Chapter List

• Introduction
• Achilles Tendon
• Adrenal Glands
• Ankles
• Appendix
• Arteries
• Back
• Belly Button
• Birth Control
• Birthmarks
• Bladder
• Blood
• Body Hair
• Body Type
• Brain
• Breasts
• Cervix
• Childbirth
• Chin
• Circulatory System
• Clitoris
• Collarbone
• Digestive System
• Ears
• Elbows
• Emotions
• Endocrine System
• Energy
• Esophagus
• Eyes
• Fallopian Tubes
• Fat
• Feet
• Fertility
• Fingernails
• Gallbladder
• Gums
• Gynecological Exam
• Hair
• Hands
• Heart
• Hips
• Hormones
• Intestines
• Jaw
• Joints
• Kidneys
• Knees
• Larynx and Vocal Cords
• Lips
• Liver
• Lungs
• Lymphatic System
• Medical Tests
• Menopause
• Menstrual Cycle
• Moles
• Mouth
• Muscular System
• Neck
• Nervous System
• Nose
• Nutrition
• Ovaries
• Pain Relief
• Pancreas
• Pelvis
• Pregnancy
• Rectum
• Reproductive System
• Respiratory System
• Ribs
• Salivary Glands
• Scalp
• Sex
• Sexually Transmitted Diseases
• Shins
• Shoulders
• Sinuses
• Skeletal System
• Skin
• Skull
• Spine
• Spleen
• Stomach
• Stress
• Sweat Glands
• Tailbone
• Tear Ducts
• Teeth
• Throat
• Thyroid
• Toenails
• Tongue
• Tonsils
• Underarms
• Urinary System
• Urine
• Uterus
• Vagina
• Veins
• Vulva
• Wrists
• Shaping Up
• The Total Body Shaping Workoout
• Abdominals
• Biceps
• Buttocks
• Calves
• Chest
• Forearms
• Neck3
• Shoulders3
• Thighs
• Triceps
• Aerobic Conditioning

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Birth Control

Birth Control

Question: What do you call a couple who uses the rhythm method for birth control?

Answer: Parents!

Okay, so the joke''s not Seinfeld material. And you realize that the rhythm method is not much of a method at all. But are you up-to-date on current forms of birth control? Do you know as much as you need to know? And is what you think you know really accurate?

There''s a chance the answer is no.

That''s because quite a few myths and misperceptions about birth control persist, doctors say. For example, once women pass age 35, they often think they don''t need to worry about birth control as much. The reality is, they do.

Some women view sterilization as the only effective long-term method of birth control. The truth of the matter is, it''s not.

Still other women may fear that the Pill is unsafe. Yet for the right women, doctors say it''s very safe.

Many women probably think the intrauterine device (IUD) isn''t really an option for them. It''s one that some women should consider more, doctors say.

Sterilization: Should She or Should He? Suppose you and your husband decide you don''t want any more children, and sterilization is your answer to birth control. The next question, then, is who should get sterilized? Some studies have shown that male sterilization--called vasectomy--is safer and more effective than female sterilization, says Paul Blumenthal, M.D., assistant professor of obstetrics and gynecology at Johns Hopkins University Medical Center in Baltimore. For one thing, the procedure for female sterilization is often performed under general anesthesia, even though only local anesthesia is usually needed, says Dr. Blumenthal. A vasectomy is performed under local anesthesia. In addition, a vasectomy is cheaper, requires less time to do and generally requires a shorter recovery time. But despite the advantages of a vasectomy, more women get sterilized than men. Dr. Blumenthal offers several possible reasons. Women often bear the responsibility for birth control, and they visit doctors more than men do--so they may be more likely to have the procedure recommended to them. Also, the majority of tubal sterilizations take place after a woman has given birth to what she has decided will be her last child. While she''s in the hospital anyway--generally within two days of the birth--it''s a convenient time to have her tubes tied.

When it comes to birth control, clearing up rumors and misconceptions is a full-time job for Mythbusters. Here are some of those myths--and what experts say about them.

Myth #1: I''m Too Old to Get Pregnant

The first myth is the idea that birth control isn''t really an issue for women once they pass age 35 or 40, says Andrew Kaunitz, M.D., professor in the Department of Obstetrics and Gynecology at the University of Florida Health Science Center in Jacksonville.

When women reach their late thirties and early forties, they often perceive that their chances of conceiving are less likely, agrees Paul Blumenthal, M.D., assistant professor of obstetrics and gynecology at Johns Hopkins University Medical Center in Baltimore. While that can be true for some women, it''s not always true.

While one-third of unintended pregnancies occur in teens, two-thirds of them happen in women over 20 years of age. In other words, unintended pregnancy is not just a teen problem. Yet "older women believe it happens only to teens," says Anita L. Nelson, M.D., associate professor of obstetrics and gynecology at the University of California, Los Angeles, UCLA School of Medicine and director of the women''s medical clinic at Harbor-UCLA Medical Center in Torrance.

Thirty- and forty-something women can accidentally get pregnant when their birth control methods fail, when they choose less effective methods with high failure rates and when they forget and don''t use anything, says Dr. Blumenthal.

Some forms of contraception are more popular than others--though that doesn''t mean that one way is better than another. For women past age 35, sterilization is the most common method of contraception. Among the runners-up: Oral contraceptives, otherwise known as the Pill, rank second. After those top two choices come a host of other methods--the condom, diaphragm, IUD and other hormonal forms such as Norplant and Depo-Provera.

Which method should you use at this point in your life? Here''s what doctors recommend.

Start with the kid question. For women over 30, the first question to ask is, "Do I want to preserve my future fertility?" says Margaret Dooley, nurse practitioner at Thomas Jefferson University in Philadelphia, Pennsylvania.

The answer to that question will help you decide between reversible and irreversible methods and between long-term and short-term methods.

If you think that you might want to get pregnant within the next year, for instance, you''ll want to go with the methods that can be easily reversed--such as the diaphragm, condoms or the Pill.

If you want to wait between two and five years, you might want to consider Depo-Provera, the birth control shot, says Dr. Blumenthal. And if you decide that you don''t want children for five years or more, then the Norplant implant device and IUD are additional options. (For information on Depo-Provera and Norplant, see "Implanting Some Protection" on page 23.)

Talk it over. "The most important thing--for any method--is to talk it over with your partner," says Dr. Blumenthal. Try to arrive at a mutually agreeable decision, he says.

Implanting Some Protection In 1990 the Pill was no longer the only form of hormonal birth control available in the United States. That year, hormonal implants known as Norplant were introduced, and 1992 saw the approval of the birth control shot known as Depo-Provera. Both are currently available to women in this country. Norplant consists of six matchstick-size capsules that are inserted under the skin on the inside of your upper arm. The capsules contain progestin, a synthetic form of the hormone progesterone, which prevents pregnancy by inhibiting ovulation, thickening the cervical mucus and thinning out the lining of the uterus. This one-two-three combination interferes with egg production, makes it harder for sperm to reach the uterus and--by thinning the uterine lining--makes a less friendly nest for the fertilized egg. Norplant is a long-term method of birth control that provides protection for five years. And failures are rare. Fewer than 1 out of every 100 women experiences an accidental pregnancy during the first year of use. But what about getting the Norplant removed? There''s been controversy about this surgical procedure, with some women reporting complications. The key, according to experts, is to see a doctor who is trained to do a Norplant removal. The advantages of Norplant are that it is a long-acting contraceptive, and it''s convenient. Once it''s in, you don''t have to remind yourself to take a pill every day. Furthermore, once the Norplant is removed, protection against pregnancy is gone immediately. Disadvantages? Some women have experienced disruptions to their menstrual cycles, from lighter bleeding or missed periods to increased days of heavier bleeding after having their Norplant capsules inserted. In fact, this is often the reason for discontinuing Norplant use. Like Norplant, Depo-Provera, a birth control shot, only contains progesterone--no estrogen--and has effects on your reproductive system similar to those of Norplant. If you opt for Depo-Provera, you''ll have to see your doctor for a shot every three months. During the first year, you might see some spotting, and after that you may stop having periods. A significant advantage of the shot, doctors say, is that it is a totally private method of birth control. If you''re getting the quarterly shots, your doctor is the only other person who needs to know about it. But Depo-Provera is not a good choice for women who are ready to become pregnant right away, cautions Andrew Kaunitz, M.D., professor in the Department of Obstetrics and Gynecology at the University of Florida Health Science Center in Jacksonville. It can take women six months or more to get pregnant after they stop receiving the shot, he says, and it takes some women a year or more.

Ask questions. Don''t be afraid to ask your doctor for her opinion on what methods might be good for you to consider. If you don''t ask questions, your doctor might assume that you are satisfied with your current method and might not offer suggestions.

Myth #2: Only One Method Is Sure

Sterilization is a very popular means of birth control in the United States among women in the 30- to 45-year-old age group, says Dr. Blumenthal. An estimated 14 million women rely on sterilization as their means of contraception--but of course it''s not just women who request the procedure. About 9.6 million women have been sterilized, which means having the fallopian tubes closed off so sperm can''t reach the egg. Another 4.1 million women are relying on their partners'' vasectomy--the sterilization procedure for males--to ensure that they don''t have children.

For a woman, sterilization requires a surgical procedure under either local or general anesthesia. The fallopian tubes are sealed with either clips or rings, or they''re cauterized with a quick application of electrical current in the form of heat. Once you''ve had the procedure, your chances of getting pregnant during the first year are less than 3 in 1,000. That''s lower than the failure rate of most temporary methods.

But . . . should you have it done?

While the procedure is superb for women who have decided that they definitely don''t want to have any more children, says Dr. Kaunitz, the idea that it is the only effective long-term method is a myth. The IUD, Depo-Provera and Norplant can provide long-term protection and can be just as effective as sterilization, and yet they''re reversible, he says.

The only good reason to decide on sterilization, says Dr. Kaunitz, is if you decide that you never ever want to be pregnant--or you have children and you know you don''t want to get pregnant again. "If any reason prevails other than not wanting more children, the chance that a woman may regret the choice later is very real."

"We do know that the younger a woman is when she chooses sterilization, the higher the rate of regret," adds Alan Rosenfield, M.D., dean of the School of Public Health at Columbia University in New York City. "I tell women to consider this a permanent procedure. There is the misconception that sterilization reversal is easy to do; it''s not."

Myth #3: The Pill Isn''t Safe

After sterilization, the Pill is the contraception method women choose most. The Pill prevents pregnancy by interfering with ovulation, among other things. It also thickens the cervical mucus--the layer of slippery cells lining the cervix that makes a slick passageway for sperm. Thicker mucus means that sperm have a tougher time swimming their way toward the uterus.

Even though the Pill remains popular, doctors say that misperceptions and myths abound. One prevailing myth, says Dr. Kaunitz, is the assumption that it is too risky to take the Pill after ages 30 or 35. Yet both the Food and Drug Administration and the American College of Obstetricians and Gynecologists have found the Pill to be safe for nonsmoking, healthy women of any age, he says. Nonsmoking and healthy are the operative words when it comes to the Pill and women over 35.

The concern over the safety of the Pill hails primarily from the days when oral contraceptives contained higher doses of estrogen. Researchers sounded the alarm when they suspected that women taking higher estrogen levels were at higher risk for heart attacks and strokes. Over the 30 years since the Pill was introduced, however, the dosage of estrogen in the Pill has been reduced to one-fourth what it originally was, says Dr. Blumenthal.

The lower dosage of estrogen has not reduced the Pill''s effectiveness, yet it''s safer, Dr. Blumenthal says. In women who don''t smoke, Pill takers have no significant increase in cardiovascular complications over non-Pill takers, agrees Dr. Rosenfield.

In addition to being safe, the Pill has a number of noncontraceptive benefits--but women aren''t always aware of them. "Clearly, one of the biggest fears women have regarding taking hormones is the fear of cancer, particularly breast cancer," says Dr. Kaunitz. "Many women are not aware that by taking oral contraceptives they can substantially reduce the risk of ovarian cancer."

While ovarian cancer is rare, it''s the leading cause of gynecological cancer death. A woman who takes the Pill for only a year or so can decrease her risk for the deadly cancer by as much as 50 percent, he says.

If a woman takes the Pill longer than a year, she cuts the risk of ovarian cancer even more. A woman who takes it for a decade or longer can reduce her risk as much as 80 percent, says Dr. Kaunitz. This protective effect persists for years after she stops taking the Pill.

Not only that, the Pill will also slash your risk of getting endometrial cancer--cancer of the lining of the uterus, says Dr. Kaunitz.

But what about the risk of breast cancer? On this topic the message is somewhat less clear, according to Dr. Kaunitz. Studies are contradictory. Some show that the Pill increases breast cancer risk; others indicate a decreased risk. Overall, though, when you look at all the studies on oral contraceptives and breast cancer combined, researchers conclude that the Pill does not increase breast cancer risk.

In addition, the Pill offers protection against ectopic pregnancy, a sometimes life-threatening form of pregnancy in which the fertilized egg implants outside the uterus--usually in the fallopian tubes. The Pill can also help make menstrual periods more regular and relieve menstrual cramping. Dr. Kaunitz says that if you use the Pill regularly, you might lower your chances of eventually needing a hysterectomy--surgical removal of the uterus. You''ll be less likely to have the heavy, painful periods that lead some women to opt for the procedure.

Women often believe they need to take a break from the Pill. Some doctors have advised women who have been on the Pill for a number of years that they need to stop taking it and let their bodies "rest" for a while. But it''s not necessary, Dr. Rosenfield advises. "If you want to be protected, there''s no reason to stop taking the Pill." In fact, when women do come off to "rest," that''s often when they get pregnant.

If you''re considering the Pill, you should discuss it with your doctor. Here are some considerations.

Look at your medical history. The Pill is appropriate for healthy, nonsmoking women, says Dr. Kaunitz. It might be a less desirable option if you have a history of blood clots, high blood pressure, diabetes or other medical conditions. Also, your doctor might advise against the Pill if you''re a regular smoker over age 35.

Look at the calendar. The effects of the Pill can be reversed fairly quickly, says Dr. Kaunitz. While it may take you a little longer to get pregnant when you stop taking the Pill than it would have if you hadn''t taken it, the delay appears to be two to three months at most. Nearly 1 out of 50 women, however, will not menstruate for six months or more after coming off the Pill.

Look at your habits. "Sexually active women who miss more than two or three pills in a row will increase their risk of pregnancy," says Dr. Kaunitz. Ask yourself, in all honesty, whether you are a good pill taker. If you aren''t, then you may want to consider another method.

Myth #4: The IUD Is Out of the Question

According to doctors, the IUD currently suffers from an identity problem in the United States. "American women need to rethink the IUD," says Dr. Kaunitz.

The IUD is a little plastic device that is inserted by your doctor and sits inside your uterus. A string connected to the IUD hangs down through the cervix and serves as a telltale for detecting if the device is in place properly.

They Call It Emergency Contraception Forget something? If the cold light of day finds you worrying about what happened last night--and the possible consequences--you may still have an option. "I think one thing women in this country should be aware of is emergency contraception," says Paul Blumenthal, M.D., assistant professor of obstetrics and gynecology at Johns Hopkins University Medical Center in Baltimore. This is a form of contraception that women can access within three days after they''ve had unprotected intercourse. If taken within 72 hours of unprotected intercourse, low-dose birth control pills are 97 percent effective in preventing pregnancy, says Dr. Blumenthal. If your doctor recommends this route, you''ll get a prescription for eight pills: four to take immediately, with another four 12 hours later. If conception hasn''t occurred yet, the pills will interfere with the movement of sperm toward the egg by thickening the cervical mucus and changing the rate at which the sperm move through the fallopian tube, if they make it that far. Even if a sperm has fertilized an egg, pregnancy might be blocked, because the pills change the lining of the uterus so that the fertilized egg cannot implant. While birth control pills are not approved by the Food and Drug Administration as emergency contraceptives, doctors are free to prescribe them for this kind of use. Women who have unprotected sex can also use the intrauterine device, or IUD, as an emergency form of birth control, says Dr. Blumenthal. The device should be inserted within three to five days of unprotected sex, he says. Once in, it prevents a fertilized egg from implanting in the wall of the uterus.

In the 1970s and 1980s the IUD became synonymous with risk and danger. Most of the unfavorable publicity was the result of lawsuits over the Dalkon Shield, an IUD whose use was associated with an increased risk of pelvic infection. "That publicity really killed the IUD in this country," says Dr. Kaunitz.

Studies have shown that the IUD is a safe and effective method of birth control for women who are at low risk for sexually transmitted diseases (STDs), says Dr. Kaunitz. If you have one partner, and you know that your partner is monogamous and disease-free, the IUD can be a very practical form of birth control, offering protection for as long as ten years. So it is a good alternative to sterilization if you''re finished with childbearing but have yet to reach menopause.

If you''re comparing the IUD with the Pill, the IUD might be preferable if you can''t use hormonal methods of birth control--if you''re a smoker, for instance, or if you''re breastfeeding, says Dr. Blumenthal. But some doctors won''t recommend the device unless you''ve had a child.

There are two types of IUDs currently available. The first is the copper-T 380A, also known as ParaGard in the United States. "While we used to think that this device prevented pregnancy by preventing a fertilized egg from implanting in the uterus, we now have learned more about how it works," says Dr. Blumenthal. Research indicates that the device actually interferes with conception. That is, it appears to interfere with the ability of sperm to navigate up through the uterus and into the fallopian tubes.

The second type of IUD is called the Progestasert, an IUD that is medicated with progesterone. Progestasert works by changing the cervical mucus so that sperm have a harder time swimming north, so that if conception occurs, a fertilized egg is less likely to implant in the uterine lining.

Myth #5: Barrier Methods Are Old-Fashioned

If you''ve dismissed condoms, the cervical cap and the diaphragm as too clumsy, out-of-date and unreliable, maybe you should reconsider. Condoms, for instance, are the most commonly used barrier method. Not only are they effective birth control devices, they''re also insurance against sexually transmitted diseases, including HIV/AIDS. So if you''re not in a monogamous relationship, or you''re sleeping with someone who you''re not absolutely positive is disease-free, it makes sense to use condoms.

In fact, Dr. Kaunitz says that women who are not in monogamous relationships should use condoms even if they''re already using an effective birth control method such as the Pill or sterilization. "Some physicians call this the ''belt and suspenders'' approach," adds Dr. Kaunitz. Other barrier methods such as the diaphragm and cervical cap also help prevent some kinds of STDs, especially when they''re used in conjunction with spermicidal jellies and foam.

 

See also Reproductive System, Sexually Transmitted Diseases