We have compiled a list of valuable tips so you can arm yourself with facts! As always, we are here to help seven days a week!

What are hormonal birth control pills?

Combined estrogen-progestin oral contraceptives (COCs), also known as birth control pills, provide reliable contraception as well as several non-contraceptive benefits. COCs contain an estrogen component and one of a dozen different progestins. For healthy, nonsmoking women, COCs may be continued until the age of menopause. The type of pill selection should include a patient’s experience with COCs, patient preferences, clinical characteristics, insurance coverage, and cost. Shared decision-making improves adherence to any contraceptive method.

How does the pill work?

The COCPs suppress ovulation by inhibiting gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and the mid-cycle LH surge. This effect is mediated by the synergistic action of the COC’s progestin and estrogen components.

How effective is the pill?

When taken correctly, COCs are a highly effective form of contraception. Although the perfect-use failure rate is 0.3 percent, the typical-use failure rate is more typically approximately 7 percent, due primarily to missed pills or failure to resume therapy after the pill-free interval.

Who should avoid taking the pill, and when?

We call these absolute contra-indications (Unacceptable risks: CDC – category 4 rating)  because of the risk of blood clots, stroke, and death!

• Undiagnosed abnormal vaginal bleeding (Irregular cycles or heavy bleeding)
• Age ≥35 years and smoking ≥15 cigarettes per day
• Multiple risk factors for arterial cardiovascular disease (such as older age, smoking, diabetes, and hypertension)
• Hypertension (systolic ≥160 mmHg or diastolic ≥100 mmHg)
• Venous thromboembolism
• Known thrombogenic mutations- genetic mutations that can cause blood clots.
• Known ischemic heart disease
• History of stroke
• Complicated valvular heart disease (pulmonary hypertension, risk for atrial fibrillation, history of subacute bacterial endocarditis)
• Current breast cancer
• Severe (decompensated) cirrhosis
• Hepatocellular adenoma or malignant hepatoma
• Migraine with aura
• Diabetes mellitus of >20 years duration or with nephropathy, retinopathy, or neuropathy.

When can you take the pill but under close supervision?

We call these relative contra-indications (CDC- Category 3 rating).

OCPs may be considered individually if no other acceptable alternative is available.

• Age ≥35 years and smoking <15 cigarettes per day
• Hypertension (systolic 140 to 159 mmHg or diastolic 90 to 99 mmHg)
• Hypertension adequately controlled on medications
• Past breast cancer and no evidence of current disease for five years
• Current gallbladder disease
• Malabsorptive bariatric surgery
• Superficial venous thrombosis (acute or history)
• Inflammatory bowel disease with risk factors for venous thromboembolism (active or extensive disease, surgery, immobilization, corticosteroid use, vitamin deficiencies, or fluid depletion)

I have a family history of breast cancer and/or have the BRCA gene-positive status.

A family history of breast cancer or BRCA-positive status is NOT a contra-indication. COCPs can help reduce the risk of ovarian cancer and colon cancer in such patients.

There are so many birth control pills; how do I know where to start?

Again, a healthcare professional knowledgeable about the types, side effects, and dosing can guide you properly.

Below is a primer to help you get armed with facts!

Types of Combination Oral Contraceptive pills and dosing.

There are three types of OCPs based on the dose of Ethinyl Estradiol in the pill.

Ethinyl Estradiol (Estrogen types)

• Ultra low dose (<20mcg)
• Low dose (20 mcg)
• Standard dose (30-35mcg)

Progestin types

• High androgenicity but low blood clot risk. – Norethindrone/ Levonorgestrel.
• Low androgenicity but slightly increased clot risk – Norgestimate/ desogestrel.
• Anti-androgenic – Drospironone/ dienogest/ cyproterone acetate

The overall effect of all COCs, however, is antiandrogenic (suppress testosterone), regardless of the type of progestin used

1. Oral Contraceptives (Mono-phasic)- these pills have the same dose of estrogen and progesterone throughout the cycle

First choice:

Low dose  – for routine use, low side effects

(Ethinyl estradiol/ desogestrel or levonorgestrel)

Generic –Microgestin Fe 1/20 x 28/ Junel Fe 1/20 x 28 days/ Alesse/ Mircette

Second choice: (if history of breakthrough bleeding)

Standard dose (30-35 mcg) –  Apri/ Microgestin – 1/30/ Junel 1/30

Ultra-low dose (10mcg) – Lo-loestrin.

This is usually preferred for patients unable to tolerate low-dose pills.

2) Oral contraceptives (Tri-phasic)

These pills have a different dose of estrogen and progesterone every week of the cycle. Below are some examples:

• Ortho-tricyclen Lo
• Camrese
• Tri-sprintec, regular or lo

Usually, these are not the first preference because of varying doses, but if you are already on one, there is no need to switch. 

3) Oral contraceptives – 3 monthly – Endometriosis/ chronic pelvic pain

Skipping the placebo in Monophasic pills is the best option.

Or

• Quattro (4 months)
• Seasonique ( 30mcg EE).
• Jolessa (3 monthly packs – 30mcg EE).
• Lo-loestrin – skip placebo.

4) Transdermal – These are the same as the pill but come as a patch.

If you have increased breakthrough bleeding / are forgetful/ have a busy lifestyle, you can miss pills/ have small kids/ shift workers/ PMS, etc.

XULANE patch 1 q weekly x 3 weeks, then one week off.

5) Transvaginal – If increased breakthrough bleeding / forgetful/ lifestyle – missing pills/ have small kids/ shift workers/ PMS

Nuvaring – 1 ring every three weeks in, one week off.

THERE is a LOWER  RISK OF THROMBOSIS WITH NUVA-RING -/ PATCH because it bypasses the liver, and there is constant absorption with stable serum levels. Avoids the peaks and troughs from oral absorption.

How should I start, and what should I watch out for?

• Start on the first Sunday after the period or Day 1 of the period. If start on Day 1 of period, will be protected in the same cycle. If Sunday start, use additional contraception in the first cycle. We do not recommend an early start or immediate start (even though many other providers do, we want to be safe).
• Take bedtime after meals (Never on an empty stomach).
• Initial few days – nausea/ increased appetite – body develops quick tolerance.
• Very low dose ones like Loestrin/ lo loestrin – you may have irregular spotting throughout the cycle for the first three months. Just wait it out. No need to change the pill.
• Some of you may have decreased libido, hair fall, and weight loss.

I want to get pregnant; how long should I wait after stopping the pill?

COCPs do not cause infertility. There is no waiting time recommendation.

Always complete the pack when you stop the pills; otherwise, you can get irregular cycles.

I am 50 years old and on the pill. How do I know I am in menopause?

• If you need to check for menopause, stop OCPs for at least six weeks and then get blood work done with your provider to check for FSH and Estradiol levels.

I am on the pill. Can I still get STDs?

No, OCPs do not offer protection against STDs.

I have severe PMS. Will the oral pill help?

NO! That’s a myth!!!

Check out our PMS blog to learn more!

Do pills help with Acne?

Yes, if the acne is from high testosterone

Prefer Low androgenic and monophasic types.

Example: Junel 1/20 ( Desogestrel containing).

*https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf

How do I know if any other drugs that I am taking can affect the pill?

It’s hard to know! That’s why you should consult your healthcare provider. Still, we have compiled some interactions to watch for:

DECREASED EFFICACY (High chance of failure)

The efficacy of COCPs may be decreased by any drug that increases liver microsomal enzyme activity.

Anticonvulsants :

Anticonvulsants that reduce the efficacy:

Phenytoin, carbamezapine, barbiturates, primidone, topiramate, felbamate, or oxcarbazepine.

If using OCPs with above anticonvulsants:

• Use a standard dose OCP with a minimum of 30 mcg of ethinyl estradiol + progestin with a longer half-life (drospirenone, desogestrel, levonorgestrel).
• Skip placebo or preparation with a four-day hormone-free interval.

Anticonvulsants that do not appear to reduce contraceptive efficacy:

Gabapentin, levetiracetam, valproate, zonisamide, and tiagabine.

Lamotigrine and OCP’s

COCs can result in a decrease in plasma lamotrigine concentrations by 45 to 60 percent. This can increase the risk of seizure.

• Consult with neurology to adjust dosing.
• To avoid fluctuating lamotrigine levels, continuous dosing of the COC rather than cyclic is recommended.

Antibiotics

Rifampin is the only antibiotic proven to decrease serum ethinyl estradiol and progestin levels in women taking COCs (due to enzyme-inducing effects).

Antiretrovirals – Refer to current texts.

 St. John’s wort –May increase the risk of ovulation.

Useful things to remember:

1. If you have irregular cycles or bleeding between cycles or after sex, it’s essential that you see a GYN for a complete evaluation, including an ultrasound and blood work!
2. If you are obese or overweight patients – please get blood work to rule out pre-existing elevated liver enzymes.
3. NEVER do an immediate start.
4. If you miss one pill, take two the next day and finish the pack. If you miss two, finish the pack but use additional protection in that cycle.
5. With many pills, your periods may get lighter and may even go away, but please do a pregnancy test to confirm.
6. Try and take the pills at the same time every day – set an alarm on your phone.
7. Pills do not cause weight gain by themselves, but if your body is not a good estrogen metabolizer, you may experience bloating breast tenderness, and water retention.

Overall, it’s great to have easy access to hormonal birth control, but please remember to be well-informed!

Be safe, be strong, and be prepared!

Dr. Adeeti Gupta and the lovely team at Walk In GYN Care

The post Oral Contraceptive Pills!! Must know facts! appeared first on Walk In GYN Care.

Some checklists should never get old. Here is a reminder for all women out there. As we start yet another year, we need to remember that we, women are the foundation! Our health is paramount for all those around us. So, we decided to post a friendly reminder to you to get rocking! Here is your go-to check list for 2021. #womenshealthispower

1. Get that PAP– Cervical cancer is still one of the leading causes of genital cancer deaths in women. A cervical swab to test of abnormal cells and HPV can help in early diagnosis and treatment. It’s not fun but our compassionate team will make the process as comfortable as possible. We understand!
2. Do not forget your birth control – Whether they are refills for your pills or time for the IUD to be changed or time for the next shot, do not let the dates slip. Missing pills or being late for your shot can lead to accidental pregnancies. So, dig into your wallet for the next appointment card or just walk in!
3. STD testing – As we mentioned last month, 2019 saw the rates of syphilis related newborn deaths rise by 126% and 376 women newly diagnosed with HIV with nearly 500 deaths attributed to the deadly disease. We all tend to think that those STDs happen only to someone else. We could be that someone! Don’t become a number! Get tested, ask for PREP (HIV prevention meds) and ask your partner to be tested. There is no shame in safety!
4. Stock up on those supplements- Vitamin D deficiency has been associated with diabetes, depression and dementia. Probiotics help keep your gut and above all that vagina healthy wealthy and wise! Visit our website for a full list of what is needed and when 
5. Get physical– Take that walk, do some jumping jacks or do that favorite yoga pose you have been missing out on because you been stuck at home working or caring for your loved ones! It takes only a few minutes out of your day and gives you 10X the benefits. The ROI on that one…. Is a no brainer 

If you have lost your insurance, don’t want bills for STD tests reaching your house or have a high deductible, just walk in and ask us for our, “Well Woman Package”. We specially designed this package to cover your pap, STD testing and an ultrasound so you don’t have to worry!

#wegothis

Be safe, be strong and be prepared!

Your team at Walk In GYN Care

The post New Year, new goals…. Old checklists!!! appeared first on Walk In GYN Care.

The post Covid-19 – Your questions answered! appeared first on Walk In GYN Care.