Friday, March 19, 2010

No Babies: Getting Off the Hormone Train

A woman taking hormonal birth control will usually stop using it at one point or another, either because she's ready to make babies, she's not getting any, or she's just ready for a break. Just like it takes the body a little time to get used to a woman taking hormones, it needs a little time to get used to her not taking them, too.

Common symptoms are mild nausea, fatigue, sluggishness, breast tenderness, weight loss (usually 2-10 lbs), changes in sexual desire (some want it all the time, others want none of it at all), and some variability in menstrual cycles. These symptoms can last for several weeks up to a couple of months, but will eventually dissipate completely.

Move it, gorilla, she wants off the hormone train!!

Now, something to know is that these symptoms are also signs of early pregnancy. If a woman is still having sex with boys, especially if she's not using condoms nigh-unto-religiously, and these symptoms don't dissipate or start to get more pronounced in that time frame, it's time to pee on a stick. Many women need a month or two for their reproductive parts to get back online, but not everyone.

Of this I am 100% sure. Know why? Because my sistercreature, who went off the Pill in December because she was sick of it, wrote me in January saying "Damn, girl, you need to write something about how messed up you get after going off birth control. I feel all funky and my tits hurt," but it wasn't because of her pills, it's because she's PREGNANT! She and her amoreaux were "kinda half-assing" birth control, and now I get to be an AUNTIE! Of a HUMAN! YAY!

My nephew, Pepino. His brother, Duquan, is an ill-tempered bird.
Neither enjoy lullabies.

So, moral of the story is that getting off hormonal BC takes some getting used to, just like getting on did. And if making babies is not in the plan, make sure condom usage is not half-assed!

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Wednesday, March 3, 2010

No Babies: Insert Clever Patch Reference Here

Birth control patches are often referred to by their brand name, Ortho Evra. There is currently no generic version of the patch, nor will there be until Ortho Evra's patent expires in 2015. They require a prescription, and the per-month cost for the patch is between $15-$50.

The patch delivers both estrogen and progestin (the standard birth control hormones) through the skin. These hormones prevent ovulation, make the uterus inhospitable, and thicken cervical mucus, like other hormonal birth control methods. The patch is placed on the skin of the arm, hip, bum or shoulder once a week for 3 weeks out of the month. The 4th week, no patch is used.

Patches: not just for pirates anymore!

It's as effective as the Pill, meaning that less than 1 out of 100 women will get pregnant if the patch is used correctly. There is some evidence that it's less effective in women who weigh more than 198 pounds, but not universally. More voluptuous ladies should discuss this with their health provider person. All ladies should discuss any other medications they're taking, including over-the-counter and natural ones!

As far as safety goes. . .there are some concerns. There's a whole group of ladies who shouldn't use the patch at all, including anyone with any kind of heart or liver problems. In 2008, the FDA changed the prescribing information for the patch to include results from a study showing an increased risk of serious blood clots in young women. However, the FDA does still consider Ortho Evra a safe and effective medication.

Other side-effects include nausea, bleeding between periods and breast tenderness, similar to other hormonal birth control. Some women also see changes in sexual desire and skin irritation at the site of the patch. Positive side effects include reduced risk for pelvic inflammatory disease and severe menstrual cramping, reduction in facial and body acne and even a reduced risk of certain uterine cancers.

I have never been able to even try the patch because 1) as I've mentioned, hormonal birth control makes me go crazy, and 2) I have the most sensitive skin on the planet and would undoubtedly get some kind of hideous rash from sticking drugs to it. Also, the concept of transdermal medication is a little creepy to me, no matter how irrational that may be, or how awesome and futuristic medication patches are.

If you have experience with the patch and are willing to share, please do so in the comments!!

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Tuesday, January 26, 2010

No Babies: Shot 'o' Depo

We are nearing the end of our safari of hormonal manipulation, and I thought I'd bring in one of the more controversial before the finale. Depo-Provera, or Depo, was initially developed to treat uterine and cervical cancers, but was also found to very effectively prevent pregnancy in smaller doses. It is administered by injection, in a clinic, every three months.

Depo releases progestin, a female sex hormone, into the system. This prevents ovulation and thickens cervical mucus, making it nigh unto impossible for sperm and egg to meet and zygote it up. If injected on time every time, less than 1% of users will become pregnant while using it. That great percentage goes down quickly if shots are gotten late.


The main benefit is that it's birth control you think about only every 3 months, leading to increased efficacy and decreased pain-in-the-assedness. It's also very discreet, reduces the risk of uterine cancers, and can decrease menstrual flow significantly. The lack of estrogen makes it appropriate for women with cardiovascular problems, or who are breastfeeding. The shots are $35-$75 each, plus clinic costs.

Most of the side effects common to hormonal birth control also apply here - weight gain, mood disturbances, spotting between periods, headache, nausea, etc. The unfortunate thing is that if you do experience these, there's no way to reverse the shot - you've just got to deal for 3 months.

There are also some more serious side effects. The most talked about is that Depo causes temporary bone loss, which increases with prolonged use; as a result, the FDA placed a "black box warning" on packaging in 2004. Less commonly known is the 3-9 fold increase in risk for cervical cancer, and that some animals involved with the drug's testing developed breast tumors. Most shocking to me, however, is that babies exposed to Depo while still in the womb have an 80% chance of not surviving their first year. Ho-ly crap.

The controversy surrounding Depo is pretty significant. During many of the inital clinical trials, both in the US and the developing world, record keeping and protocol was shoddy, at best. It was unclear whether or not participants had been properly informed of the risks. In one major study, women with clear contraindications were given the shot anyway, and others were deliberately misinformed of the risks.

The vast majority of the participants were very poor women of color with limited education, groups that have been historically vulnerable to unethical scientific research practices, which raised questions about ethics and coercion. It's crap science like this that makes all clinical researchers look bad, and that is something this former clinical researcher takes kinda personally.

There's more detail about the controversy here, about 2/3 of the way down the page.

I have to say Depo is a method I have never considered using. I do have some friends who've used it and love it, but I've heard more horror stories than love stories. I'd love to hear your experience, if you've had one - I'm always down to learn something that might change my mind.

If you have any questions about any of this, give me a shout, or talk to your health care provider!

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Sunday, January 10, 2010

No Babies: Ring a Ding Ding Dong

The vaginal ring is a flexible plastic drug delivery system that is placed inside the vagina, resting close to/around the cervix, that releases estrogen and progestin continually over time. NuvaRing is the most popular brand name, but there other brands, as well as generic options, out there.

The ring prevents ovulation and thickens cervical mucus, in basically the same way birth control pills do. It's not going to turn anyone into a lady Gollum, but lots of women I know have a similar devotion to their rings as that twitchy little dude did to his. Yes, I'm a dork.

The Precioussssss...

The ring stays in place for three weeks out of every month, then is removed for one week, letting menstruation occur. The women I've spoken to that use vaginal rings, (both friends and patients at the research clinic) insist they're super comfortable, but I've never used one myself, so can't confirm or deny it. I have handled them, and they are very flexible, and also very soft. I don't have a male perspective about how they feel during sex - men? Any thoughts?

Vaginal rings are 99% effective if used properly and always changed on time, and about 82% if changed late. It's slightly more effective than the Pill, most likely because the dosing is much easier to comply with - there's only one chance a month to use it late, instead of one chance a day. If the ring is changed late, a backup method of birth control is needed until the next time it's changed on time. The cost comes to around $10-$50 per month.

Just as the action of ring is very similar to that of the Pill, so are its side effects. Weight gain is common, though at least 3 women I know only gained weight in their boobs, which they were mostly stoked about. Also noted are nausea and vomiting, bleeding between periods (especially in the first 6 months), decreased sex drive and mood alteration. There's also an increased risk of serious cardiovascular problems, especially in smokers, women who are older than 35 or are significantly overweight.

One final thing about NuvaRing in particular: I want to encase in carbonite the marketing team that made up that damn synchronized swimming commercial with that f***ing annoying days of the week song. Direct-to-consumer marketing of pharmaceuticals was already the bane of the American healthcare system before that drivel was barfed into existence to rub salt in the wound. It has absolutely nothing to do with how well NuvaRing works or how good a choice it is for someone, but I just had to get that out.

As always, if you have any thoughts to add, please comment, and if you have any questions, ask away!

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Wednesday, December 30, 2009

No Babies: The Pill

The first birth control pill was FDA approved for use as a contraceptive in 1960. By 1964, 25% of all American couples were using them as their primary method of contraception, and today they are the most commonly used method of birth control in the US. Many people credit the introduction of The Pill as the start of the sexual revolution.

you say you want a rev-o-lu-shu-uu-uun...

Most birth control pills are comprised of a combination of two hormones: estrogen and progestin, though some contain progestin only. These hormones prevent the ovaries from releasing eggs, so when spermies show up, there's nothing for them to fertilize. They also thicken cervical mucus (to make it harder for spermies to swim) and thin the uterine lining (so if on the off-chance something is fertilized, there's no soft warm place for it to latch on to and grow into a person.)

The Pill (of which there are a zillion brands to choose from) comes in monthly packs that cost between $15-$50. The packs usually contain 28 active pills and 7 placebo pills, which allow for a menstrual period each month. Some newer pills, though, come in packs without placebo pills, with the intention of reducing the number of periods women have each year, which I think is rad.

Birth control pills are taken once a day, and should be taken at the same time every day. This is super important, because each pill is formulated to work for 24 hours, and 24 hours only. A delay in replenishing the medication, even of just a few hours, can conceivably leave the body unprotected. If a pill is skipped, or more than a few hours late, it should be taken as soon as its remembered, and a backup method should be used for the rest of the month. It's a drag, but it's the reality.

There are considerable side effects of The Pill, though not all of them are considered negative. Happy side effects include a reduction in facial and body acne, the regulation of wacky menstrual cycles and the reduction in severity of menstrual cramps. They can also reduce the risk of Pelvic Inflammatory Disease, which is something I did not know! I love learning new things!

On the negative end of the side effect train are weight gain (about 5lb., on average), nausea and vomiting, mood alteration, reduction in sex drive and vaginal lubrication, bleeding between periods, and an increased risk for blood clots and stroke, especially in women who smoke cigarettes or have certain kinds of migraine headaches.

It's very important that all your healthcare providers knows you're taking birth control pills, as there are medications (like some antibiotics and anti-depressants) that can kill the efficacy of The Pill.

So, it's not right for everyone (I, for example, have experienced every single negative side effect of every pill I've ever tried), but birth control pills are crazy effective and very safe. If your bod can handle the side effects, and your brain can remember to take them on time, it's an excellent, safe and extremely popular choice for No Babies!

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Tuesday, December 15, 2009

No Babies: Implanon

This one is relatively new - it was FDA approved in 2006. Implanon is a tiny rod that's inserted into a woman's upper arm that delivers a continuous supply of the hormone progestin, which prevents ovulation (among other things) for about 3 years. It's similar to an older product called Norplant, which was discontinued in the US in 2000, but is more effective and has fewer side effects.

these guns ain't tryin' to have no babies

Implantation is done with a local anesthetic, takes only a few minutes, and costs between $400-$800. Removal also occurs under local anesthetic, but takes longer than implantation and only costs between $75-$150. Both are usually covered by insurance or Medicaid.

Implanon is more than 99% effective, meaning less than 1 in 100 women will get pregnant while using it. It's progestin-only, so women who can't take estrogen or are breastfeeding can use it. Monthly period often become lighter and less frequent, with 1 in 3 women stop having a period altogether after about 6 months. If a woman wants to get pregnant, she can usually do so within a month or two of removing the implant.

There can be spotting between periods for the first 6 months or so, and there can be some discoloration, scarring and pain at the implant site. Other than that, the side effects are similar to that of other hormonal birth control: nausea, decreased sex drive, sore boobs, weight gain and mood swings.

From what I can see, women are split on Implanon. Those who like it really like it - a former co-worker of mine loved hers, and she was not one to be shy with complaints. Most women do experience some of the side effects listed above, especially in the first 6 months, but for some they either go away or are not troublesome. For others, though, the symptoms are more serious - acne, constant nausea, headaches and serious mood disturbance. Several women reported needing to have the implant removed after only 8-12 weeks.

I would personally hesitate before using Implanon, but systemic hormonal birth control tends to make me go batshit crazy. If hormones are something you tolerate well, though, Implanon sounds like it could be your new best friend.

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Tuesday, December 8, 2009

No Babies: Our Intrauterine Friends

The intra-uterine device, or IUD, is extremely effective (more than 99%), and lasts for a very long time. There are 2 IUDs currently on the market: the Paragard (or 'copper T') and the Mirena. I had the Mirena placed about 3 years ago, and I heart it.

Both types look very similar - a small plastic 'T' that rests inside the uterus. The Paragard contains a small amount copper which inhibits sperm motility, while the Mirena contains a tiny amount of the hormone progestin, which prevents ovulation and thickens cervical mucus so the sperm can't swim well. The devices themselves create a physical obstacle, as well. The Paragard remains effective for 12 years, the Mirena for 5 years.

Paraguard Mirena

Both are placed by a health care professional. The placement procedure takes about 20 - 30 minutes, costs between $175 and $650, and is covered by most insurance. Now, I can't lie...the placement hurts like hell. It's supposed to be easier for women who've given vaginal birth, but even then, it's not fun. Don't fear, though...local anesthesia is available and is WORTH EVERY PENNY. It's called a 'cervical block', and it is your friend.

Side effects are few, but include spotting between periods, especially in the first several months. The Paraguard can make monthly periods heavier, which can lead to anemia, and can also make cramps worse. Mirena can stop periods completely - I only have 3-4 super light periods per year, which is win.

One rare side effect (that I experienced, unfortunately) is a temporary, but marked, decrease in sex drive. For me, it lasted about 5 months. Everything got 100% back to normal, but it definitely put a kink into my relationship for a while there, and not in the fun way.

If someone is ready to get busy right away, Paragard is effective immediately. Mirena is effective immediately if placed within 7 days of a woman's last period. If it's placed at any other time during her cycle, a backup method is needed for 1 week.

IUDs are best suited to women in monogamous sexual relationships, as the strings used for retrieval pass through the cervix into the vagina, creating a veritable superhighway for bacteria (chlamydia, gonorrhea, even normal flora) to enter into the uterus. Bacteria + uterus = OW. I have known a few health care professionals that insist women with more than one partner can safely use IUDs, but most recommend against it.

Less than 1 in 100 women will get pregnant while using and IUD. Unfortunately, if a woman does get pregnant while using one, there is an increased risk for ectopic or tubal pregnancy. A woman can get pregnant within a month or two of having the IUD removed, so if "No Babies!" turns into "Babies, Please!", you're solid. They're also both safe to use while breastfeeding!

An IUD gives the protection and forget-about-it-ness of permanent birth control without having to commit to the permanent part. It's the most effective non-permanent method (some say it's most effective, full stop) and also the most cost-effective. That equals 2 thumbs up 'round these parts!

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Monday, November 23, 2009

Essure

After plugging vasectomy as the superior choice for couples looking for permanent birth control, I got an email from Nicole, senior account executive with Loomis Group. Nicole is part of the team that is marketing a type of female sterilization method that I had neglected to mention: Essure.

The Essure system places a nickel coil into each fallopian tube using a 'simple, in-office' procedure. The system was FDA approved in 2002. Both Nicole and the Essure website make it sound fantastic - short recovery time, no anesthesia required, no incisions and high efficacy. However, advertising executives and websites are around to make shit smell like roses, so I decided to do a little more digging.

you want to put that where?

Research shows that women do tend to be happy with the procedure compared to standard laparoscopic tubal ligation. It sounds like if it goes well, it's pretty great. The procedure is only supposed to take about 15 minutes, and usually works after about 3 months (alternate birth control is required in the interim), and works permanently.

However, the stories from women who've had bad experiences scare the crap out of me. First of all, it may be simple, but it's not painless - which is not surprising considering it has to be placed through the cervix. Pain, bleeding, expelled coils...yowtch. It also appears that the coils are difficult to remove without at least a partial hysterectomy. Internet forums are hardly unbiased reporting, but they're also unsolicited and uncompensated.

So, I'm sticking with my guns and going on record as saying that vasectomy is the way to go, but think that Essure is definitely something for women with higher pain threshold than I to talk to their docs about. If you've had Essure placed and are willing to share your experience, please comment!!

Finally, although I can't fully recommend the product, I appreciate Nicole for contacting me and letting me know I'd missed something - and for being the first person I don't know to read Chakabox. Thanks, Nicole!!

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Thursday, November 19, 2009

No Babies: Women Go Under The Knife

Tubal ligation is the clinical name for female sterilization. The fallopian tubes are altered in such a way that egg and sperm can't ever get together. There are 4 methods utilized to make sure those frisky cells don't dance their magical conception dance:
  • cutting the fallopian tubes then re-attaching them off-kilter (most common)
  • squeezing the tubes shut with clips, causing scar tissue to permanently block them
  • same as above except using fancy hi-tech silicone rings in place of clips
  • cauterizing teach tube closed with electrical current (can be done laparoscopically)
You will notice that none of the methods involve any tying of any tubes, but "she got her tubes tied" is just catchier than 'she got a partial salpingectomy'.

knot tying badge not required

These procedures can be done under general or epidural/spinal anesthesia. If general anesthesia is used, there is no pain at all during the procedure, but there can be some discomfort if the epidural is chosen. Happy drugs are usually given in conjunction with the epidural option. The cost can be anywhere from about $1500 to $6000.

Recovery can take everywhere from a couple of days to a week or two. Aside from pain, there can be some period-like symptoms...bleeding, gassy feeling, cramping, etc. Sexual abstinence is recommended for at least a week, and alternate forms of birth control are needed until blockage is confirmed if the clip/ring procedure was performed.

Tubal ligation is intended to be permanent. It can be reversed, but it's a pretty serious surgery. As a result, it's generally difficult for women under 30 find someone to do it for them. It has a failure rate of less than 1%, but when it does fail there's an increased risk of it ending up as a tubal or ectopic pregnancy, which is lame.

All in all, folks, a vasectomy seems a whole lot easier than tubal ligation to me. It carries less risk and costs a WHOLE lot less. Should it come time to choose sterilization in Chakabox world...here's hoping the Manfriend can be convinced to wear an ice jock for a couple of days. I'd totally make it worth his while.

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Monday, November 16, 2009

No Babies: Men Go Under the Knife (or not, apparently!)

A vasectomy is a procedure that cuts or blocks a man's vasa deferentia, the tubes that carry sperm from the testicles during ejaculation. Traditional vasectomies involve a small incision in the scrotum. Newer, 'no-scalpel' vasectomies do not.

Both procedures are hella outpatient - traditional ones take about 20 minutes, the no-scalpel methods only 5-10! Local anesthesia is used, and if a guy's nervous, he can ask for sleepy/happy drugs.

Recovery time ranges from a day to a week (no-scalpel methods boast shorter recovery time). Not having a scrotum or vasa deferentia, I can't really imagine what a vasectomy would feel like, but it doesn't sound horrible - I saw the pain generally classified as 'moderate', 'achy', and well controlled with OTC painkillers. Ice and a jock strap for a day or so also appear to be keys to happy post-snip balls.

nope, can't even imagine

Sexual abstinence is recommended for a week following the procedure, but there should be no lasting sexual side effects once recovery is complete. An additional form of birth control is needed for the first 3 months to make sure no stragglers try and make a run for glory.

There is less than a 1% chance that a vasectomy will fail, making it the most effective form of male birth control available. The procedure is intended to be permanent, so it's definitely something to think about before having it done. Prices range from about $350 - $1000, and many insurance plans cover the procedure in at least one form.

For those of us who love balls, it can seem a little freaky to go messing with them like this. But, as a fan myself, I wouldn't tell y'all it's safe if it wasn't. Cross my heart and hope to die, fer serious.

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Thursday, November 12, 2009

No Babies: 100% Effective

There are 3 methods of birth control that are utterly foolproof. No matter how drunk you are, no matter how caught up in the moment you are, no matter how hard you try:

1. Same-sex partners

The whole birth control thing is moot if you're shaggin' your own sex. Gay and lesbian couples can raise babies as well as anyone, but making them...that's a different story.

2. Hysterectomy
GTFO, uterus

Taking it out merely to prevent pregnancy is not a good call, because it also creates and helps regulate a woman's hormones. However, if the uterus is removed for other reasons, not having to worry about birth control is a bonus. No oven, no bun. Commence boning.

3. Abstinence from intercourse.

Now, I'm not suggesting replacing sex with a walk in the woods or a rousing game of Uno. I'm suggesting that it's possible to be sexy while making sure your tingly bits don't ever touch. Easy tip for success - only one person gets to be naked at a time!

Next up - the almost foolproof!


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Wednesday, November 11, 2009

No Babies!!

For the most part, animals have little need for birth control. The only reason most species have sex at all is for reproduction. Some do have sex for fun (humans, bonobo chimps and dolphins, to name a few), but if dolphins are boning for fun and that fun leads to babies...well, what else are they doing? It's not like dolphins need to pay for fish or decide if they want to establish a career before having kids.

We humans, however, do have these considerations, and need to be a little more careful with our fun. For one thing, just because two people CAN have a baby, doesn't mean they should. I mean, 13-year-olds and meth addicts can have babies - 'nuff said. Secondly, not everyone wants to have children, and even those that do mostly don't want a million of them.

Three (or nine million) cheers for birth control! It allows humans to enjoy their bodies without making new ones until they're good and ready to make them. There are tons of options available: condoms, hormones, spermicides, cervical barriers - we'll get to them all. So sit back and enjoy the cavalcade of contraception!!
just say no

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