Side Effects of Birth Control Pills

Here is a concern I often hear: "Since I started birth control pills, I noticed my vaginal discharge has changed. Most of the time I have an increase in vaginal dryness and I've noticed that I have a lot more yeast and bacterial infections."

These are common side effects because of how the pill works. The pill stops the natural fluctuations of estrogen and progesterone (and a spike called the LH surge - which causes ovulation and an increase in sexual libido.) The pill is made up of estrogen and progesterone and, when taken daily, flattens and overrides the natural fluctuations. This prevents ovulation, reduces vaginal discharge and can suppress our libido.

We've talked many times about how important pH balance is to vaginal health. Any change in hormonal balance can affect vaginal pH - like starting birth control pills, hormone replacement, menopause and the first few months post-partum (i.e. post-partum depression) - making us more susceptible to bacterial and yeast infections.

Bacterial vaginosis can also be triggered by douching and the use of chemicals, vinegar, lemon, or soap to cleanse the vagina. It doesn't matter if it is mixed in water and put inside with a douche bottle, or by using your soap covered fingers to clean up inside the vagina, or if a tampon is soaked in watered down lemon juice, tea tree oil, vinegar etc..

But women can get desperate to get rid of vaginal odor. It is embarrassing, worrisome, makes us want to avoid sex and feels uncomfortable, causing us to have less confidence. So we douche anyway or soap up inside and cover up with lotion. But it only works for a short time before the odor returns and keeps getting worse.

Untreated, BV can lead to significant health problems, including premature births, postpartum infections, pelvic inflammatory disease, and increased vulnerability to HIV infection. It's estimated that up to one-third of women in the United States will have BV at any given time, even during pregnancy.

How can it make us more susceptible to HIV? Because constant irritation causes little openings in the vagina. Think of when you fall and get a "road rash". It's not really a cut, but rather many little scratches. These can lead to a break in the skin or vaginal mucosa, making a way of entry for the HIV. Anal sex can do the same, because the stretching of the anus can cause micro-tearing, making an entry way for bacteria and viruses like HIV.

Bacterial infections can cause PID (pelvic inflammatory disease) because sex or douching can push that bacteria from the vagina up into the uterus and Fallopian tubes. PID is extremely painful and can damage your Fallopian tubes, so you could be unable to get pregnant naturally. It also puts women at risk for ectopic (tubal) pregnancies. This happens because fertilization happens in the Fallopian tube, but because of scarring, the embryo get stuck there. This is a life threatening condition and you can bleed internally and even die.

So don't ignore odor that doesn't go away or an increase of discharge that itches or has an abnormal "fishy" sourish odor. See your doctor if you think you have a bacterial or yeast infection, as you may need antibiotics or anti-fungal medication to clear it. And you may have to repeat it back to back if it's been going on a long time. That's because sex, your period, or taking allergy medications like a steroid injection can bring it right back. It's not that we are not clean enough, in fact most of us fail at clearing these infections by trying to be too clean. It's best to let the vagina heal internally on its own. Washing externally with soap is just fine. Just don't let any soap, or feminine wash, get inside the vagina.

Now wouldn't you love to have a safe way to cleanse your vagina internally? Wouldn't it be wonderful to wash out old period blood, excess discharge, or semen after sex?

Well there is an FDA cleared device called WaterWorks that we can use every day for feminine hygiene purposes and to keep odor away. Many of my patients use it every day to feel clean or after sex to rinse out semen and at the end of their period to rinse the old blood out.

WaterWorks is reusable and uses only plain water. It appears to be a reusable douching system but is nothing like that. The water sprinkles downward out of the stainless steel tip. The reaction that happens between the stainless steel, water and vaginal mucous works similar to the stainless steel bars that chefs use to get onion and garlic odors off their hands.

My patients who struggled with odor for years have not had vaginal odor for years now and rarely have a yeast or bacterial infection as the pH balance is under control.

I'm pleased and amazed myself at how well WaterWorks performs and how well made this device is.

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Birth Control During Menopause

Hard to believe we're already in October! What an awesome time of year! Beautiful warm days & cool nights - we've even had some rain thunderstorms. I know, I know, but hey it's a real luxury here in the southwest. We actually go outside when it rains so we can feel the rain on our skin smell it as it moistens the dry, desert air.

We've been talking a little bit about menopause and hormone changes, which brings us to the next question that many of you are concerned about.

Do I have to take birth control even though I have started menopause?

As a reminder, menopause is that time in a woman's life when, for the first time since puberty, her entire female reproductive system is shutting down. Age 50 - 54 are the most common times for menopause, when menstrual cycles will stop, the ovaries stop ovulating they stop producing estrogen progesterone.

It is also during this time that women may go through hot flashes, night sweats, fatigue, emotional ups; downs and lack of sexual desire. Go see your doctor to verify that your symptoms are truly the result of menopause. Once your cycles have been absent for more than 6 months, and your blood tests confirm that you are in menopause, only then you can be sure you are no longer ovulating and do not need to use birth control.

The mistake many women make is that they believe that once they are in their forties, they are too old to get pregnant, and they become less careful about using birth control. I cannot tell you how many surprise babies I've delivered for my 40-plus year-old patients who though they couldn't conceive any longer. So it’s best not to assume. If you are having regular cycles, chances are you are still ovulating, no matter what symptoms you are having.

So menopause means no more periods, no more ovulating, and no need for birth control. But before you stop taking birth control, be sure you visit your doctor to verify with a blood test that your ovaries are not functioning, so there are no surprises.

I hope this helps you and answers your question this week. Keep your questions coming, have fun and be safe.

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What Is Emergency Contraception?

Contraception use is one of those ongoing controversies we, as women, face throughout our lifetime.

Surely, the weight of these decisions continue to be mainly in our court. Women now have more birth control options and, whether married, in a committed relationship or not, we are the ones who end up pregnant - we cannot just walk away once we are. Once we are pregnant, our bodies go through extreme changes, and whether we feel we want to continue the pregnancy or end it, we are left with the decision and consequences it brings. Even terminating a pregnancy causes irreversible changes to a woman's body- physically, chemically and emotionally - that are for a lifetime.

That is why planning pregnancy and preventing unwanted pregnancy is so important. Contraception choices have changed over the years, giving women safer options and more to choose from. Unfortunately, not everyone is so prepared or can have problems with condoms breaking (or slipping off)….. and then worry about what to do after the fact.

That is why 'Emergency Contraception' (EC) allows a woman the chance to decrease her risk of pregnancy after unprotected or under-protected intercourse. According to the National Institute of Health (NIH), nearly 50% of pregnancies in the United States are unintended. Of these 50% of pregnancies, 52% of women report no contraception use and 43% report inconsistent use. This is why EC has become such an important option of contraception for all women. It allows women the chance to decrease the risk of pregnancy.

EC is not an abortion pill, nor method, but rather a method of birth control that's been around since 1974. It can be used within 72 hours after having sex to prevent pregnancy by delaying ovulation. The original forms of EC started by a doctor by the name of Yupze, who used 2 to 3 birth control pills, 2 days in a row, within 72 hours of having unprotected sex, to delay ovulation and hopefully prevent unwanted pregnancy. The current method most of us are familiar with is "Plan B" and can be obtained at most pharmacies.

So even though now there are many forms of birth control to choose from, EC allows women another option that is safe to use for those scary situations. Babies are awesome, but there is nothing more terrifying to a woman than becoming pregnant when she is not prepared.

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Pregnancy Prevention Myths

I'm so sorry for those of you on the east coast having to endure hurricane Sandy. I hope and pray for comfort and safety to those of you that are there and have family there.

Recent research from the medical literature shows that, out of the top reasons for having sex, having a baby is the least frequently mentioned! Most couples want to enjoy sex without the worry of pregnancy and want the ability to choose when they are ready for pregnancy and childbirth. There are a lot of myths and out-of-date information passed along from friends and family pertaining to methods of pregnancy prevention.

A woman's chances for becoming pregnant are always the same (whether it's the first time or not) – about 1 out of 20. A woman can become pregnant any time after she begins to ovulate, which can mean before she even has her very first period (since she ovulates approximately 14 days before her period begins). She can also get pregnant when nursing an infant, even if her cycles have not returned. Don't ever be pressured by thinking you are too young to get pregnant or even too old. Many women have been pleasantly or unpleasantly surprised.

It amazes me that I still have many patients who feel that douching or jumping up immediately after sex and washing off or changing positions is an effective way to prevent pregnancy. It is impossible to move and get up fast enough. Immediately upon ejaculation, the sperm are deposited into the vagina and swim through the cervix into the uterus and are to the egg to fertilize before we are finished climaxing. So this would not be an effective method of birth control at all!

Among young teens, withdrawal of the male penis just before ejaculation still seems to be a popular method of birth control, and, unfortunately, there are some websites that will support this. Withdrawal has never been a reliable method, and there are several reasons for this. Once a male becomes aroused, he ejects pre-ejaculate fluid and this fluid can contain at least 300,000 sperm! Only one is needed to fertilize a ready and waiting egg. Most of the time the risk is that he doesn't pull out in time, because in the heat of the moment, it is hard to keep control. Even if a man ejaculates outside of the vagina, sperm can swim, so semen anywhere near the vagina can still lead to pregnancy. So, this means that pregnancy can occur even without penile penetration. It is extremely hard to practice withdrawal effectively and especially enough to believe it is a reliable form of birth control.

Many women still believe that they cannot get pregnant during their period, because they believe there will not be an egg available at this time of their cycle. But the truth is, it is possible for a female to get pregnant at any time during her menstrual cycle. Usually, when you are having your period, it means that you are not ovulating and, if this is the case, then you will not get pregnant. But there are women with irregular or shorter cycles that can actually ovulate during their period. It is not guaranteed that you will ovulate mid-cycle. Sperm can live inside a woman's body for to 3-5 days, so if you ovulate anytime within 7 days of having unprotected sex, you could become pregnant.

Honestly, there is no substitution for a condom. Those of you who seriously believe that plastic sandwich bags, balloons or Saran/plastic wrap can be used as substitution for a condom could be in for a baby surprise. The materials these are made of and how they are made are in no way strong enough to resist micro-tears or perforation. If you do not have a reliable birth control method handy, wait or risk pregnancy and STDs.

Okay now, not even adding toothpaste in place of a spermacide with the balloon or plastic wrap will work, as it does not kill sperm - I don't care what you have heard.

Let's just say some of you have heard sneezing, coughing, jumping out of bed really quickly and jumping up and down will work. Or that having sex standing up will either dislodge sperm or push it out. Or that, if standing, the sperm cannot even reach the egg. And, believe it or not, some women believe that placing certain seeds and plants into the vagina during intercourse will prevent pregnancy. Sperm are too quick and too tiny for any of these methods to work. This behavior can be dangerous, as it can be harmful to a woman's body. And still, as silly as it seems, a lot of women believe that if they don't allow themselves to climax during sex, they will not get pregnant. Pleasure has nothing to do with birth control - whether or not you enjoy sex with or without an orgasm, you can still get pregnant.

Douching is never recommended, as it is usually a solution of chemicals or home remedies that can increase chances of vaginal infections, have no effect on pregnancy and increase problems with vaginal odor and discharge.

If you feel a need for feminine cleansing, the WaterWorks system is an all-natural system that uses plain water only, and is reusable, and washable. It gently sprinkles water into the vagina and rinses out unwanted blood or discharge, and removes odor by reaction of the medical-grade FDA-cleared stainless-steel head. Many of my patients and family members are enjoying and finding the benefits of its regular use.

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