Dr. Michelle Becher discusses birth control options for women.
Transcription:
Deborah Howell: Welcome to Sparrow Speaks, the podcast with the latest health news and information from Sparrow, mid-Michigan's premier community healthcare leader. I'm your host, Deborah Howell. And today, we'll be talking about birth control options for women. Our guest is Dr. Michelle Becher, an obstetrics and gynecology specialist with Sparrow Medical Group Obstetrics and Gynecology. Welcome to you, Dr. Becher.
Dr. Michelle Becher: Thank you so much for having me today. I'm here to talk about a very important topic that will guide women from their teen years all the way through their reproductive life cycle.
Deborah Howell: Well, absolutely. Let's get into it. It's 2021. What birth control options are out there?
Dr. Michelle Becher: There's several options. And some of them start, depending on their partner, if they have a male partner, it can include condom use, which we recommend for all male-female partners to use condoms, because it is the best thing to protect against sexually transmitted diseases. But condoms also work very good for birth control in a male-female relationship. They just have to be used and be used effectively. So that's just kind of the basis for the male-female relationship, are the male condoms.
When we move out of that though and when women want to have more control of their own birth control, then we move into different options from taking a pill to wearing a patch on the skin. There can be a ring that can be inserted into the vagina. However, it also needs to be removed from the vagina. There can be a shot that we can teach you actually to give the shot to themselves, and that's given every 90 days. And then there's a couple of office procedures, where we can insert various IUDs. And there's quite a few IUD. We'll get into those I'm sure in a bit. And then there's an implant that goes underneath the skin on your upper arm. And so there's a whole host of options out there. And I would say one of the biggest things is merry an upset patient and figuring out what would work best for them in their situation. So that's really where the conversation starts, what they're looking for and what they need out of a birth control.
Deborah Howell: Well, doctor, let's take these one by one. First, let's start with the IUD.
Dr. Michelle Becher: Yes, the IUD is such a lovely device because it's thoughtless and also has one of the lowest pregnancy rates because it is thoughtless. You can't really forget to take it like you do a pill or that sort of thing, because it's implanted into the uterus. And so the pregnancy rate with a male-female couple is one out of a hundred. They become pregnant with IUDs. So those rates are very low compared to condom use, which is up to 28 out of a hundred. And so the rate of pregnancy is much lower, so they have real great control there. It does involve an office procedure. And in that procedure, we take a device to look at the cervix, which is up inside the vagina and then this device goes into the cervix, into the uterine cavity. So that can be uncomfortable, but women get through it. I mean, stubbing your pinky toe, I would say, is worse than the IUD at some points because of where we put it, but it is all up in our personal area. So that has anxiety certainly that goes with placing the IUD. But I can tell you, I have women who I placed them in, who've never even had sex and do a really good job of getting through it. So I think some of it is just the mental preparedness we have to have IUDs placed.
But what's lovely about them is they last anywhere between three years and 10 years. And so they only need to be replaced, for some, every 10 years. So that works really nice to have it thoughtless. And the other lovely thing about several of the IUDs is it also will improve periods very significantly and get rid of the period for many people. So that's an added bonus to providing birth control, is it also really improves our period control.
Deborah Howell: And once it's placed, there's no longer any pain, right?
Dr. Michelle Becher: It's true. Very good point, Deborah. Once it's in place, the pain really improves. In fact, it's, you know, just a few moments of pain, just like you stubbing your pinky toe, how that gets better, usually rate off. It's the same with placing the IUD. There's a few moments where it's a little bit more intense, but then it settles right down. And every once in a while somebody does take a couple of doses of ibuprofen through the day, just because there's some increased crampiness. But for the most part, it does go right away.
Deborah Howell: Well, lovely. Let's move on to Nexplanon.
Dr. Michelle Becher: So Nexplanon is an implant that sits in the skin of our arm, our upper arm. And no one will know it's there unless you pointed it out to them for the most part, because it sits just under the skin and you can feel it if you touch it. But for the most part, you can't even see it in most women. And so it again involves an office procedure. We numb the skin just ever so slightly and then insert it. And so it's really quite simple. And then it's replaced every three years. And so at that third year mark, after you've had it in place, then you can come back. We can take that one out and put a new one right back in. So you don't even have to go without birth control.
This is similar in the benefits to the IUD in that it also usually gives a lot of relief to the period and often gets rid of our menstrual cycle altogether once you've had it in place for six to 12 months. It really improves those menstrual issues that women can have. What's also nice about the Nexplanon is it also has a low rate of pregnancy for male-female relationships, where it's about one out of a hundred, similar to the IUD.
Deborah Howell: So what if I play racquetball and I bang my arm into wall when I go for a shot?
Dr. Michelle Becher: No issues with it at all. It will hold tight and be fine. It would take a lot of trauma, like pretty significant, like if you think about like a glass window or something like that to cause a trauma to it, it really has to be very significant. Otherwise, it holds its own. You can even get a ball thrown right at it. It's not going to shatter or anything like that. It will hold its own.
Deborah Howell: All right. Well-designed. Now, the patch.
Dr. Michelle Becher: So the patch is such a lovely thing as well. And we have that applied on our skin. It's changed once a week. So you take the old patch off, you put a new patch on and we have women generally wear it through the waist region or on their shoulder blades. We don't like women to place it around the breast, just because of the estrogen hormones that are in the patch. And we like to keep that away from the breast region. So around the waist or on the back, around our shoulder blades is the best place for them. It's applied. It stays on for a week. You can get into hot tubs, go into steam saunas, and it typically sticks on the skin. Now, there's a few women who have really, really oily skin. And in that situation, we have them clean their skin with alcohol and then let the alcohol dry and then apply the patch and that seems to work really well. That's pretty rare for someone to come back and need to change birth control because the patch isn't sticking. It usually sticks really well.
And so they go three weeks of changing out their patch, taking off the old, putting out a new each week. And then the fourth week they generally go patch free. And that's when they would generally have a period. And that works really well too for birth control, similar to the pill. And that there can be up to six out of a hundred pregnancies that can occur from male-female relationships. And that's because not everyone remembers to change their patch. So if they forget to change it or after their week of being off the patch, if they forget to put it back on. So you just got to set little reminders in our phones because we all carry those about, and that can help women to remember to change that patch in a timely way and avoid those pregnancy rates.
Deborah Howell: Sounds good. All right. The vaginal ring.
Dr. Michelle Becher: The vaginal ring, So there's two different rings that are out there. One is placed for three weeks at a time. You take it out for a week, you set it aside and then you put it back in a week later and you do that through cycles over a year. The other one is replaced every month. So NuvaRing is the one that's replaced monthly and that ring, when it goes into place in the vagina, sits there for up to 30 days, and then you need to reach in the vagina and remove that. And then you can actually replace it if you want continuous birth control and avoid periods is allowed with the NuvaRing, and that can be in place for 30 days at a time. And then some women choose to have a menstrual cycle with it. So then they would wear it for 24 days, take it out, leave it out and throw that one away. Do nothing for six days, then put a new one back in for that 24-day timeline, because they're not having a period during the time the NuvaRing is in typically. And what's nice about the NuvaRing as well is similar rates to the patch, where there's about six per a hundred that become pregnant in the male-female relationships with that. But it works really nice because they also have the option if they want to avoid their periods with it, they can.
Deborah Howell: Yeah. Nice. I'm terrible with assembling Ikea stuff. Is there any way to put in the ring wrong?
Dr. Michelle Becher: There is not a way to put it in wrong. In fact, it's much like a tampon. Once it's up and in proper location, it just finds its way. We have found couples when they have intercourse, male-female intercourse, it can come off on the penis. So when they notice that, they just put it right back up in the vagina, so it works out well. And yup, there's not a wrong way to put it in. So good question, too, Deborah.
Deborah Howell: Okay. OCPs, what are they?
Dr. Michelle Becher: So OCPs are oral contraceptive therapy or pills is what the P used to stand for. And they work really nice for women who want that control. Other period want to gauge when they're having it, want that control when they stop it or when they started birth control. Because once you stop it, it's out of your system in 24 hours.
And so regarding the pill, we have that too. We start it when we start our period and we can do the same as we have the other options we spoke of. You can take them continuously where you take only active pills and you can avoid your period altogether with the pill and have that control of taking it each day. The thing is remembering to take it each day and then having your pills with you when you remember. And so that can be a bit tricky with the pills and especially in, I feel like in our teen women, we don't have as typical of a schedule as we do as we get into the workforce. And so I think they can vary on that timeline and having their pills with them or not.
But a lot of young women are really great about setting the alarm on their phone and keeping, you now, the pills in their phone or right nearby and are great at being on top of taking it on time. Most of the pills are a combination pill where they have estrogen and progesterone in them and those work by stopping ovulation or the release of the egg and that's how they prevent pregnancy. And that doesn't happen until you've had the medication in your system for 30 days. So your first pill pack is not preventing pregnancy yet. It's your second pill pack. So that's also why there's a higher pregnancy rate with pills because it does take a month for those to engage our system and be actually providing birth control.
There's a different type of birth control where they're progesterone-only pills, which we utilize for a lot of different reasons. And those work a little bit differently. They don't prevent ovulation, but they really cause our cervical mucus to be very thick and prevents sperm from going up. And so those work a bit differently and those do need to be taken on time every day. And I tell women, "If you take it at eight o'clock, eight o'clock, eight o'clock every day, and then one day you take it at 10, you're not protected from pregnancy for a week. So they have to be really diligent in the progesterone only birth control pills and taking those in a very timely fashion because they do work a little bit differently than the combination birth control pills.
Deborah Howell: Yeah, you really have to be on it. Finally, last but not least, DMPA.
DMP.
Dr. Michelle Becher: Yeah. So DMPA is depot medroxyprogesterone acetate or Depo, a lot of people just call it, although that's just the avenue of how they were putting that into the body. The depot medroxyprogesterone acetate is the actual medication and it's a shot that's given every 90 days, works really well to alleviate periods. And it's like 90% to 95% of women after a year aren't having any periods when they use the Depo-Provera shot. So that works really nicely.
There's a couple of caveats with the shot. One is that there is about a 10-pound weight gain associated with the Depo-Provera shot. And typically, that does come back off after they stop it. Any weight over the 10 pounds isn't associated with the Depo-Provera shots, associated with the trips to the refrigerator and, you know, maybe not making the best choices in life.
But the second issue with the Depo-Provera shot is that when women choose to go off from it, it can actually cause you to not ovulate for 18 months after the Depo-Provera shot is given. Now, you can't count on that and you can't use that as a birth control, but for people who want to time their family and time when they want the pregnancy, that can definitely play a role because it can impact our fertility for about 18 months once we stop it. But otherwise, it's a great product and teaching women how to give themselves a shot sounds scary, but our team does a great job in teaching how to give those.
Deborah Howell: Are there any side effects in using these birth control options?
Dr. Michelle Becher: There are side effects, just like there are in any medication. One of the things like I mentioned with the Depo-Provera shot, that 10-pound weight gain, that's also true with the Nexplanon implant. That also has about a 10-pound weight gain associated with it. All the other birth controls do not. So the NuvaRing, the patch, the pills, the IUD, no weight gain associated with any of those. So that's a nice thing.
And then I would say for the most part, their side effects are beneficial because they're side effects that impact our periods. And as I mentioned, with several of them, we can get rid of our periods and significantly improve our periods. Well, it's the same with painful periods. All of these routes, generally, no matter how you take the medication, whether it's by a pill or a patch or ring, a shot, the implant, the IUD, all improve painful periods and really settle the pain down significantly. So from those benefits, it's quite lovely.
When we talk about women who are breastfeeding, then we also utilize the birth control pills when they want to use a pill for progesterone only. And so the Depo-Provera shot would also be progesterone only, and then the IUD and the implant. And we do that because we know estrogen can impact our breast milk. It doesn't always, but especially when we're first establishing it, we want to have as little impact because we want breastfeeding to be successful. So there's things like that I would say that you would want to talk with your provider about and they would address those issues in each unique situation for the patient and what they're at in their lifetime.
Deborah Howell: It's so good to have you break all this down because it is a very, very large body of work to get our arms around when it comes to birth control. In your opinion, Dr. Becher, is hormonal or non-hormonal birth control better?
Dr. Michelle Becher: Whether we choose hormones or not hormones, there's a very personal choice there, first of all. Second of all, some of that can depend on different medical issues that you may have. So you'd really want to lay that out in the perspective of the patient with her provider. There are certain things, like I mentioned, the first example I would give is migraines with auras. Auras cause us to have visual changes before we get the bad migraine headache. And when you have an aura anytime that occurs, if we have estrogen in your body, we increase your risk for clotting. And so we don't want that to happen. And so we use birth control methods that don't have estrogen in them, and there are several options out there. So there's situations like that, that I would say need to be discussed on each person by person basis. And that's what those appointments are for, is to start learning those things and decide which one works perfect for what your given circumstances are.
Deborah Howell: How effective is birth control at preventing pregnancy in general?
Dr. Michelle Becher: In general, they're great to prevent pregnancy. Especially as I mentioned in some of the briefings about each device and each option, we know the IUDs and the implants are the best at preventing pregnancy with one out of a hundred pregnancies occurring with use. When we step down to the pill, the patch, the ring and the Depo-Provera shot, it's around six per hundred. And why that is because we can forget to give ourselves a shot. We can forget to place the NuvaRing and we can forget to remove the patch or place a new patch. We can forget a pill. And so there's just less forgetting, so to speak, with the Nexplanon, with the IUD. But women are very good at remembering these things. And for the most part, I would say those rates are pretty low.
Deborah Howell: And, you know, this is such a lot of information. How do I figure out the best birth control option for me?
Dr. Michelle Becher: When you come in for those visits, that's a discussion that's had right there in the room with the provider and they can go over all those issues and where your concerns lie as a patient, and then address those and figure out where to tailor and what would work best for your situation.
So I mentioned some of those health issues because there's other health issues too we need to take into consideration. And when I go in and see a patient, I just know there's certain things, "Okay. We can't even talk about like birth control pills if you have had a blood clot in your lungs before. It's just totally off the docket." And then same with the patch and same with the NuvaRing. But there's other items that we can use, like we can use the Depo-Provera shot, we can use the Nexplanon, we can use IUDs. And so some of that will just have to be tailored to that given situation.
For the most part, women that need the birth control, they have all sorts of options out there. And there's certainly information that you can find online to educate yourself before the meeting with the provider and then of course having that discussion in real time.
Deborah Howell: Is birth control usually covered by insurance?
Dr. Michelle Becher: Thankfully most birth control is covered by insurance. Every once in awhile, it's not. And thankfully, there's some programs out there at pharmacies where a lot of the birth control pills are $9 a month. And then there's also a program called GoodRx. It also brings that cost down quite significantly.
Deborah Howell: Excellent. GoodRx. Is there anything else you'd like to add to our discussion?
Dr. Michelle Becher: I just want to send the message that we're here. Providers are here for you as a patient. And to go in and have that discussion if something particularly piques your interest, I think we can help direct that and help you to decide what the best mechanism for your birth control will be.
Deborah Howell: Well, we want to thank you so much, Dr. Becher, for your time and your expertise today. I learned a ton. Thank you.
Dr. Michelle Becher: It's been my pleasure, Deborah, and hopefully this will bring information to people that need it.
Deborah Howell: I think it will. And to learn more about Sparrow Medical Group Obstetrics and Gynecology services and practices, visit sparrow.org/obgyn. And be sure to subscribe to Sparrow Speaks in Apple Podcast, Google Podcast, or wherever you listen to your podcast for our additional healthcare topics. I am your host, Deborah Howell. Thanks for listening and have yourself a great day.
Deborah Howell: Welcome to Sparrow Speaks, the podcast with the latest health news and information from Sparrow, mid-Michigan's premier community healthcare leader. I'm your host, Deborah Howell. And today, we'll be talking about birth control options for women. Our guest is Dr. Michelle Becher, an obstetrics and gynecology specialist with Sparrow Medical Group Obstetrics and Gynecology. Welcome to you, Dr. Becher.
Dr. Michelle Becher: Thank you so much for having me today. I'm here to talk about a very important topic that will guide women from their teen years all the way through their reproductive life cycle.
Deborah Howell: Well, absolutely. Let's get into it. It's 2021. What birth control options are out there?
Dr. Michelle Becher: There's several options. And some of them start, depending on their partner, if they have a male partner, it can include condom use, which we recommend for all male-female partners to use condoms, because it is the best thing to protect against sexually transmitted diseases. But condoms also work very good for birth control in a male-female relationship. They just have to be used and be used effectively. So that's just kind of the basis for the male-female relationship, are the male condoms.
When we move out of that though and when women want to have more control of their own birth control, then we move into different options from taking a pill to wearing a patch on the skin. There can be a ring that can be inserted into the vagina. However, it also needs to be removed from the vagina. There can be a shot that we can teach you actually to give the shot to themselves, and that's given every 90 days. And then there's a couple of office procedures, where we can insert various IUDs. And there's quite a few IUD. We'll get into those I'm sure in a bit. And then there's an implant that goes underneath the skin on your upper arm. And so there's a whole host of options out there. And I would say one of the biggest things is merry an upset patient and figuring out what would work best for them in their situation. So that's really where the conversation starts, what they're looking for and what they need out of a birth control.
Deborah Howell: Well, doctor, let's take these one by one. First, let's start with the IUD.
Dr. Michelle Becher: Yes, the IUD is such a lovely device because it's thoughtless and also has one of the lowest pregnancy rates because it is thoughtless. You can't really forget to take it like you do a pill or that sort of thing, because it's implanted into the uterus. And so the pregnancy rate with a male-female couple is one out of a hundred. They become pregnant with IUDs. So those rates are very low compared to condom use, which is up to 28 out of a hundred. And so the rate of pregnancy is much lower, so they have real great control there. It does involve an office procedure. And in that procedure, we take a device to look at the cervix, which is up inside the vagina and then this device goes into the cervix, into the uterine cavity. So that can be uncomfortable, but women get through it. I mean, stubbing your pinky toe, I would say, is worse than the IUD at some points because of where we put it, but it is all up in our personal area. So that has anxiety certainly that goes with placing the IUD. But I can tell you, I have women who I placed them in, who've never even had sex and do a really good job of getting through it. So I think some of it is just the mental preparedness we have to have IUDs placed.
But what's lovely about them is they last anywhere between three years and 10 years. And so they only need to be replaced, for some, every 10 years. So that works really nice to have it thoughtless. And the other lovely thing about several of the IUDs is it also will improve periods very significantly and get rid of the period for many people. So that's an added bonus to providing birth control, is it also really improves our period control.
Deborah Howell: And once it's placed, there's no longer any pain, right?
Dr. Michelle Becher: It's true. Very good point, Deborah. Once it's in place, the pain really improves. In fact, it's, you know, just a few moments of pain, just like you stubbing your pinky toe, how that gets better, usually rate off. It's the same with placing the IUD. There's a few moments where it's a little bit more intense, but then it settles right down. And every once in a while somebody does take a couple of doses of ibuprofen through the day, just because there's some increased crampiness. But for the most part, it does go right away.
Deborah Howell: Well, lovely. Let's move on to Nexplanon.
Dr. Michelle Becher: So Nexplanon is an implant that sits in the skin of our arm, our upper arm. And no one will know it's there unless you pointed it out to them for the most part, because it sits just under the skin and you can feel it if you touch it. But for the most part, you can't even see it in most women. And so it again involves an office procedure. We numb the skin just ever so slightly and then insert it. And so it's really quite simple. And then it's replaced every three years. And so at that third year mark, after you've had it in place, then you can come back. We can take that one out and put a new one right back in. So you don't even have to go without birth control.
This is similar in the benefits to the IUD in that it also usually gives a lot of relief to the period and often gets rid of our menstrual cycle altogether once you've had it in place for six to 12 months. It really improves those menstrual issues that women can have. What's also nice about the Nexplanon is it also has a low rate of pregnancy for male-female relationships, where it's about one out of a hundred, similar to the IUD.
Deborah Howell: So what if I play racquetball and I bang my arm into wall when I go for a shot?
Dr. Michelle Becher: No issues with it at all. It will hold tight and be fine. It would take a lot of trauma, like pretty significant, like if you think about like a glass window or something like that to cause a trauma to it, it really has to be very significant. Otherwise, it holds its own. You can even get a ball thrown right at it. It's not going to shatter or anything like that. It will hold its own.
Deborah Howell: All right. Well-designed. Now, the patch.
Dr. Michelle Becher: So the patch is such a lovely thing as well. And we have that applied on our skin. It's changed once a week. So you take the old patch off, you put a new patch on and we have women generally wear it through the waist region or on their shoulder blades. We don't like women to place it around the breast, just because of the estrogen hormones that are in the patch. And we like to keep that away from the breast region. So around the waist or on the back, around our shoulder blades is the best place for them. It's applied. It stays on for a week. You can get into hot tubs, go into steam saunas, and it typically sticks on the skin. Now, there's a few women who have really, really oily skin. And in that situation, we have them clean their skin with alcohol and then let the alcohol dry and then apply the patch and that seems to work really well. That's pretty rare for someone to come back and need to change birth control because the patch isn't sticking. It usually sticks really well.
And so they go three weeks of changing out their patch, taking off the old, putting out a new each week. And then the fourth week they generally go patch free. And that's when they would generally have a period. And that works really well too for birth control, similar to the pill. And that there can be up to six out of a hundred pregnancies that can occur from male-female relationships. And that's because not everyone remembers to change their patch. So if they forget to change it or after their week of being off the patch, if they forget to put it back on. So you just got to set little reminders in our phones because we all carry those about, and that can help women to remember to change that patch in a timely way and avoid those pregnancy rates.
Deborah Howell: Sounds good. All right. The vaginal ring.
Dr. Michelle Becher: The vaginal ring, So there's two different rings that are out there. One is placed for three weeks at a time. You take it out for a week, you set it aside and then you put it back in a week later and you do that through cycles over a year. The other one is replaced every month. So NuvaRing is the one that's replaced monthly and that ring, when it goes into place in the vagina, sits there for up to 30 days, and then you need to reach in the vagina and remove that. And then you can actually replace it if you want continuous birth control and avoid periods is allowed with the NuvaRing, and that can be in place for 30 days at a time. And then some women choose to have a menstrual cycle with it. So then they would wear it for 24 days, take it out, leave it out and throw that one away. Do nothing for six days, then put a new one back in for that 24-day timeline, because they're not having a period during the time the NuvaRing is in typically. And what's nice about the NuvaRing as well is similar rates to the patch, where there's about six per a hundred that become pregnant in the male-female relationships with that. But it works really nice because they also have the option if they want to avoid their periods with it, they can.
Deborah Howell: Yeah. Nice. I'm terrible with assembling Ikea stuff. Is there any way to put in the ring wrong?
Dr. Michelle Becher: There is not a way to put it in wrong. In fact, it's much like a tampon. Once it's up and in proper location, it just finds its way. We have found couples when they have intercourse, male-female intercourse, it can come off on the penis. So when they notice that, they just put it right back up in the vagina, so it works out well. And yup, there's not a wrong way to put it in. So good question, too, Deborah.
Deborah Howell: Okay. OCPs, what are they?
Dr. Michelle Becher: So OCPs are oral contraceptive therapy or pills is what the P used to stand for. And they work really nice for women who want that control. Other period want to gauge when they're having it, want that control when they stop it or when they started birth control. Because once you stop it, it's out of your system in 24 hours.
And so regarding the pill, we have that too. We start it when we start our period and we can do the same as we have the other options we spoke of. You can take them continuously where you take only active pills and you can avoid your period altogether with the pill and have that control of taking it each day. The thing is remembering to take it each day and then having your pills with you when you remember. And so that can be a bit tricky with the pills and especially in, I feel like in our teen women, we don't have as typical of a schedule as we do as we get into the workforce. And so I think they can vary on that timeline and having their pills with them or not.
But a lot of young women are really great about setting the alarm on their phone and keeping, you now, the pills in their phone or right nearby and are great at being on top of taking it on time. Most of the pills are a combination pill where they have estrogen and progesterone in them and those work by stopping ovulation or the release of the egg and that's how they prevent pregnancy. And that doesn't happen until you've had the medication in your system for 30 days. So your first pill pack is not preventing pregnancy yet. It's your second pill pack. So that's also why there's a higher pregnancy rate with pills because it does take a month for those to engage our system and be actually providing birth control.
There's a different type of birth control where they're progesterone-only pills, which we utilize for a lot of different reasons. And those work a little bit differently. They don't prevent ovulation, but they really cause our cervical mucus to be very thick and prevents sperm from going up. And so those work a bit differently and those do need to be taken on time every day. And I tell women, "If you take it at eight o'clock, eight o'clock, eight o'clock every day, and then one day you take it at 10, you're not protected from pregnancy for a week. So they have to be really diligent in the progesterone only birth control pills and taking those in a very timely fashion because they do work a little bit differently than the combination birth control pills.
Deborah Howell: Yeah, you really have to be on it. Finally, last but not least, DMPA.
DMP.
Dr. Michelle Becher: Yeah. So DMPA is depot medroxyprogesterone acetate or Depo, a lot of people just call it, although that's just the avenue of how they were putting that into the body. The depot medroxyprogesterone acetate is the actual medication and it's a shot that's given every 90 days, works really well to alleviate periods. And it's like 90% to 95% of women after a year aren't having any periods when they use the Depo-Provera shot. So that works really nicely.
There's a couple of caveats with the shot. One is that there is about a 10-pound weight gain associated with the Depo-Provera shot. And typically, that does come back off after they stop it. Any weight over the 10 pounds isn't associated with the Depo-Provera shots, associated with the trips to the refrigerator and, you know, maybe not making the best choices in life.
But the second issue with the Depo-Provera shot is that when women choose to go off from it, it can actually cause you to not ovulate for 18 months after the Depo-Provera shot is given. Now, you can't count on that and you can't use that as a birth control, but for people who want to time their family and time when they want the pregnancy, that can definitely play a role because it can impact our fertility for about 18 months once we stop it. But otherwise, it's a great product and teaching women how to give themselves a shot sounds scary, but our team does a great job in teaching how to give those.
Deborah Howell: Are there any side effects in using these birth control options?
Dr. Michelle Becher: There are side effects, just like there are in any medication. One of the things like I mentioned with the Depo-Provera shot, that 10-pound weight gain, that's also true with the Nexplanon implant. That also has about a 10-pound weight gain associated with it. All the other birth controls do not. So the NuvaRing, the patch, the pills, the IUD, no weight gain associated with any of those. So that's a nice thing.
And then I would say for the most part, their side effects are beneficial because they're side effects that impact our periods. And as I mentioned, with several of them, we can get rid of our periods and significantly improve our periods. Well, it's the same with painful periods. All of these routes, generally, no matter how you take the medication, whether it's by a pill or a patch or ring, a shot, the implant, the IUD, all improve painful periods and really settle the pain down significantly. So from those benefits, it's quite lovely.
When we talk about women who are breastfeeding, then we also utilize the birth control pills when they want to use a pill for progesterone only. And so the Depo-Provera shot would also be progesterone only, and then the IUD and the implant. And we do that because we know estrogen can impact our breast milk. It doesn't always, but especially when we're first establishing it, we want to have as little impact because we want breastfeeding to be successful. So there's things like that I would say that you would want to talk with your provider about and they would address those issues in each unique situation for the patient and what they're at in their lifetime.
Deborah Howell: It's so good to have you break all this down because it is a very, very large body of work to get our arms around when it comes to birth control. In your opinion, Dr. Becher, is hormonal or non-hormonal birth control better?
Dr. Michelle Becher: Whether we choose hormones or not hormones, there's a very personal choice there, first of all. Second of all, some of that can depend on different medical issues that you may have. So you'd really want to lay that out in the perspective of the patient with her provider. There are certain things, like I mentioned, the first example I would give is migraines with auras. Auras cause us to have visual changes before we get the bad migraine headache. And when you have an aura anytime that occurs, if we have estrogen in your body, we increase your risk for clotting. And so we don't want that to happen. And so we use birth control methods that don't have estrogen in them, and there are several options out there. So there's situations like that, that I would say need to be discussed on each person by person basis. And that's what those appointments are for, is to start learning those things and decide which one works perfect for what your given circumstances are.
Deborah Howell: How effective is birth control at preventing pregnancy in general?
Dr. Michelle Becher: In general, they're great to prevent pregnancy. Especially as I mentioned in some of the briefings about each device and each option, we know the IUDs and the implants are the best at preventing pregnancy with one out of a hundred pregnancies occurring with use. When we step down to the pill, the patch, the ring and the Depo-Provera shot, it's around six per hundred. And why that is because we can forget to give ourselves a shot. We can forget to place the NuvaRing and we can forget to remove the patch or place a new patch. We can forget a pill. And so there's just less forgetting, so to speak, with the Nexplanon, with the IUD. But women are very good at remembering these things. And for the most part, I would say those rates are pretty low.
Deborah Howell: And, you know, this is such a lot of information. How do I figure out the best birth control option for me?
Dr. Michelle Becher: When you come in for those visits, that's a discussion that's had right there in the room with the provider and they can go over all those issues and where your concerns lie as a patient, and then address those and figure out where to tailor and what would work best for your situation.
So I mentioned some of those health issues because there's other health issues too we need to take into consideration. And when I go in and see a patient, I just know there's certain things, "Okay. We can't even talk about like birth control pills if you have had a blood clot in your lungs before. It's just totally off the docket." And then same with the patch and same with the NuvaRing. But there's other items that we can use, like we can use the Depo-Provera shot, we can use the Nexplanon, we can use IUDs. And so some of that will just have to be tailored to that given situation.
For the most part, women that need the birth control, they have all sorts of options out there. And there's certainly information that you can find online to educate yourself before the meeting with the provider and then of course having that discussion in real time.
Deborah Howell: Is birth control usually covered by insurance?
Dr. Michelle Becher: Thankfully most birth control is covered by insurance. Every once in awhile, it's not. And thankfully, there's some programs out there at pharmacies where a lot of the birth control pills are $9 a month. And then there's also a program called GoodRx. It also brings that cost down quite significantly.
Deborah Howell: Excellent. GoodRx. Is there anything else you'd like to add to our discussion?
Dr. Michelle Becher: I just want to send the message that we're here. Providers are here for you as a patient. And to go in and have that discussion if something particularly piques your interest, I think we can help direct that and help you to decide what the best mechanism for your birth control will be.
Deborah Howell: Well, we want to thank you so much, Dr. Becher, for your time and your expertise today. I learned a ton. Thank you.
Dr. Michelle Becher: It's been my pleasure, Deborah, and hopefully this will bring information to people that need it.
Deborah Howell: I think it will. And to learn more about Sparrow Medical Group Obstetrics and Gynecology services and practices, visit sparrow.org/obgyn. And be sure to subscribe to Sparrow Speaks in Apple Podcast, Google Podcast, or wherever you listen to your podcast for our additional healthcare topics. I am your host, Deborah Howell. Thanks for listening and have yourself a great day.
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