There are many options available for birth control, and it can be confusing to sort through the different kinds.  In order for it to be most effective for you, it has to be an option that works well for you.

This discussion is going to be limited to reversible birth control methods, meaning ways to prevent pregnancy that can be stopped at anytime.  So, what’s out there?

Barrier Methods

These are things like condoms, diaphragms, female condoms, and sponges.  The barrier methods work by blocking the movement of semen into the female genital tract.  They have to be used every single time, so they do take some planning—condoms need to be on hand, the diaphragm needsto be fitted and placed into the vagina. The big benefit to them is that using condoms consistently and correctly can decrease your risk of sexually transmitted infections (STIs), including HIV.  You can also use condoms along with other forms of birth control- either as a back-up method, or to protect against STIs.  They are also able to be purchased without a prescription and are inexpensive.  The actual efficacy of male condoms is ~85%, meaning that 85 couples out of 100 using them will not get pregnant in a year (or 100 – 85 = 15 pregnancies per year).  In theory, condoms used correctly and consistently- every single time- will be 98% effective (only 2 pregnancies)…but no one really lives in a perfect world! 

The Pill, the Patch, and the Ring

These methods all work by giving you a dose of two hormones, estrogen and progestin.    The combination of these hormones blocks the signals that would normally trigger ovulation, or the monthly release of an egg.  There are many different kinds of pills, which need to be taken every day.  For women who may not want to take a pill - or have a difficult time remembering to take it-  there are other ways to take the hormones.  The patch is a sticker that is placed on the skin for a week at a time, and the ring is a flexible, plastic ring that is placed in the vagina for 3 or 4 weeks at a time, and can be left in place during sex. The actual efficacy rate of pills, patches, and rings is 92%, meaning that 92 women out of 100 women using them will not get pregnant.  But that’s 8 out of 100 that may get pregnant in a year. 

Taken every day, perfectly with no missed or late pills, patches, or rings, these methods may be 99% effective.

All of these methods have the same side effects; most commonly, these are breakthrough bleeding or spotting, nausea, and breast tenderness.  Because of the estrogen in these methods, these methods can increase the risk of developing blood clots in the legs or lungs.  Women who have had a history of blood clots or strokes and women who smoke over the age of 35 should not take these methods.  But it’s not all bad news:  the pill, the patch, and the ring can improve acne, cramping, heavy periods, unwanted hair growth, and reduce the risk of uterine and ovarian cancers.  If desired, they can also regulate whether and when periods occur; it’s possible to have a period once a month or once a year. 

The Mini-Pill

These pills contain only one hormone, a progestin.  They are much smaller doses that those in regular pills, which also contain estrogen.  They work by thickening cervical mucus and preventing the sperm from reaching the egg.  After taking a mini-pill, the effects wear off after ~22-24 hours- and they don’t always prevent the release of an egg, so it’s very important to take the mini-pill at the same time everyday for it to be effective in preventing pregnancy.  Because of the decreased effectiveness compared to regular pills, it’s often recommended for women who cannot take regular pills, such as breastfeeding women or women who are at high risk of complications from regular pills.

The Emergency Birth Control Pill

These pills, which contain progestins (like the mini-pill, but higher doses), can be used to prevent pregnancy when another method may have failed.  They work by preventing ovulation, or the release of an egg.  If you are already pregnant, they will not cause a miscarriage or abortion.  They are most effective at preventing pregnancy when taken as early as possible after sex, but they can be taken up to 5 days later.  They may decrease the risk of pregnancy as much as 89%.  Because of the cost and the way that they work, they are most useful for unexpected or emergency situations and shouldn’t be used as the main method of birth control. 

The Shot (Depo-Provera)

This method is a hormone shot containing a progestin hormone.  It works through a combination of actions: it prevents ovulation and thickens the cervical mucus.  It is very effective- 97%, meaning 3 out of 100 women may get pregnant using it during the first year, and it can be a very private method to use- once you have taken the shot, no one else would know it.  The main side effects are irregular bleeding or spotting, and most women who use Depo-Provera for 1 year will stop having menses at all. Sometimes after stopping the shot, it can take some time before periods return to normal.  The shot can also cause some bone thinning, but this is reversed when women stop using the shot and does not seem to increase the risk of bone fractures.

The Implant

This method is similar to Depo-Provera, but instead of a big dose every three months, the small plastic rod releases a smaller amount of a progestin hormone continuously.  The rod is placed into a woman’s arm in the office, and it can stay in place up to 3 years, making it a long-acting method birth control.  It is also very effective- also <1% of women will become pregnant during the first year of use.  It can also cause irregular bleeding or spotting as a side effect, similar to Depo-Provera, but these effects wear off very quickly when the implant is removed. 

Intra-Uterine Contraception

This form of birth control is used by placing a contraceptive device into the uterus.  There are two different types of intrauterine contraception that are most common in the US (see below).  Both kinds are very effective, with <1% of women becoming pregnant during the first year.  Both are also very safe to use, although there is a small risk of infection, especially at the time of placement- and can be used by most women, even women who are teenagers, have never been pregnant, or cannot take estrogens. 

The Mirena IUS (for intra-uterine system) is a T-shaped piece of plastic that releases a progestin hormone into the uterine lining, and it prevents pregnancy by thickening cervical mucus and making the uterine lining so thin that a pregnancy cannot develop there.  It can also decrease the amount of bleeding and cramping with periods. The Mirena can stay in place for 5 years.  The Paragard IUD (intra-uterine device) is also a T-shaped piece of plastic, but instead of a hormone, it has copper on it that causes a reaction that kills sperm; it may also prevent pregnancies from implanting into the uterus.  It may cause heavier periods.  The Paragard can stay in place up to 10 years. 

Both of these methods can be stopped at any time by making an appointment to have the devices removed, and the effects wear off very quickly.

As you can see, there are many methods out there.  If you’re interested in any of these forms of birth control, or if you have any questions, you should make an appointment to talk with your doctor.  

by:  Gretchen Reinhart, M.D.

 Believe it or not, this is a very popular question.  And just a reminder: there is no such thing as a dumb question.  This statement is even more applicable in medicine than in a classroom.  This description is how it normally happens. There are exceptions to every rule.  If the below information doesn’t sound like you or you have more questions, then you need to see your doctor. It is often beneficial to have preconception counseling with your doctor before you try to have a baby.   On to the answer…

A review of the basics:
To get pregnant you need a healthy sperm to meet a healthy egg.  In a normal couple, the man produces millions of functional sperm with each ejaculate which live approximately 2-4 days while they search for an egg.  If the sperm don’t find an egg, they die (don’t worry, he’ll make billions more).  On the other hand, the woman produces one egg per month (twins can happen about 1-3% of the time, but we’re talking normal one-baby pregnancies here).  When the egg leaves the ovary, it is called ovulation.  The egg then travels into the fallopian tube where the sperm is hopefully hanging out and ready to join the egg.  If the sperm and egg join, that is called fertilization. The new embryo (early baby) then travels down the fallopian tube to the uterus (womb) where it lives and grows until the baby is ready to be born.

How do I know when I am ovulating?
If you are having regular monthly periods, you are most likely ovulating every month.  Like I said before, there are exceptions to every rule, but think positive. There are all sorts of fancy ovulation kits which “predict” ovulation by measuring your hormone levels and body temperature.  These tend to work well, but if you use some simple math and a calendar you can do just as well.

Approximately 14 days after you ovulate, you start your period. Therefore, if you know when your period started this month, you can count backwards 14 days and tell the approximate day that you ovulated last month.  This can help you predict approximately  when you will ovulate this month.  When I am helping patients figure this out, I have a good ole’ fashioned paper calendar in front of me and I mark the days with a pen. I suggest you do the same. For example…

Let’s say Suzy starts her period on July the 1st.  She then starts her next period on July the 30th.  If you count backwards 14 days from the 30th, this is the day Suzy ovulated, July 16th.  Then figure out how many days after her period on July 1st this happened…15 days.  By doing this we have figured out that Suzy’s body ovulates about 15 days after she starts each period.  So Suzy can now predict about when she ovulates each month.  In August, she should ovulate about the 14th (using my calendar I just counted 15 days after July 30th).

Now remember that sperm lives 2-4 days inside the woman.  You just need to have sex every 2-3 days starting a couple days before you ovulate until a couple days after you ovulate.  So for Suzy I would tell her to start having sex on August 10th or 11th until about the 17th or 18th.  Remember, sex every 2-3 days is fine for most people to conceive. 

Urine pregnancy tests are very accurate these days and if you become pregnant will be positive when you miss your next period. If so, congratulations!  Remember to take your prenatal vitamins, because they can be helpful for the very early development of your baby before the test turns positive!

If not, don’t get discouraged, stay positive.  Getting pregnant can take several months in the best of circumstances.  If this is not successful after 6-12 months, or you are becoming frustrated, then call your doctor. 

I hope this was helpful, and good luck!

by: Robbie Conatser, M.D.

To schedule an appointment with Dr. Conatser, please call (843) 792-5300 or you can fill out the online appointment request form.

Pictures are posted of the NEW Birthing Suites on the Women Services website.  Keep checking back for more updates!

MUSC Labor and Delivery unit renovation project is underway! Our Special Delivery of new Labor and Delivery Birthing Suites, Room Service Dining, and State-of-the-Art Equipment are due fall 2010. 

For updates on the renovation project, please visit MUSChealth.com/deliver.

The Medical University of South Carolina (MUSC) in downtown Charleston is widely recognized as having some of the top physicians in the country.  What people don’t know is that some of our premier specialists also see patients in convenient locations throughout the tri-county area. 

Starting Tuesday July 6, women living West of the Ashley won't have to travel far to access the medical expertise and care offered by MUSC obstetricians and gynecologists. MUSC Specialty Care West Ashley:  Women's Health is specifically devoted to the unique health care needs and issues facing women and girls. 

We invite you to explore the NEW website, then make an appointment and see the difference at Women's Health.  The providers and staff are here to serve you, and strive to make all visits outstanding experiences.

This Saturday, May 8

11:30- Festivities conclude

Noon- Post Race Reception at Daniel Island Grille
"Make Your Own" Bloody Mary Bar
*A portion of the proceeds to benefit the RRCF

Depression during pregnancy

Depression affects approximately 10 to 15 % of pregnant women.  Sometimes symptoms may be difficult to differentiate from normal changes of pregnancy.  Symptoms of depression include depressed mood, irritability, feeling no pleasure, weight changes, appetite and sleep changes, loss of energy, feelings of guilt or worthlessness, agitation or suicidal thoughts.  Depression during pregnancy can be caused by increased stress, decreased social support, poor maternal weight gain, smoking, alcohol and drug use.  Untreated depression in pregnant women is associated with an increase in negative pregnancy outcomes such as premature birth, low birth weight infants, poor fetal growth or other complications during the pregnancy. 

Antidepressants:  Are they safe?

Overall antidepressants are safe to use during pregnancy or while breastfeeding and their use has not been shown to cause birth defects with the exception of paroxetine (Paxil) which has been found in some studies to cause heart defects in the fetus and therefore should be avoided in pregnancy.  Several studies have suggested that managing depression in pregnancy is beneficial for neonatal outcomes. The selective serotonin reuptake inhibitors (SSRIs) are the most widely studied and most frequently used antidepressants in pregnancy.  Patients with depression can be managed during pregnancy with or without medication but those with more significant depression will need to continue their medications during pregnancy to prevent relapse of their illness which occurs in about 70 percent of those who discontinue their medication.  Each patient is evaluated individually and should discuss their situation with their doctor.  Currently available data suggests that use of SSRIs during late pregnancy is associated with an increased risk for neonatal complications (jitteriness, gastrointestinal symptoms, irritability, decreased muscle tone, seizures, mild respiratory distress) and probably pulmonary hypertension.  The neonatal complications are temporary and rarely require treatment.  Pulmonary hypertension also appears to be a rare occurrence.  The neonatal symptoms should be discussed with the patient and the potential risks of the medications can be balanced against the effects of untreated maternal depression on the individual patient and her family.

by:  Tameeka Law, M.D.

Request an appointment with a MUSC provider.