Modern Medical Birth Control - Risks

 Sometimes people wonder why I go through all the trouble of charting to avoid pregnancy when women have so many other birth control options. 

I just wonder why they put themselves through medical birth control methods. 

Let's look at the risks of some of the modern methods. By the way - It concerns me that I had to do extensive searches on each website to find this information. Some even hide the full side effects from the FAQs portion of their site.

Hormonal birth control pills and patches

Taken from the pdf file (download here) for OrthoTriCyclen - "The use of oral contraceptives is associated with increased risks of several serious conditions including myocardial infarction, thromboembolism, stroke, hepatic neoplasia, and gallbladder disease, although the risk of serious morbidity or mortality is very small in healthy women without underlying risk factors. The risk of morbidity and mortality increases significantly in the presence of other underlying risk factors such as hypertension, hyperlipidemias, obesity and diabetes."

OthroEvra (the patch) contains almost identical wording. 

Seasonique (the three-month no-period pills) -  "Vascular risks: Stop Seasonique if a thrombotic event occurs. Stop Seasonique at least 4 weeks before and through 2 weeks after major surgery. Start Seasonique no earlier than 4 weeks after delivery, in women who are not breastfeeding. (5.1)
• Liver disease: Discontinue Seasonique if jaundice occurs. (5.3)
• High blood pressure: Do not prescribe Seasonique for women with uncontrolled hypertension or hypertension with vascular disease. (5.4)
• Carbohydrate and lipid metabolic effects: Monitor prediabetic and diabetic women taking Seasonique. Consider an alternate contraceptive method for women with uncontrolled dyslipidemias. (5.6)
• Headache: Evaluate significant change in headaches and discontinue Seasonique if indicated. (5.7)
• Uterine bleeding: Evaluate irregular bleeding or amenorrhea."

Depo-Provera Shots - "Thromboembolic Disorders: Discontinue Depo-Provera CI in patients who develop thrombosis (5.2)

Cancer Risks: Monitor women with breast nodules or a strong family history of breast cancer carefully. (5.3)

Ectopic Pregnancy: Consider ectopic pregnancy if a woman using Depo-Provera CI becomes pregnant or complains of severe abdominal pain. (5.4)

Anaphylaxis and Anaphylactoid Reactions: Provide emergency medical treatment. (5.5)

Liver Function: Discontinue Depo-Provera CI if jaundice or disturbances of liver function develop (5.6)

Carbohydrate Metabolism: Monitor diabetic patients carefully. (5.11)
----------------------------------ADVERSE REACTIONS---------------------------
Most common adverse reactions (incidence >5%) are: menstrual irregularities
(bleeding or spotting) 57% at 12 months, 32% at 24 months, abdominal
pain/discomfort 11%, weight gain > 10 lbs at 24 months 38%, dizziness 6%,
headache 17%, nervousness 11%, decreased libido 6%. (6.1)

To ensure the patient is not pregnant at the time of the first injection, the first injection should be given ONLY during the first 5 days of a normal menstrual period; ONLY within the first 5-days postpartum if not breast-feeding; and if exclusively breast-feeding, ONLY at the sixth postpartum week."

Mirena (IUD device) (This was by far the most difficult to find information on. While others listed their "prescription inserts" with a bit of searching, Mirena asks that you talk to your health care provider for a full list of possible side effects) - "Call your healthcare provider right away if you think you
are pregnant. If you get pregnant while using Mirena, you may have an ectopic pregnancy. This means that the pregnancy is not in the uterus. Unusual vaginal bleeding or abdominal pain may be a sign of ectopic pregnancy.
Ectopic pregnancy is a medical emergency that often requires surgery. Ectopic pregnancy can cause internal bleeding, infertility, and even death.
There are also risks if you get pregnant while using Mirena and the pregnancy is in the uterus. Severe infection, miscarriage, premature delivery, and even death can occur with pregnancies that continue with an intrauterine device (IUD). Because of this, your healthcare provider may try to remove Mirena, even though removing it may cause a miscarriage. If Mirena cannot be removed, talk with your healthcare provider about the benefits and risks of continuing the pregnancy. 

Life-threatening infection can occur within the first few days after Mirena is placed. Mirena may become attached to the uterine wall. If embedment happens, Mirena may no longer prevent pregnancy and you may need surgery to have it removed. Mirena may go through the uterus. If your uterus is perforated, Mirena may no longer prevent pregnancy. It may move outside
the uterus and can cause internal scarring, infection, or damage to other organs, and you may need surgery to have Mirena removed.
Common side effects of Mirena include: Pain, bleeding or dizziness during and after placement. If these symptoms do not stop 30 minutes after placement,
Mirena may not have been placed correctly. Your healthcare provider will examine you to see if Mirena needs to be removed or replaced."

 

Essure - permanent placement of coils within the tubes - "The most frequent adverse events and side e ffects reported as a result of the hysteroscopic procedure to place the Essure micro-inserts were as follows: cramping (29.6%), pain (12.9%), nausea/vomiting (10.8%), dizziness/lightheadedness (8.8%), and bleeding/spotting (6.8%). Hypervolemia occurred in <1% of cases. During the rst year of reliance on the Essure micro-inserts for contraception (approximately 15 months after micro-insert placement), the following episodes were reported as at least possibly related to the Essure micro-inserts: back pain (9.0%), abdominal pain (3.8%), dyspareunia (3.6%). All other events occurred in less than 3% of women." A number of women had to undergo a second surgery because the initial surgery failed to properly place the devices or they became dislodged."

Tubal Ligation - difficult to find direct information since this is not a device or pill, but a procedure. Some general information may be found at webmd - "Minor complications include infection and wound separation. These affect about 11% of women after mini-laparotomy, and 6% of women after laparoscopy.³ Major complications include heavy blood loss, general anesthesia problems, organ injury during surgery, and need for a larger laparotomy incision during surgery. These affect 1.5% of women after mini-laparotomy, and 0.9% of women after laparoscopy. Although fewer complications occur with laparoscopy than with other kinds of tubal ligation surgery, these complications can be more serious. For example, on rare occasions, the bowel or bladder is injured when the laparoscope is inserted. The general risks of surgery are greater if you have diabetes, are overweight, smoke, or have a heart condition."

I encourage women to embrace their fertility. I wonder why so many doctors (and women) feel that loosing a period - and therefore fertility - is a fine or even good thing (think about those "unnecessary period" commercials). Fertility has long been feared by some men and now by some women.

I've heard it said that bottles were invented by men to separate the woman from her child. Don't allow men to separate you from your fertility.

A Beginner's Guide to Charting, Part 4 - Putting it all together

Let’s review some things first. The part of your cycle where estrogen is dominant is the first part – the part before ovulation. Progesterone is dominant after ovulation – the last part of your cycle. Estrogen causes lower BBT and higher fertile quality cervical fluid. Progesterone causes a temperature shift to higher temps and a drier (non-fertile) cervical fluid.

During one’s period at the beginning of the cycle, you cannot get pregnant. When we talk about your period, I mean true bleeding and shedding of the uterine lining that is built up during the progesterone phase. You may have heard, however, of women getting pregnant during “their period” – however, this is not a true period with shedding of the lining. Rather, it is an episode of “break-through” bleeding after a long estrogen period. Anytime you are charting and have not had a temperature shift to confirm ovulation, you should assume you are still fertile – even if it has been thirty or more days of a low pattern.

How can this happen? Many times stress is the culprit here. My cycle around my wedding was 43 days long; I didn’t ovulate until a week and a half after the wedding on cycle day 25. Job stress can contribute; as can sudden increases in exercise training (exercise on its own should not inhibit ovulation and fertility, unless you are training for the Olympics and not giving yourself enough rest time. Let’s just go ahead and bust that myth).

Additionally, you can have an annovulatory cycle, a cycle without ovulation. My wedding cycle was simply a very long cycle, but you can have cycles where it seems like your body simply starts over. This is ok if it happens every once in a while, and is quite normal. However, if you only have annovulatory cycles, or have many more of them than fertile/true cycles, you should check with a doctor or midwife. Just like with really long cycles, you should use protection (if trying to avoid pregnancy) or keeping going (if trying achieve pregnancy) until you have that temperature shift. It can be hard to tell when your body will go ahead and ovulate on super long cycles or annovulatory cycles. 

Here’s one of my pregnancy charts – Elias chart. You can see how we achieved pregnancy. Any time we made love before the fertile period was just for fun; same for any time after the fertile period. That fertile window is what you want to focus on. This is especially important for anyone who naturally has short cycles or long cycles. If you don’t ovulate on day 14 (again, many of us don’t), you’ll want to analyze your cycles to understand the best time to try.

What about if you are trying to avoid getting pregnant? This is one of the things that I really loved about charting when I first started. Traditional birth control – shots, pills, barriers, spermicides – require that you use them throughout the cycle because they don’t tell you when you are fertile. By knowing when you are fertile, you can limit the use of these methods. (Of course, taking birth control pills 5 days out of your cycle is not going to work!) My husband is not a fan of condoms – many of us aren’t. Knowing my fertile days allowed us to only use condoms during those days; we were free to go without any other time of my cycle. 

If you are trying to avoid, there are a few rules/guidelines to follow. You are free during a true period (see above!). You are free three days after a temperature shift with dry-up of cervical fluid (they have to go together). You are free anytime you do not have fertile quality cervical fluid, though the closer you get to expected ovulation, the more careful you will want to be. The best advice – chart for at least three cycles before relying totally on this method to avoid pregnancy.

There are so many other things we could discuss about the finer points of charting, but it would take a great deal of time. I suggest that everyone own a copy of Taking Charge of Your Fertility, or at least check out a copy from the library. It’s an invaluable resource and well worth it.

Again – I have no affiliation with Ovusoft, etc. I simply like and use the software. Thanks.

A Beginner's Guide to Charting, Part 2

The first step to charting is the easiest – taking your temperature. It is a little more involved that just sticking a thermometer in your mouth whenever; so let’s look at the why’s and how’s.

Basal body temperature is one of the most important things in charting. In fact, you can do it alone (without what I’ll talk about in the next post) and get a pretty good idea of what is going on. I would even suggest that you just do your temps for a month before going into the rest of charting – ease yourself in.

In the first part of your cycle, before ovulation, your temperature is generally “low.” Average  temperatures may range from 97.0-97.7, though yours may be different. The number is not what’s important – you’re looking for a pattern of lows. My general pattern for pre-ovulation temps is around 96.8-97.0, lower than “average.” However, it’s my pattern.

Right around ovulation, generally the day following, you should have a temperature spike followed by more “high” temps until your period. They might range from 97.7-99.0, but again yours may be different. Mine are usually 97.3-98.1. If mine go any higher and stay, I can usually guess that I’m pregnant and I buy a test. That’s my pattern. You’re trying to find your pattern.

How do temperature patterns show ovulation? (It’s all too convenient I know). Before ovulation, estrogen is the reigning hormone in the reproductive cycle. One of the “side effects” of estrogen is a lower body temperature. Therefore, while in the low pattern, it is usually safe to assume you haven’t ovulated.

After ovulation, progesterone takes over. One of the “side effects” of progesterone is an increase in body temperature. For some women, this increase is gradual, but most of us get a nice “spike.”

How do you determine what temp to chart? You can’t just take your temp whenever and however you want to; it changes too much throughout the day to give your resting temperature. Fortunately, it’s easy to get that BBT – no math involved.

1. Take your temp as soon as you wake up, first thing in the morning. This sounds harder than it is, and takes just a little getting used to. You need to take your temp the very first thing in the morning – before you get out of bed, kiss your husband, say good morning, stretch, etc. When your alarm goes off, reach for the thermometer, stick it in, wait for the beep. Period. Doing anything beforehand will likely alter your temperature. In order to see a good pattern, you want it to be as accurate as possible.

2. Also time is important. You want to try to take it at the same time every day. When I worked full-time as a teacher, I got up at 6:00. On the weekends, I just kept my alarm at 6, took my temp, and fell back asleep (remember that I wanted you to get a thermometer with memory? This is why!). Now, my husband gets up at 6, usually disturbing me, so I take my temp then.

3. Take your temp after at least three hours of sleep. It generally takes three hours for your body to settle down to its resting temp. Some may take longer. While at least three hours is the rule, for accurate charting you really want to be getting close to the same amount of sleep each night. An hour or half may not make much of a difference, but going to be at 1 instead of 11 probably would. If you’re unsure if your sleep was disturbed, the best thing to do is take the temp anyway and make a note. If that particular temp matches your pattern, keep it. If it doesn’t match, mark it out with an X.

4. Take your temp the same way with the same thermometer each time. Don’t change your thermometer (if at all possible) until the start of a new cycle. Different thermometers (even the same kind/brand) may read slightly differently, making a pattern hard to see.

Most women when they start out charting choose to take their temp orally. In this case, you want to try to take your temp in the same part of your mouth under your tongue every time. Different parts of the mouth are warmer than others, particularly if you sleep with your hand on your face or something like that. If you sleep with your mouth open, it may difficult for you to temp accurately. You can try for a couple of cycles if you like, or you can just try the second way.

You can temp vaginally. A vaginal temp will give you the most accurate temp; it doesn’t hang open at night (we hope!) and it doesn’t get warmer if you sleep with your hand on your cheek. Vaginal temping also gives you a little break when you’re on your period – unless you’re really dedicated (I’m not!). It’s really not difficult or gross; just stick the thermometer in and wait for the beep.

I’ve temped this way for years. I temped for a year orally before I switched. (And yes, it’s the only thing I use that thermometer for and it gets an alcohol bath!). My temps are generally a couple points higher this way and my pattern is much more stable – thus easier to read.

If temping vaginally makes you feel funny, just wait until the next post. Learn to be comfortable with your body and life will be a whole lot easier!

A Beginner's Guide to Charting, Part 1

Also see necessary definitions.

Let’s talk a little first about what charting is and why I think all women should do it. Charting is a component of natural family planning (NFP) and the fertility awareness method (FAM). Charting allows you to analyze your fertility signs and determine your fertile and non-fertile days.

If you remember your 6th grade sex ed class, you remember how easy it seemed to get pregnant. Not quite so. Men are fertile all the time. Semen is always being produced; it always has sperm (in healthy men of course). Women on the other hand are not always fertile. We are not constantly releasing mature eggs to be fertilized at any time of the month. Most of the time, women are fertile for about five to seven days of any given cycle.

Why is this important? I’m no feminist (well, some would probably consider me one…), but I feel the birth control and birthing industries are to entirely male-dominated. Culturally, we consider it a woman’s responsibility to take birth control pills, even though women are not fertile all the time. Some even consider it a woman’s responsibility to make sure her partner wears a condom – even though that’s not her equipment shall we say. Birth control pills are costly, both financially and physically. There have been too many women who have had adverse effects from these supposedly “safe” pills. (I’m one; you’ll hear me rant about it all the time.)

Understanding your fertility through charting is non-invasive – unlike pills, spermicides (do I really want something that toxic in me!? In there!?), shots, patches, and surgical procedures. The United States has one of the highest incidences of surgical sterilization FOR WOMEN in the entire the world.

Understanding your fertility gives you more understanding about your body than taking something. This goes beyond trying to conceive. It can help you determine when your period is to be expected, when you can safely have unprotected monogamous sex, and where to start in diagnosing hormonal problems. It also gives you an intimate understanding of how your body works.

For today, we’ll just look at the supplies you’ll need. They are really simple and overall cheap. I’ll also let you know my personal preferences here.

1.A good thermometer. The heart of charting is based on your BBT. This is the resting temperature of your body – the next post will talk about how to determine it.

I like a digital thermometer that has a memory function. You need one that goes at least to the tenth decimal (97.6), but I like one that goes to the hundredth (97.68). The one that I’ve used is a BBT from Walmart. I bought my first years ago when I first started charting, and it lasted until I got pregnant. To be safe, I bought another after I started charting again post-partum. It’s white with a pink tip, and is specifically a BBT thermometer. It’s been very accurate, and it beeps when then temp is read after 60 seconds.

I tried a regular thermometer that was ready and beeped after 9 seconds. I found that it wasn’t very accurate for me. There are some that say that you must have a BBT thermometer to be accurate for those lower temperatures; that regular thermometers are just looking for fevers. I don’t know, but personally I’ve found that my BBT worked better for me. It’s worth saving your money buying one good thermometer than buying two after you don’t like the first. You’ll want this thermometer to be only for your charting.

2. Pencils and downloaded charts such as these:

(If you choose to do the next supplies, you won’t need the pencils and paper charts unless you want a backup).

Charting, in a way, is like graphing in high school math. You mark specific number points and connect the dots. You’ll want a pencil in case you make a mistake. The nice thing about pencil and paper charts is that they are relatively low-cost. I don’t regularly use them, though I have if I’m out-of-town and can’t use the next option – computer required.

3. Charting software: such as Ovusoft, Fertility Friend, and others.

The first thing you should know about charting software is this: you must be smarter than your software. Buying (or using free) software is not a substitute for understanding your own fertility and how to chart it. This is especially important when you are first starting out.

For example, most charting software starts out assuming you have a 28-day cycle, the average. It will make predictions based on those values. These predictions may very well be incorrect if your cycles are not average. However, the longer you use the software, the more it will understand your personal fertility.

I personally use Ovusoft. I bought it in 2007, and paid a one-time fee. In 2009 while I was pregnant, our computer crashed and I lost the software. Fortunately, customer service was able to send me the activation code. I downloaded the software again and started using it at no additional cost. It’s a very user-friendly software. The book that goes with it cannot be recommended HIGHLY ENOUGH! Every woman should own a copy of Taking Charge of Your Fertility. It’s explains the finer points of charting – things I won’t get into on a post.

I’ve also used Fertility Friend. It’s a nice simple software, online-based. And it’s free (though additional features are available by subscription). I highly, highly recommend putting it on the FAM setting if you do use it. The others are less accurate, especially in your first few cycles. Every once in a while, even on the FAM setting, Fertility Friend gets confused and doesn’t give you accurate assessments. This is where you need to be smarter than your software.

4. Your fingers. Yep! But I’ll explain this in later posts.

For the record: I have no affliation with any of the products mentioned here.

A Beginner's Guide to Charting, Definitions

Basal body temperature (BBT) – your body’s resting temperature, almost always lower than 98.7
 

Cervical fluid or cervical mucus – the fluid within the cervix that is created by the body as a carrier for semen. The fluid changes as ovulation nears to allow conception to take place.
 

Charting – keeping track of BBT and cervical fluid throughout cycles and using that information to determine fertile and non-fertile days.

Fertility awareness method (FAM) – recognized by the FDA as an aid to conception, also used by many as a method of “birth control”. Based on BBT and cervical fluid checks. May or may not involve abstaining during fertile days (can use “back-ups” such as condoms)
 

Fertility Friend – an online based charting method, free for basic service, monthly fees required for “premium services”
 

Natural family planning (NFP) – a method of “birth control” recognized by the Catholic church, involves abstaining during fertile days. Based on BBT and cervical fluid checks

Ovusoft – a charting software, requires one-time payment for the software. Not available for MACs. Currently testing a web-based version.

More definitions to be added as needed!