Guest: Dr. David Soper – Obstetrics and Gynecology
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I am Dr. Linda Austin. I am interviewing Dr. David Soper who is professor of OB/GYN at the Medical University of South Carolina. Dr. Soper, there are so many new options now for women who are seeking birth control. What are some of the new advances in that area?
Dr. David Soper: Linda, I am happy to be able to share with your listeners the advances that have occurred in contraception and I really do want to send a message that for those women that are out there that are concerned that only birth control pills in the usual fashion are available, and that maybe they have had a bad experience with them, they need to go back to their health care provider because newer low-dose pills with different biochemicals that are being used now are much more patient friendly. There are some options that allow women to not have menstrual periods, to not take a pill everyday, and to use different delivery systems for the contraceptive hormones.
Dr. Linda Austin: Some women might find it odd to skip a menstrual period or not to have a period altogether. Are there any adverse effects from not having a period?
Dr. David Soper: That is a very common question that we get. Nowadays, we are able to prescribe certain types of birth control pills where the patient continues to take the active pill, not the placebo pill that ends up leading to a menstrual period, but they continue to take the active pill for as long as 84 days. What this translates into is, instead of having a menstrual period every month, you only have four menstrual periods a year and this is perfectly safe. I kind of remind my patients that our great grandmothers probably had no more than 10 or 12 periods in their entire lives because they were always pregnant, because they did not have these kinds of technologies that are available. So, it is perfectly safe and it is particularly good for those women that suffer very significant menstrual cramps.
Dr. Linda Austin: Now, you mentioned that there are other options, new options, other than taking pills. What are some of those alternatives?
Dr. David Soper: There are two new delivery systems. One is the patch. It is a transdermal patch and it has the same hormones that are present in the birth control pill. But, instead of having to take a pill everyday, you just put a patch on for a week, replace it weekly for three consecutive weeks and then pull the patch off, and during that patch-free week that is when you have your menstrual period, much like the pill-free week that you take when you are taking oral contraceptives. There is another technological advance. It is called a NuvaRing. This is a ring that has hormones in it. You put the ring in the vagina, it automatically finds the right place where it needs to be, the patient is unaware that it is there and sexual partners do not feel it. This, again, releases hormones regularly and only has to be changed once every three weeks. So, again, another way of not having to remember to take a pill everyday and, actually, the ring contraceptives have the lowest hormones that the body is exposed to. So, if you have some side effects like nausea, breast tenderness, that is going to be less likely with the ring contraceptives.
Dr. Linda Austin: So, are the old days of IUDs and diaphragms behind us then?
Dr. David Soper: Well, I am glad you brought up the IUD because the IUD has always been under used and the current IUDs on the market are very safe and they are very good contraceptives, particularly for women who have at least one child. One of the more popular IUDs is called the Merina IUD which has a hormone called progestin in it and this lightens the menstrual period, even allows some women to miss their menstrual periods, and it can be left in for five years. So, if you have had a baby or two, you’re not sure if you want another one, the intrauterine device, which is just as effective as having your tubes tied is a real good option for these women so that they do not have to undergo a surgical procedure, can ameliorate some of their menstrual bleeding and still get the same effectiveness as permanent sterilization.
Dr. Linda Austin: And how about the old fashioned diaphragm?
Dr. David Soper: The diaphragm is not very popular these days. I cannot remember actually the last time that I fitted one. It is still available. I think young women these days are going after convenience. The convenience of hormonal contraception or the intrauterine device certainly is probably the way to go.
Dr. Linda Austin: We have talked about women, how about for men?
Dr. David Soper: Of course, condoms are still available for men. There are not really any hormonal contraceptives available for men. It does allow me, though, to emphasize the point that hormonal contraceptive devices and the IUD do not prevent sexually transmitted infections, but condoms do. So, for particularly in young women who may be at risk for sexually transmitted infections, they may want to take what we call a belt- and-suspenders approach and that is, be on hormonal contraception because it is going to be more effective in preventing pregnancy but also make sure that your partner is using condoms to prevent sexually transmitted disease.
Dr. Linda Austin: Are there any risks for a woman being on contraceptives for, say, a couple of decades?
Dr. David Soper: The beauty of hormonal contraception is, frankly, all of the healthcare benefits. The healthcare benefits include a decrease in the risk of ovarian and endometrial cancer, a decrease in the risk of benign breast disease, a decrease in the risk of heavy menstrual periods and anemia that is related to that. There are some risks, though, to birth control pills and to other hormonal contraceptives. We all know that these hormones increase the potential for blood clots, usually in the legs. In women that are over the age of 35 and who smoke, hormonal contraception should not be used.
Dr. Linda Austin: Dr. David Soper, thank you so much for talking with us today.
Dr. David Soper: Thank you.
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