for lab work or pathology (which can be important if you are having testing for sexually transmitted diseases, are having a Pap smear, or need a biopsy). Otherwise you may be surprised by the amount you are charged at check-out or by mail a few weeks later.
Once you have selected a few possible providers, you’ll want to find out a little more information about them. Many providers have a website for their practice or have a bio posted on a hospital website. This information may help you learn where the doctor went to college and medical school. You can also find out where he or she completed residency (and in which specialty), and where any fellowship or advanced training took place.
The government is also checking up on your doctor. This is done through a process through which physicians must apply for and maintain a license to practice medicine in a given state. Physicians submit information to the state medical board who evaluate the adequacy of a physician’s training. They also seek to know whether a physician has been convicted of a crime, and whether he or she is fit (physically, mentally) to practice.
Most physicians will make their state license readily available, often displaying it in their office. The medical board of most states also offer a site online where you can look up a physician by name. The American Medical Association has a site where you can find a link to your state medical board. Physicians can (and often do) hold licenses in multiple states.
Whatever you do, make sure your doctor makes you comfortable at the time of your visit. A positive relationship with your doctor is key to making good health decisions!
Whose advice are you taking anyway?
Hello all! Sorry I’ve been out of touch for a while. After a brief vacation, I think I suffered a sense of discouragement under the impression that my blog was being frequented exclusively by my facebook friends (thanks guys! keep reading!) and not reaching anybody new.
So imagine my surprise and joy when a patient came to my office with the following request “I want an IUD like you describe on your blog.” No way! Somebody who had never met me read my blog, liked what she read, and acted upon it to improve her healthcare. Wow.
So that got me thinking about how people find health information on the internet and who they go to when they seek healthcare. So many of my patients come in to the office with questions they think about after a perusal of others’ internet blogs and Mommy/Baby related bulletin boards. They often quote something they saw on ‘The View’ or mention an advertisement on T.V.
I want you to be careful what you read. Obviously, an advertisement is aimed to sell you something. But I’m not just talking about the pharmaceutical company ads that suggest you allow a fluorescent green butterfly to lull you to sleep.
If you read somebody’s post or watch a T.V. segment and think “Hey, now there’s something I should do!” you should first consider the following: Who is this person giving advice?
Is it a doctor? Not everybody who calls themself a doctor is a physician. Then again, as Dr. Evil (from the Austin Powers movies) so succinctly puts it “I didn’t spend 4 years in Evil Medical School to be called Mister Evil.”
Dr. Evil
Any person who received a doctorate in any field of study can call themself a doctor. For example: Dr. Ruth completed a PhD in psychology and a masters in sociology. She can give you great advice, but she can’t write you a prescription and won’t do your pap smear. Remember “Ross” on friends? He was Dr. Geller, a PhD in paleontology. You wouldn’t let him give you medical advice of any kind, would you? Unless you were a dinosaur. (And don’t get me started on Dr. Phil, who also has a psychology degree and who also is not performing my pap smear.)
In contrast, Dr. Mehmet Oz, Dr. Drew Pinsky and even Dr. 902010’s own Dr. Robert Rey have medical doctorate (M.D.) degrees. They are physicians, like me. Wait, did I just say Dr. 90210 is like me? Well, nevermind. But eew.
A physician can also be a D.O. (doctor of osteopathy, a degree which is essentially identical to an M.D.). A physician may call him or herself by a first, last, or nickname. But they’ll all tell you about their hard-earned degree and extensive medical training. That information is usually also available by reading their bio (see mine) on a website, on Google, or by looking at their degree-covered wall. My Mom made sure all of mine had matching frames. Seriously.
Most practicing physicians have completed a residency in some field of medicine (Internal Medicine, Neurosurgery, Dermatology, Obstetrics/Gynecology, etc) which can take three to seven-plus years of training in addition to the four years spent in medical school. That’s a whole lot of years devoted to the study and practice of medicine before anybody is going to let you hang up your shingle. And even then, you definitely want to check out your doctor before you check in for a visit (more on that in my next post, but kudos to me for the pun).
Is it a nurse? Nurses also give great medical advice. A nurse may have L.P.N. (licensed practical nurse) or R.N. (registered nurse) after her name. A nurse practitioner has had additional training and may add N.P. Back in the old days, each nursing school had a different shape of those white nursing caps you still see in old movies. A nurse was literally wearing her bona fides on her head. Nowadays, a person who calls him or herself “Nurse” will usually be proud to tell you of her hard-earned degrees and outstanding qualifications.
Julianna Margulies (as Nurse Carol Hathaway on E.R.)
On the other hand, a lot of information on websites, blogs and bulletin boards comes from people just like you. Patients who may or may not have any formal medical knowledge can use the internet to share information and help other people who may find themselves in similar circumstances. This is incredibly empowering. Learning about other people’s experiences can lead patients to ask better questions, seek alternative treatments, and otherwise ensure that the care they receive is the best available.
But beware of negative posts describing the unfortunate experience somebody had with a disease, doctor, hospital or medication. The internet is often a place where posts describing gripes far outnumber those recounting tales of successful care. People who are pain-free, pregnant, or otherwise relieved of their health woes are less likely to spend hours on the computer blogging/posting about it. They are often busy working, raising children, and enjoying their family and friends.
A person who is dissatisfied with her care may have ample reason to be unhappy. People out there really get crappy care/luck sometimes, and some of the things I read absoultely break my heart. But if there’s supposed to be a take-home message from somebody’s post, you’ll want to find a reliable source against which to check it.
So if you see something on the internet that sounds like somebody giving you advice, it’s best to talk it over with somebody who is is medically knowledgeable and trustworthy. And I’m going to hope your doctor or nurse is one of those people.
Progesterone In Your Pill: If the shoe fits, wear it!
So, what makes one combination oral contraceptive pill (OCP) different from another? What’s the difference between brand-name and generic versions, if any?
The answer generally boils down to one word: progesterone. How do we know this? Because the chemical composition of the estrogen component of almost every OCP marketed in the U.S. is exactly the same. It’s ethinyl estradiol. The only thing that changes from pill-to-pill is the dose (thus the idea of “low dose” pills, “triphasic” pills etc), as described in my previous post.
So, although all “low dose” OCP’s may contain 20 micrograms of estrogen, there are dozens of different kinds because each manufacturer uses one of eight different kinds of progesterone in each type of pill.
Progesterone
The type of progesterone is indicated by the second word in the pill’s generic name. For example, Loestrin is ethinyl estradiol and NORETHINDRONE. Other pills have other progesterone components (i.e. Ortho-Tri-Cyclen and Ortho-Tri-Cyclen-Lo contain NORGESTIMATE, Yasmin andYaz contain DROSPERINONE). You get the idea.
So, why do we need so much variety? Can’t everyone just use the same pill in different doses? Like Advil or Tylenol, just use a higher dose if you need more of it?
Well, it’ s not that simple. The dose isn’t the important thing (it’s usually low, about 1-2 mg). It’s the differences in the chemical characteristics of the progesterone that make each pill unique and separate it from its similar contraceptive cousins.
Some progesterones have a higher level of “progestational activity.” This means the degree to which it binds with progesterone receptors in the body. In addition to preventing pregnancy, stronger progestational agents can lessen menstrual bleeding, reduce acne, lessen excessive hair growth, etc.
Some progesterones have an effect on blood levels of potassium or cholesterol. Some can increase a person’s risk of blood clots. These risks and benefits are an important topic to discuss with your gynecologist (or other prescriber).
As if things weren’t confusing enough, generic OCP’s have active ingredients (estrogen and progesterones) which are chemically identical to the brand-name version. They are, however, made by different manufacturers. They may contain different additives or be formulated in a slightly different way.
That’s why some people find that, while the brand name version worked well for them, different symptoms occur when they switch to the generic version(or vice-versa). This means you may need to pay more (or less) for the version you prefer. The cost difference can be significant ($50 or more!), so consider the choice carefully.
It’s often difficult to predict which oral contraceptive (and which progesterone) will work best with a particular person’s chemistry. While your gynecologist (or other provider) can often guide you toward picking an oral contraceptive which is the most likely to satisfy your partiuclar needs, sometimes, it’s necessary to try out a few different types before you hit on a pill that you like.
But when you do… Wow. It’s like Cinderella fitting perfectly into that glass slipper and living happily ever after. And not getting pregnant on that pumpkin-carriage ride home.
Happily Ever After
Why are there so many different types of oral contraceptives? – The Estrogen Equation
Well, if you’ve read my previous post (which I’m sure you did!) you already know that the two main components of combined OCP’s are estrogen and progesterone. What makes each type of pill distinct is the way in which these two components are dosed and formulated. In this post, let’s discuss only the estrogen component. We can talk about the progesterone later.
Combination OCP’s can be described as low-dose, medium-dose or (rarely) high-dose. This refers to the dose of estrogen in the tablet. A low-dose pill usually contains 20 micrograms of estrogen. Medium dose pills contain between 30 and 35 micrograms. Higher doses can go up to 50 micrograms.
Why does it matter? Well, a low-dose pill is great for somebody who needs the pill for pregnancy prevention, but doesn’t require the higher doses needed to suppress other conditions (like endometriosis or excessive menstrual bleeding). A low dose of estrogen also minimizes the risk of complications from oral contraceptives (such as an increased risk of blood clots and other potentially life-threatening medical conditions).
So, why wouldn’t everyone choose to take a low-dose pill? Some women taking low-dose pills may not have bleeding during the week of placebos (inactive pills) because the low dose of estrogen keeps the lining of the uterus (womb) very thin. Therefore, little tissue is shed (as menstrual flow) when the body withdraws from the estrogen. Amenorrhea (absence of a period) can be normal and healthy in this situation and is not a cause for concern in the absence of other symptoms.
In some women, bleeding between periods (metrorrhagia) may occur when the dose of estrogen is too low to stabilize the lining of the uterus between cycles. If this occurs, it doesn’t mean the pill isn’t protecting you against pregnancy. It just means you may need to switch to a different pill in order to reduce inconvenient or unpredictable bleeding.
Spotting or mid-cycle bleeding can also be more likely to occur on a low-dose pill if doses are missed or are taken late. Therefore a low-dose pill may be a poor option for women who can’t manage to take their pill on time every day. Obviously, back-up contraception (a condom, perhaps?) should be used when necessary.
Oral contraceptives with 30 to 35 micrograms of estrogen may be a better choice for women who need to suppress their menstrual cycles because of endometriosis, pelvic pain, excessive menstrual bleeding (menorrhagia), or who have had irregular bleeding on lower dose oral contraceptives.
If they dose of estrogen is the same in every pill, the type of pill can be called “monophasic.” Some oral contraceptives have a dose of estrogen which varies from the first to the third week (triphasic). These pills are meant to mimic the natural variation in hormones that occurs during a normal menstrual cycle. Whether a monophasic or a triphasic pill is right for you will depend on a number of factors which you may wish to discuss with your gynecologist.
Condoms: A little something for everybody
Condoms are one of the cheapest and most widely available methods of pregnancy prevention. They are a type of barrier protection. This means that they work by forming a physical barrier between sperm and egg. Most condoms are made of either latex or lamb skin and may be lubricated (or not) with spermicide (a chemical intended to kill sperm).
A condom is placed over the penis prior to intercourse. If the condom is put sometime in the middle of intercourse (ie prior to ejaculation), unintended pregnancy is still possible. This is because the penis does emit some pre-ejaculatory fluid which can (and often does) contain sperm.
Female condoms are also availabe. These are placed in the vagina and are held in place by a flexible plastic ring. They are a little more expensive than male condoms and a little trickier to put in place, but they work essentially the same way.
So if you choose to use condoms, the rules are
1. put one on before intercourse
2. leave it on until after intercourse is complete
3. use a new condom with each act of intercourse
4. never “double-wrap” with more than one condom at a time (this causes friction and can lead to breakage)
Condoms come in a variety of shapes and sizes. Some have features like flavor (a plus if you are using one to protect your partner during fellatio [oral sex]), texture (ie “ribbed for her pleasure”), color (to match your partner’s dress and/or eyes?), or glow in the dark (for… I don’t know what– A sudden loss of electrical power?!). In short, there’s something for everybody.
Condoms are cheap and, when used correctly, over 90% effective in preventing pregnancy. They are also one of the only methods of birth control that can also help prevent the transmission of a number of sexually transmitted diseases, including gonorrhea, chlamydia, HIV/AIDS, hepatitis, syphillis, HPV (human papilloma virus), herpes and other unpleasant nasties.
So what do you do if the condom breaks, falls off, or never made it out of your partner’s wallet? Plan B is a medication intended to prevent unintended pregnancy if used within 72 hours of unprotected intercourse. It’s more effective the sooner it is taken (ie 24 hourse is better than 48 hours is better than 72 hours). It contains progesterone, a hormone that is one of the 2 main components of conventional birth control pills.
Plan B is not the abortion pill and won’t bring an end to an already-established pregnancy. It is available over the counter at a number of major pharmacy chains nationwide. If you have questions about how to use it properly or how to make sure it was effective, or you need testing for sexually transmitted diseases, you should call your doctor.
The Gynecologist 