Birth Control Secrets


TCW’s Top 10

Contraception has come a long way since the first FDA-approved birth control pill in 1962. For example, did you know the 30-day pill pack was fashioned after the widespread belief that women must bleed for seven days and not deviate from the ‘normal’ menstrual cycle? In reality, any menstrual cycle between 21-35 days is physiologically normal.

Contraceptive technology has evolved and today there are many safe, discrete hormonal options. The list includes birth control pills (combination pills of estrogen/progestin or progestin only pills), patches, vaginal rings, implantable devices in the arm, injectable medications (even self injectable meds), intrauterine devices (IUDs), one non-hormonal IUD and office-based tubal ligation.
Beyond the benefit of reproductive freedom, there are ways your birth control option could be helping…or harming you. What other secrets are lurking amidst the most commonly prescribed contraceptive medications for young and mid-life women?

1. Cancer prevention in pill form.
Despite numerous studies, no multivitamin has been shown to reduce risk from any cancer. Birth control pills do. Ovarian cancer risk decreases 20 percent for every five years of use, endometrial (uterine) cancer risk decreases 50 percent and colon cancer decreases 18 percent. For women with hereditary breast or ovarian cancer carrying the BRCA1 or 2 gene mutation, birth control pills significantly reduce ovarian cancer rates. The progestin IUD is a treatment for women with endometrial thickening with pre-cancerous changes. None of the hormonal contraceptives increase rates of breast cancer.

2. fewer or no periods are okay. Period.
My former colleague and guru in the field of women’s health, Holly Thacker, MD, Cleveland Clinic, used to say, “If you want to give blood every month, go to the Red Cross.” Translation: There’s no medical necessity to have a period every month. It’s medically safe to take an extended-cycle pill (no periods for three months) or a continuous pill (no period for one year.)

3. It helps with acne.
All estrogen-containing contraceptives can help acne, and certain formulations are better suited than others. Ovaries secrete both estrogen and testosterone. Any estrogen hormonal contraceptive (pill, patch, ring) will shift the balance of those two hormones and alleviate stubborn acne, particularly along the jawline and forehead.

4. Smoking puts you at risk.
Using cigarettes and estrogen containing contraceptives is an absolute no-no for women over 35, even if you’re a ‘social smoker,’ because your risk of stroke is significantly elevated. Smoking is also linked to lower bone density and more symptomatic peri-and post-menopausal hot flashes.

5. “Everyone takes the pill – so should I.” Wrong!
Many women request the same pill their best friend, neighbor, yoga buddy or hairstylist recommends. However, the decision of a contraceptive is like buying jeans, no size really fits all. A more effective option for women who want to delay pregnancy for a few years is an IUD. Other IUD perks: One less thing to remember every day and significant reduction in menstrual bleeding and cramps. In fact, 33-50 percent of progestin IUD users have no bleeding after one year. And you don’t need to have undergone the joys of childbirth before having an IUD. Particularly a new, smaller three-year IUD is perfect for young women and even teens.

6. Obesity matters.
Americans are getting fatter, which predisposes us to heart disease, diabetes and osteoarthritis. In addition, being overweight increases complications of pregnancy and delivery. Evidence shows that an IUD or hormonal implant is a safer, more effective birth control option for obese women (body mass index over 30).

7. The blood clot myth has been debunked.
A blood clot in the leg (deep vein thrombosis) or lungs (pulmonary embolus) is a very rare risk of any hormonal contraception, including postmenopausal hormone therapy. The World Health Organization rates the risk of blood clot among oral contraceptive users to be very rare. Usually women who develop a blood clot on birth control have an underlying hereditary blood condition that is unmasked by taking an estrogen-containing contraceptive.

8. Older women are still at risk for unexpected pregnancy.  
The average age of menopause in this country is 51.5 years. During the menopause transition (one year before the final menstrual period) and peri-menopause (which can last years) women ovulate less frequently and with poorer quality eggs. Thus, although pregnancy is less likely to occur, women in their 40s are the second most common cohort (behind adolescents) in the rate of unexpected pregnancy. Most are shocked to hear this statistic, but it’s true.

9. Mixing antibiotics and birth control is risky.
The last thing you want to worry about when you’re feeling feverish and need an antibiotic is if your birth control won’t work as well. Liver enzymes break down birth control pills and many other medications. The truth is most common antibiotics (except rifampin) don’t cause an interaction. But medications known to decrease the efficacy of birth control pills are: phenytoin (Dilantin), carbamazepine (Tegretol) and toprimate (Topamax). Birth control pills can decrease blood levels of lamotrigine (Lamictal), increasing risk of seizure if you have epilepsy. Let your health care provider know if you take any of these medications.

10. There’s a ‘Plan A’ and ‘Plan B’ for everyone.
Recently the age restriction on access to ‘Plan B’ or emergency contraception (EC) was lifted. Now women of all ages can purchase EC over the counter. It works best within 72 hours of unprotected intercourse. Remember Plan A is having a reliable, contraceptive that doesn’t require Plan B or pregnancy alarms.  n


About Kristi Tough DeSapri, MD

Kristi Tough DeSapri, MD, is an internist and director of The Bone Health Center at Gynecologic Specialists of Northwestern. She is also a certified menopause practitioner and on faculty of The Feinberg School of Medicine at Northwestern University. Her interests include internal medicine, menopause, osteoporosis, preventative medicine, sexual dysfunction, women's health and women's reproductive health.