Birth Control Myths, Part 4: Wrap Up Q+A

So this is the final part in my series on birth control myths (Part 1, Part 2, Part 3). I covered all the major myths I wanted to, however I got a selection of additional questions regarding birth control – and since these seemed to be common questions people had, I wanted to do my best to provide information in response to those + give a list of some recommended resources from some of my followers who are truly experts on the subject (OBGYNs and more).

*Disclaimer: This blog is intended for informational purposes only. The information on this blog should not be used as a substitute to medical advice or medical treatment. As always, your Primary Care Provider, a doctor, or another health professional is your best resource for specific questions and medical advice. If you believe you or a loved one are experiencing a medical emergency, please contact 911.*

Q: What are the best (and worst) birth control options for breastfeeding moms?

A: Special shout out to Dr Yolanda Kirkham who stepped into to answer several of these questions via Twitter. Options include: the mini-pill (or progestin-only pill), copper or progestin IUDs, Depo-Provera, or the implant. Progestin-only is the go to for breastfeeding moms because they don’t interfere as much with milk supply. Generally speaking, you would start this at your 6-week postpartum appointment when you are usually discharged from OB or midwifery care back to your PCP.

Of course, there are always the non-hormonal options which have been discussed in my previous posts as well – this is something you can discuss with your maternal care provider at your discharge appointment, or your PCP at any point while you’re breastfeeding. Keep in mind, they won’t be as effective as the options listed above but there are many factors to consider when deciding what birth control is right for you.

Q: If I have a C-section, do I have to wait 6 weeks to resume having intercourse?

A: The same recommendation is given to women post C-section as to women post vaginal delivery – wait 6 weeks before you have sex. This is because, even though you did not deliver vaginally or you may not have as much bleeding as someone who did, there is still a risk for infection because your cervix is still slightly open and your uterus is still healing. If you have questions or concerns regarding your specific situation or delivery, ask your OB or primary care provider.

The other reason you’d want to wait is because you are probably not on birth control yet – if you are planning to use it. If you are going with a non-hormonal method, you should still be seen by & get the OK from your doctor before going forward with intercourse in the immediate postpartum period.

Q: If I’m on a hormonal oral contraceptive, do I need to be take extra precautions while using prescribed antibiotics?

A: This is an old study but it was confirmed by Dr James Smith, OBGYN, on Twitter – this is mostly a concern with rifampin, which isn’t used very commonly. There are a few others that may reduce their effectiveness – so follow the advice of your prescriber/pharmacist about using back-up contraception if needed.

There are other drug interactions with oral contraceptives. That is why medication reviews with your PCP or pharmacist are very important. It is also important to always report any medication you are taking to the person prescribing you contraceptives, as well report any over the counter medications, herbs or supplements you may be using.

One example is St John’s Wort which can decrease the effectiveness of oral contraceptives.

Q: Can doubling my birth control dose work like the morning after pill (emergency contraception)?

A: Yes but it is pill dependent (and you should check with your provider). The Yupze regimen is a formula for emergency contraception that does use a combination pill – however, your pill may not contain the correct dose of ethinyl estradiol or levonorgestrel to actually meet the requirements for this purpose.

Long story short – yes this is a real thing, but follow the recommendations of your provider. Also there is Plan B – which is levonorgestrel in the appropriate dose.

Also no – this is not an “abortion pill”. Plan B is meant to be taken within 72 hours of unprotected (or accidentally unprotected) intercourse – it can stop ovulation temporarily and prevent pregnancy. If you are already pregnant or think you might be, this is not for you. Contact your provider or trusted pharmacist for more information.

Q: Why do some forms of birth control impact women more than others (mood swings, acne, irritability, etc.)?

A: Because everyone reacts differently to medications, especially hormonal ones. Each oral contraceptive also acts differently in the body and has different levels of different hormones. The amazing Dr Kirkham provided a great resource for this here.

She noted that if you are having issues with for example, mood swings, you may need to decrease the amount of progestin in the oral contraceptive – this would involve you having to try another option. If acne is a problem, a pill with less androgens would be better. Sometimes extended-cycle pills are a good option with problems like headache or nausea. Trial and error is a big part of oral contraceptives, I think. I know I certainly had to “try” a few before I found one that didn’t make me feel off in some way or another.

An important message here is to make sure you have a provider you trust so that you can bring these issues up with them. Don’t be afraid. Don’t think that it happens to everyone because it very likely may not. There are lots of different options on the market to try if the pill you’re on doesn’t work for you, and there are also other methods of contraception. Don’t feel trapped if you’re miserable on an oral contraceptive – talk to your care provider about what’s going on and work with them to find a solution that is right for you.

Q: Can acid reflux stop the oral contraceptive from working, similar to vomiting?

A: I could not find anything saying that acid reflux would be an issue. I would think not because it isn’t removing the pill from your system entirely like vomiting is, however this is a very valid question.

I did find that oral contraceptives can actually worsen acid reflux symptoms though, as a result of the progesterone. GERD (gastroesophageal reflux disease) is therefore, also significantly more common in women who take oral contraceptives than those who do not take them.

Additionally, certain medications for heartburn may decrease the effectiveness of oral contraceptives as they may decrease its absorption in the stomach. The evidence is mixed though, with some sources saying it’s very unlikely. A precaution that might be advised by your prescriber or pharmacist is spacing out the timing of the medication, just in case.

Q: Are low dose birth controls as effective in women who are overweight?

A: I was searching around for a solid answer to this one because I saw a lot of mixed reviews during my initial search. Luckily, I stumbled upon a systematic review that is fairly recent (2017) – however, the authors of this review seem just as perplexed as I was because the studies that do exist on this topic are so poor and so limited! Also, all the studies that do exist have mixed results, so there isn’t really a solid and reliable answer for this one yet.

It seems that risk for failure of contraceptive in relation to weight is most relevant in regards to the patch, based on the review, but again – more robust studies need to be done and replicated. Sorry guys! This does provide another interesting area of research for someone though – it’s certainly needed.

Q: Does all contraception work the same?

A: Certainly not – that’s part of the reason why people prefer one type over another, or have different side effects on one compared to another. The World Health Organization (WHO) has a great page discussing the differences between mechanisms of action here.

An additional resource that was shared with me is here. If you are a more visual learner, you may prefer this one to learn about some of the types of hormonal birth control options available. It’s actually really fun – I went through some of them and it’s an easy and fun way to obtain information about birth control.

Thank you to all who read & shared this series and I hope I managed to touch on most if not all of the major questions! Stay safe and protected and help others to do the same!

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