- What is your recommendation for birth control,
with least amount of risks and side effects?
What are your thoughts on the controversial depo shot?
What are your thoughts on fertility awareness method
as birth control?
I've heard the depo shot can cause infertility issues,
is that right?
Hey y'all welcome back.
I'm Mama Dr. Jones, a board certified OB-GYN
and today I am answering your questions about birth control.
I asked on Instagram what questions you had.
I'm answering a whole bunch of them in this video.
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Let's jump into it.
Oh, this is one I get a whole lot and they must be doing
tons of advertising on social media.
What are your thoughts on Phexxi?
So Phexxi is a spermicide.
Spermicides are basically a gel or cream
that you use prior to intercourse that kills sperm
and it has a failure rate of about 16%.
I think Phexxi is probably not the best option
if you are really concerned
with the possibility of an accidental pregnancy,
if you're kind of in a situation where you're like,
well, if it happens it happens.
I'd rather it not, but it's not that big of a deal
then maybe a spermicide would be a good option for you.
But in general, it's not my favorite option for anyone
and Phexxi is just a new rebranded spermicide.
Spermicides can also be kind of irritating to some people,
especially if they're used frequently.
So if you know that you get vaginal infections often
or that you get irritation easily,
that may not be the best option for you as well.
What are your thoughts on fertility awareness method
as birth control?
Fertility awareness method
is basically tracking your cycles,
tracking your fertility signs and symptoms
and knowing which days of the month
you are potentially fertile and avoiding having sex
on those days or using condoms on those days.
My thoughts on it are, it can be a very effective
and great form of birth control for the right person.
The right person for this method of birth control
is somebody who is very motivated to learn
all about it and learn how to use it correctly
and also to put in the effort to do that
on pretty much a daily basis.
That being said, if used incorrectly
or by someone who doesn't understand it well,
it can fail more often
just because of that simple requirement of being, you know,
more understanding of what you're doing and why.
This requires a really good discussion
with your partner and also a very good understanding
and motivation to use it
and in that situation where those two things
fall into place, totally think it's fine to use.
What are your thoughts on taking birth control pills
with no breaks?
What this person is asking is what are your thoughts
on taking the birth control pill and when you get
to the bottom where you're taking the placebo pills,
instead of taking those, you just throw away the pack
and immediately start a new pack.
This is called continuous contraception
and I think it is totally great for some people.
The most common side effect is breakthrough bleeding
or bleeding at random times in the month.
I tell my patients to use the rule of threes
to help with breakthrough bleeding.
When you start having bothersome bleeding,
you're going to look back at your calendar
and make sure you haven't missed a pill
or taken placebo pills or skipped your birth control
in the past three weeks.
So the rule of threes is
I've had three days of bothersome bleeding.
I'm going to look back at my calendar
and make sure I have not missed a pill for any reason
or taken a placebo pill for any reason
in the past three weeks.
And if I haven't, then I'm going to take a three-day break
from my birth control pills
and then restart the active pills
after those three days off.
Usually this will induce a withdrawal bleed or a period
and then once you get back on the pills continuously,
you'll be fine.
No weird spotting, no weird bleeding.
So the most important step in is the I haven't missed a pill
or taken a placebo pill in the past three weeks
because that is what keeps the birth control
working as contraception.
So if you don't check that box, don't skip your pills,
call your doctor, ask them for their insights.
The most common problem or complaint
with continuous pills is breakthrough bleeding
and that's one way that I found my patients to be empowered,
to, you know, try to treat it on their own
and avoid a doctor's visit.
Are there any types or brands
of combined pills that are best for acne?
Yes.
There are pills which seem to be better
at treating hormonally induced acne.
They will not be the only option
nor will they work in every person who tries it.
But if you are getting on contraception
and you specifically would like one that improves
hormonally triggered acne in more people,
this is going to be one with a higher anti-androgen
content of progestin.
So something like Yaz which has drospirenone in it,
a progestin that is more anti-angiogenic.
What this means is that it's going to better bind
to free testosterone to keep it
from having the effects on the skin,
which is often what hormonally related acne is caused by.
So there's others also.
So any that is higher anti-androgen
is going to be better for this.
What is the best birth control for a breastfeeding mom?
The best birth control for someone who is breastfeeding
is going to be anything that does not contain estrogen.
Progesterone only birth controls
include the depo shot,
nexplanon which is the one that goes in your arm,
an IUD either copper or progesterone,
and I'm blanking on the other one, a progestin only pill.
So those are the prescription based birth control options
that I would say are an option
for people who are breastfeeding.
The biggest thing you want to remember there
is just avoid anything that has estrogen in it
because that decreases milk supply
or in some cases completely shuts it off.
What are your thoughts on the controversial depo shot?
I don't see any birth control
as being inherently controversial.
I think every birth control like I was saying
a little bit earlier has pros and cons,
risks and benefits and depo is no different.
I have some patients who have been on depo
and absolutely hate it and I have a bunch of patients
who have been on the depo shot
and will never use anything else.
The one thing about depo is that when you get it,
it's there for three months.
So if you're having side effects,
especially if they're really significant side effects,
we can't just take it back.
It can be very, very frustrating for some people.
So the person that I would definitely say
I would never recommend depo to is someone
who has very significant depression or anxiety
because depo shot can trigger worsening of that.
Just like any birth control, hormonal birth control can.
And I also need to add in there any hormonal birth control
can also help with depression and anxiety in some people,
but unlike the other ones,
depo shot can't be removed once it's given.
And if you have a really severe reaction to that
with regards to depression or anxiety,
you can't take it back.
So if you are prone to labile or severe depression, anxiety,
I would not go to the depo shot
as my first recommendation for you.
But otherwise I think you just have to kind of let
whoever's helping you decide know what you're looking for,
what your lifestyle is, what your symptoms are,
what side effects you want to avoid or treat and things
like that to let you know
if that's an option for you to try.
But again, I have a lot of patients
who are very happy with it.
I've heard the depo shot can cause infertility issues
is that right?
No birth control causes infertility.
We have tons and tons of information on this
and long-term infertility is not caused
by birth control of any kind.
That being said, the reason depo shot tends to get
this kind of name to it a little more easily
is because return to ovulation with the depo shot
is way less predictable than if you just go off a pill
or get your Nexplanon or IUD removed.
It can take many, many months for some people
to go back to ovulating normally
after they get a depo shot.
So my biggest recommendation here
is if you're considering getting pregnant anytime
in the next six to 12 months, don't do depo shot
because we don't know for sure when your ovulation
will return and something else
would be a better option for you.
No association with long-term infertility,
just delayed return to ovulation of six to eight months
in some people, longer in some people, shorter in others.
What is your recommendation for birth control
with least amount of risks and side effects?
This is a great question and unfortunately,
it's the most common question I get that I can't answer.
Every single birth control is good and bad,
is going to have side effects in some people
and not in others and there's going to be risks
in some people and not in others.
So the biggest thing is to discuss
with your doctor or advanced practice provider
exactly what you're trying to do.
If you're simply trying to prevent pregnancy almost
any birth control pill is going to do that very well.
If you have other things that you're trying to improve
like acne or you are sensitive to mood changes
or you're having hormonally induced headaches,
things like this,
that we may be able to give you a certain type.
If you have really heavy bleeding,
there's a certain type that may better for you.
All kinds of different factors
go into choosing the best type of birth control
and it's always individual.
So I'm sorry, I can't give you a great answer on that.
Now, if this person is asking about most and least risk
of like pill versus ring versus shot versus condoms,
all of these things, again,
they're all going to have pros and cons.
Some are more effective
but have more chances of annoying bleeding.
Some are less effective like condoms
but they also prevent STDs.
So it just depends what you are wanting and needing.
Does that make sense?
And also like your individual health status
and diagnoses and different things that go into choosing
a birth control type.
I tested positive for an STD
and got treated with antibiotics.
Do I need to have the IUD removed?
There is no reason if you are being treated for an STD
that you need to have your IUD removed,
leave your birth control in place,
take the antibiotics and get treated
and move on with your life.
Don't let someone take out your birth control
simply because you're being treated for an STD.
Do you give IUDs to women who have not given birth?
Yes.
IUDs are perfectly safe in anybody
who wants one with a few rare exceptions,
but not having had a baby is not one of those exceptions.
This is an old, old, old thought about old, old, old IUDs
that has kind of carried over into modern days.
But IUDs are safe and having a baby
is not a prerequisite to getting one placed.
This is information that is supported
by American Academy of Pediatrics,
American College of OB-GYN,
World Health Organization,
American Academy of Family Practice.
All these organizations support the use
of IUDs in people who have not had a baby.
There's nothing about having a baby that magically
makes an IUD okay for you to use.
They are easier to place and often less painful
in people who have had a baby before,
but I have placed IUDs in probably hundreds of people
who's never had a baby who have done excellent with them.
So definitely not a contra-indication.
How bad does IUD removal hurt?
This is an interesting question
because I usually get questions about the opposite.
How bad does it hurt to have the IUD placed?
And the answer to that one is it really varies.
There's a lot of factors that go into that.
An individual's pain tolerance,
if you've had a delivery or not.
I have a video discussing IUDs,
reviewing some of Molly Burke's IUD information.
If you'd like to watch that
I will link it in the description below.
As far as getting an IUD out, I would say by and large
this hurts way less in a large majority of people
than getting it placed.
If you've had it placed and now you're worried about getting
it out because you found the procedure to place it
very painful you should feel like this
is probably going to be a lot better.
Usually it's really quick.
I just have patients cough and before they know it,
it's out, it takes about three seconds once we get set up
for the pelvic exam and most of the time
patients do extremely well with removal.
All right guys, that's all for today.
I hope you learned something about birth control.
If you have any more questions that you would like me
to answer in a future video,
leave them in the comment below.
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