A woman’s choice: Correcting birth control myths

Once was a taboo subject, open discussion about contraception options is now as common and easy as a conversation over cellphone to choose.

The only problem is that sometimes the informal chatter can lead to misconceptions about how to prevent conception. According to Dr. France Morin of the Cree Board of Health and Social Services of James Bay (CBHSSBJ), there are a lot of myths circulating about prescribed (hormonal) birth control.

“The biggest myth surrounding birth control is that women think that they are going to gain weight,” said Morin. “This is wrong. Birth control pills, the patch or the vaginal ring doesn’t make you gain weight.”

Morin works part-time in the north as a replacement physician in the communities while serving as a family doctor in the Montérégie town of Bedford. Her lengthy career in medicine has gained her a great deal of expertise in reproductive health.

Morin says contraception has come a long way since “the pill” hit the market back in the 1960s with many innovations and the phasing out of older forms of treatment.

When it comes to contraceptives and weight gain, Morin said that Depo Provera, a once-popular progestogen-only contraceptive that is administered by injection once every three months, was responsible for weight gain in some patients. However, this particular medication is no longer widely prescribed.

However, Morin said that people would sometimes attribute weight gain to the pill in error.

“Usually women who start taking the pill are young and so they are at a point in time when they might have gained weight anyway. Especially if they are a teenager, this can happen,” said Morin.

Another concern women have is that they sometimes don’t menstruate each month when they are using oral contraceptives. Morin says this is not a concern.

“We don’t need to have menstruation every month. You can take the pill continuously without having menstruation. Your body will spontaneously menstruate. Many women will take this for several months without having menstruation,” explained Morin.

Another myth Morin identified is the idea that women who have been using contraception need to halt it for six months to “give their body a break.” Morin said there are no health benefits from temporary interruptions to using the pill.

Indeed, many women use oral contraception for their secondary effects, part of the reason why the motivation and clientele has changed dramatically over the last 50 years.

“The pill really is for women of procreation age, even up to those who are going through menopause. The definition of menopause is to have gone one year without menstruation and the average age for that is 51. But, in the years leading up to that there are women whose cycles can start to come every two weeks and then every two months and then get hot flashes. Birth-control pills at that age can really stabilize that. So I would say up until the age of 52,” explained Morin.

“Women will be surprised that we would prescribe them at that age and even in circumstances where their partners have had vasectomies but it is for the hormone effect because their hormones can be really swinging at that age just before menopause.”

But, that isn’t where the usefulness of oral contraceptives ends. In 1997, the pill was licensed for the first time by the Food and Drug Administration in the United States as a treatment for acne.

“Some women get terrible migraines every cycle and so that is why they take it continuously and then they can skip menstruating for a whole week because of the terrible headaches or migraines,” said Morin.

On top of the aesthetic benefits, the pill has been attributed to decreasing abdominal pain for those who have menstrual cramps. It can decrease the bleeding and that in turn will decrease the risk of anemia (iron deficiency) – something that is quite common in women. There are also studies that have shown that the pill can reduce the risk of ovarian cancer.

If you are wondering why a doctor may prescribe one brand of the pill over or another, according to Morin, since they tend to be so similar, it is more a luck of the draw.

According to Morin, there are really two different contraceptive pills on the market today with the more popular being the mixed-hormone variety, accounting for 99% of all birth-control prescriptions.

All of the mixed-hormone varieties (estrogen and progesterone) contain low doses compared to their first-generation predecessors that were marketed in the 1960s. Retired in the late 1990s as scientists discovered that birth-control pills could be made just as effective using significantly less hormones, resulting in fewer side effects. Today there are as many hormones in a month’s supply of the pill as used to be in one pill from the 1960s.

While some pills are bigger sellers than others, Morin said there are over 30 varieties of mixed-hormone birth-control pills on the market at the moment and many are simply generic copies under different brand names.

With names like Loestrin24, Yaz, Yasmin, Seasonale, Seasonique, Marvelon, Alesse, TriCyclen and Triphasil, Morin said that each of these medications is equally effective as a contraceptive, provided they are taken properly.

As for deciding which one to prescribe to a new patient, Morin said that she will often leave that up to the patient. If a woman request the same prescription that her friend has, Morin simply prescribes that brand. If the patient is unsatisfied after a few months or wants to switch to a different kind, they are welcome to do so.

However, there is a protocol for changing prescriptions, which can sometimes lead to mild side effects like spotting (occasional light bleeding outside the frame of the usual menstrual period).

“Some (pills) tend to lead to spotting more than others, so we will move on to the next one or explain to the patient that, yes, they have spotting but they should be reassured that it doesn’t mean that the pill is not efficient for birth control,” explained Morin. “Sometimes they will change it and sometimes they won’t.”

The latest innovation occurred when Seasonale hit the market in 2003, which limits menstrual cycle to every three months, hence the product name.

For those who have difficulty taking the mixed-hormone pill, there is the single hormone pill (Micronor, a progestative) and this is prescribed to women who tend to have serious contraindications (problems).

This pill is prescribed less often because it needs to be taken on a strict timetable, down to the hour. Taking this pill three hours off the usual time can eliminate its effectiveness as a contraceptive and a patient will need to use condoms to prevent a pregnancy.

Some women want a long-term solution that is not permanent like a tubal ligation, or getting your tubes tied, which can only be reversed with surgery. Their option is the Inter Uterine Device (IUD, a plastic or copper device medically inserted into the uterus). The IUD has made a major comeback since its market debut in the 1970s.

“With an IUD the big myth is that you would get more infections. There was an issue with this in the 1970s about a type of IUD (the Dalkon Shield) but the ones that we use now are completely different. We use hormone-release IUDs now. The first one, Mirena, came out about 10 years ago and the great advantage of this that over time women will actually get fewer and fewer periods (due to the hormone release) and many women won’t get their periods at all and so they like it,” said Morin.

What has also changed is who can get an IUD. In the past, the tendency was to only install an IUD in a patient who had already given birth, but that is no longer the case. Today, anyone who wants one can have them installed, which will be done during menstruation or immediately after because the cervix tends to be more open at that time.

The Mirena could even be prescribed to someone who has never even had sex because of other beneficial effects.

“Some women have problems with the thickening of the blood or coagulation. The bleeding is so intense that they can get anemia so we have to find a treatment for it because they can become tired and so sometimes Mirena is prescribed. It actually lasts for five years,” said Morin.

Once more, most doctors can and will install an IUD at a local clinic. In cases where there is difficulty however, a patient will be sent to see a specialist for the installation.

For those looking for something less invasive, just as effective as the pill and so discreet that you can actually forget about it for three weeks at a time, there is Nuva Ring, the contraceptive ring.

“It is a polymer ring that has microscopic holes that will slowly release small amounts of hormones. For a woman who is concerned about taking medication in general and is looking for the weakest dose possible, this is for them because it really is the weakest dose. You put this anywhere in the vagina and the hormone will release very slowly and you change it every three weeks,” said Morin.

Another easy method that some women opt for is the birth-control transdermal patch. Placed on the arm once per week, the patch slowly releases a hormone that is absorbed through the skin. This method is less effective with overweight women, however.

There are risks with taking any of these medications and their benefits and drawbacks should be discussed with a physician. For example, the risk of blood clots rises if the patient smokes, particularly if they are over 35 and obese. In this case Morin said she recommends that a patient quit smoking if they want to stay on the pill.

Lastly, for someone who is not on any of these more conventional forms of birth control and has an accident with a condom and fears that they may get pregnant or has forgotten to take their pill effectively and has intercourse, there is always Plan B. Known as “the morning-after pill,” Plan B is a two-pill contraceptive that must be taken within five days of intercourse to prevent a pregnancy.

What most people don’t realize about this medication is that if need be, it can be taken multiple times in one month. It is effective as contraception for five days but is more effective if you take it within 72 hours of intercourse.

“If you are already pregnant and say you take it 10 days before you know, it won’t harm the baby. The same is true for any pill. Some women can be pregnant for two months and not know and it won’t harm the baby at all. This is available directly from the pharmacist in any clinic in the Cree Nation and you can just go in and the nurse will prescribe it,” said Morin.

All of the information in this article does not replace the necessary conversation must have with their doctor or a nurse at a clinic. And it should be emphasized that none of these treatments, with the exception of condoms, can prevent a sexually transmitted infection.

For more information on any of these medications or subjects: www.sexualityandu.ca/