Episode 18: Get to know ALL your birth control options

Dr.Sophia:
Hello everyone. Welcome to the Dr. Sophia obgyn podcast. I'm an obgyn practicing for over 15 years in my native New York City, and I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information. Based on my professional opinion and experience. For specific medical advice, please refer to your physician.

Welcome to the Dr. Sophia podcast. Today we will be speaking about all things birth control, and I'm always happy to say that I am joined by my co-host, Touseef Mirza.

Touseef Mirza:
Hi everyone. So today we are gonna talk about all things birth control. When people come and see you, Dr. Sophia, what do they ask and what are the main things? Just talk through different questions.

Dr.Sophia:
Like if you were a patient of mine and you came in to talk to me about birth control?

Touseef Mirza:
Exactly. So we're gonna look at it from that perspective. So let's say I am coming to see you and it's the first time that I am going to be considering birth control. And I ask you, I'm interested in birth control. What are my options?

Dr.Sophia:
Woo. Okay. Well, first of all, I mean, as an obgyn, it's actually part of the bread and butter of what we do, is to have the conversation around birth control. For the most part, I'm going to see women in their twenties and thirties who are not necessarily planning for pregnancy, or even better, they're planning their lives to make sure that they don't get pregnant. The birth control conversation happens rather often, and it's a good one to have because it helps to, you know, demystify things like really get rid of myths and really, take away some of the fears that women have around birth control. And also truly to understand what the fact that they actually do have options, there's more than just the pill.

Touseef Mirza:
You know, it's interesting you bring that up because when I first got on the pill in my twenties, at a certain point I honestly didn't even consider any other form of birth control. That's what all my friends were on aside from condoms. But I just went in and I said, I wanna be on the pill, without even realizing that I have other options. So do you think that has changed in terms of how people approach birth control? Or do most people come in first and ask for the pill?

Dr.Sophia:
I would say for the most part, the pill is still the most commonly used form of birth control, at least especially here in the United States. And I understand why it's convenient and it's what your mother did and your friends are doing, as you say. And so it just seems simple enough. And even from your doctor's perspective, it's very easy to write that prescription. So, yeah, birth control pills are still probably the most common, although I'd love to say that; condoms, hello? Safe sex practices.

Touseef Mirza:
Yes. We have to, we have to give that due.

Dr.Sophia:
Yes, absolutely. But from a pregnancy perspective, a pregnancy prevention perspective, we really do have so many options. I usually start the conversation by saying, well, let's think about your lifestyle. Let's think about what makes the most sense for you. Are you looking for something that is long term, meaning you're not looking to maybe have a baby in the next year or more, or are you-

Touseef Mirza:
Not wanting to have a baby.

Dr.Sophia:
Ever or ever, right? Yes. And that happens as well. That's usually where I like to start. And that's after of course, doing things like taking their history, making sure that they don't have any contraindications or problems or other medical problems and things that would make us only think about certain options. But for the basis of this conversation, we're just gonna assume everybody's healthy.

Touseef Mirza:
Yes. So then you start to talk about lifestyle and what does that indicate to you in terms of the information they give you?

Dr.Sophia:
I think about if it's someone who's got a very, like, fast paced, busy lifestyle, which many of us here, I'm speaking to you from New York City, right? We're very busy here and so we need something that's either gonna be quick, easy-

Touseef Mirza:
Convenient.

Dr.Sophia:
Convenient, we don't have to think about it, all of those things. And so when I talk about lifestyle, that's part of it. Also, even just the simple thing of asking the question, do you think you can take a pill every single day? Do you think you can do a method that requires daily maintenance in order for it to be effective? So that is part of the question. Secondly, I ask whether or not they know perhaps a plan of when they would like to have children, if at all. So if they would like to have children, then the question is, is it gonna be in two years? Is it gonna be in five years? Is it gonna be in three months? Because that also will help to kind of determine what's gonna be the preferential option for them. And then I also ask just how comfortable they are in their body. Why do I say that? Because some of the options require being very comfortable with touching yourself.

Touseef Mirza:
Like inserting stuff?

Dr.Sophia:
Exactly. With inserting stuff. How does one feel about having something that's in their body, whether it's in their uterus or another part of the body, like the arm. So just knowing that something is present there all the time, does that make them feel comfortable or uncomfortable? So there's so many things that go into it. If I had to just start, I'd be like, okay, we have the pill patch ring. When I say that, it's because they basically have similar hormones in them in terms of how they function and how they work. They work by blocking ovulation. So if it's the pill, the patch or the ring, the difference between them is how often you have to apply them or use them. So when we talk about the pill, we're talking about something that you have to take daily and preferably around the same time every day.
But usually they're very small, very easy to take. You need it only with a sip of water or no water, even at all sometimes because they're so small. For a lot of people, it's discreet, no one has to know. And number two, it's easy enough. I usually say, Hey, if you wanna take the pills, you know, use a system, whether it's always in the morning or always at night, whether it's keeping the pill pack at your bedside so that it's the last thing you do before you go to bed. Whether it's putting an alarm on your phone so that you remember to take it at that particular whatever particular time. But I do think that the pill is a nice easy way for women to be introduced to any type of hormonal therapy or treatment that has to do with contraceptives.

Dr.Sophia:
But it is daily. And so for some people doing anything, having to remember something every single day, especially if they're not taking pills for any other reason, might actually be a challenge. You know? And we have to take into account that part of the issue with if you, let's say you miss a pill, you know, that's one of the questions I get all the time, doc, oh my God, I missed my pill. What do I do now? And the reality is, is that for some of the pills, when you miss even just one pill, that could trigger an ovulation cycle.

Touseef Mirza:
Therefore you have to be kind of honest with yourself, right? As a patient. Like you have to know yourself. Yeah. And recognize, you know, am I a disciplined person? Like, am I gonna do this? Or I'm just, you know, I've, I've got too much on my mind and this might slip.

Dr.Sophia:
Exactly. So it, you know it's about having that kind of an honest conversation. So by pill, patch ring, they all basically have a similar hormone profile in them. They typically have an estrogen and a progestin combination. There are some pills that are only progestin. Actually the effective part of birth control is progestin. That's actually what's working to block pregnancy. The estrogen part of it is actually put in there to minimize some of the side effects that may happen, such as nausea, headache, bleeding, you may have unscheduled bleeding. And so the estrogen actually helps with some of that in terms of a bleeding profile.

Touseef Mirza:
Is that the same principle with the patch?

Dr.Sophia:
So same principle with the patch, and the same principle with the ring in terms of why they have the combined estrogen and progestin in them. We talked about the pill and that's every day. The next thing would be the patch. It's cool. You just put it on like a bandaid. You don't have to remember to swallow anything. You put it on as a bandaid and it stays on your body for a week.

Touseef Mirza:
Where do you usually put it?

Dr.Sophia:
You can put it on your arm, you can put it on your tummy, you can put it on your buttocks, and you usually rotate the area that you're gonna put it on. So if you put it on your arm this week, you might put it on the other arm next week, you might put it on your buttocks the following week.

Touseef Mirza:
And it's not something that pierces the skin, the patch?

Dr.Sophia:
It's like a bandaid.

Touseef Mirza:
Like you stick it?

Dr.Sophia:
You just stick it on, you clean the area first, and make sure it's really dry. You don't have any oils or things like that on your skin at the time. And then you apply it and every week you take it off. The box comes with three patches. So you do three consecutive weeks and then one week off. And when you have that one week off is typically when you would get a period. One of the other things that's very interesting, just mentioning that concept of the one week off in the pill pack, there's also a week that's called the placebo week. And during the placebo week, the pills that are in the placebo week, you would typically get your period. And so for women who feel like they have to, you know, they don't feel right unless they're getting their period or that they wanna feel like they've kind of cleaned out. I get that all the time, although that's not what's happening at all, but it's okay.

Touseef Mirza:
Cleaned out? What does that mean?

Dr.Sophia:
Like getting their period because they feel like they've cleaned themselves out somehow.

Touseef Mirza:
Hmm. Interesting.

Dr.Sophia:
I know another podcast episode. But in any case, for those women who feel like they always need to see their period, then the pill, the patch, and now we're gonna talk about the ring. So the patch weekly. The ring monthly.

Touseef Mirza:
I like this. It's daily, weekly, monthly.

Dr.Sophia:
Yeah. I like this sequence. The sequence of events of how we talk about it. So the ring literally is a ring. It's a collapsible ring, and it's one that a woman would push inside of her vagina. So she collapses it or squeezes it together so that it's flat, and then she pushes it inside of the vagina, and then it opens and sits at the top of the vagina. Why do I like the ring? The ring is so popular among young people and mostly because they don't have to think about it. Once it's in place, it can stay in place for three weeks, and then you would take it out at the end of the third week, leave it out for a week, and during that week you would get a period, and then after that week you would get a fresh new ring and reapply, meaning pushing it back, putting in that new ring into your vagina in order to give you protection again for a whole nother month.

Touseef Mirza:
So this ring, first of all, is it just a hollow ring or does it have a membrane?

Dr.Sophia:
It's a hollow ring.

Touseef Mirza:
It's a hollow ring. Okay. So it's not like it's stopping the sperm from going to the-?

Dr.Sophia:
Uterus? No, no, no. That's called the diaphragm.

Touseef Mirza:
Exactly. And that's what I was thinking about.

Dr.Sophia:
No, the ring is different from a diaphragm. The diaphragm, as you say, was something that had like a membrane on it in order to block sperm from actually getting through the cervix. You had to use a diaphragm in combination with a spermicide. Meaning you have to put like a spermicide jelly or cream around the diaphragm before placing it inside your vagina and whole, you know, making sure that it sits at the top of the vagina with the diaphragm. Women had to be fitted, quote unquote for it. It had to be a size that was enough to completely cover the cervix, in order to block sperm from getting in. Again, a very interesting and really nice form of birth control. The only thing is, it's used basically with every sexual act. You would have to take it out, reapply, spermicide, you know. Does it still exist? It definitely still exists. It's just not as popular or common.

Touseef Mirza:
People don't use it as much.

Dr.Sophia:
Yeah, we don't use it as much or prescribe it as much.

Touseef Mirza:
So I guess for the ring, when you say we have to put it in the vagina, how do you know if it's far enough? How do you know if it's placed correctly? Like, I'm sure these questions come up.

Dr.Sophia:
Oh, these questions definitely come up. So your vagina is like a tube, and it's like a collapsed tube when you push the ring into the vagina and you push it in and then the ring will open once it gets to the top of the vagina, it will open. And what's nice about the ring is that you don't feel it, your partner doesn't feel it. And if you really are weirded out or uncomfortable about it, you can take it out of your body for up to three hours after you've had it in for at least three weeks. Like you've been using it consistently. That is after that point, then you can actually, I should really say after seven days. Because once you put your new one in, it can stay out of your body for up to three days, for three hours. Then not three days, three hours.

Touseef Mirza:
Three hours, and it can still be effective?

Dr.Sophia:
Still be effective in terms of sexual activity. So for those women who feel that they are uncomfortable or if their partners do say that they feel it and it's uncomfortable somehow, that it can stay out of the body for up to three hours and still be effective.

Touseef Mirza:
Wow. Okay. And then do people usually, like the first time that they try it, do they want to be around you to see, you know, did I do this correctly? Like, do you need to make sure?
Dr.Sophia:
For sure. Where a patient is like, well, can you help me to put it in? Can you make sure that I'm doing it correctly? And I always say yes, come in and have a visit. So that way, I wanna make sure that patients feel comfortable, placing it and that they feel comfortable also to remove it. Because you have to put your hand and your finger inside, kind of hook it in order for it to collapse again and easily slide out of the vagina. Now, both processes, whether it's putting it in or taking it out, are actually very simple, but it does require that the woman is very comfortable with her body and comfortable touching herself and touching her vagina in order to make sure that she can both place it. . and as well as take it out. But, you know, one of the things that I like about the ring is the fact that it can stay in for the entire month. So you don't have to think about it. It's working for you. It's in a discreet place and yeah it works.

Touseef Mirza:
And so you're saying these three that we just talked about-

Dr.Sophia:
The pill, patch ring,

Touseef Mirza:
These are hormonal?

Dr.Sophia:
That is correct.

Touseef Mirza:
And so when patients come and see you, do they specifically ask about hormonal, or non-hormonal? Is that a discussion as well?

Dr.Sophia:
That is a definite part of the discussion. So actually it's an earlier part of the discussion because if a patient comes in and says, well, I know I wanna be on birth control, but I really wanna be on something non-hormonal, then that's a different track in terms of conversation, in terms of the options that are available to them that are non-hormonal.

Touseef Mirza:
And why would they even ask that? Because that's something that never crossed my mind when I was in my twenties. It was just like, oh, it's the pill. It's for birth control. Like, we just didn't even stop and think about whether it was hormonal or not. We would just take it.

Dr.Sophia:
Let me tell you, young people right now are so much more savvy. I'm happy about it. I'm happy that people actually stop and think about what they're putting into their bodies, and how it's working and why is it necessary? Are there other options? So the concept of having hormonal versus non-hormonal, I think is great that people ask the question to see what's right for them. For example, when we talk about non-hormonal options, non-hormonal options may be actually the best for some people who may have a lot of mood changes or mood swings in the sense that when we're trying to figure out if you have a hormonal mood disorder versus, some other mental issue and if you have to be, let's say you, you do have some other mental health issue that requires you to be on other forms of mental health medication. Well, some of the hormonal options are not great options because they may not be as effective when you're on other medications.

Touseef Mirza:
So when, when we're talking about these mood issues, we're not talking about PMS, we're really talking about mental health, mental health issues.

Dr.Sophia:
Yeah. Mental health issues. And some of the drugs that one would need to be on may render the birth control pills not as effective, or that particular medication may not be as effective because they may both be metabolized by the liver, metabolized, big word. It just means how it's cleared out of your system.

Touseef Mirza:
So can we talk about what are the options for non-hormonal birth control?

Dr.Sophia:
Yes. In my little spiel when I'm with my patients, like I said, I start typically with the pill, patch ring, I talk about that. And then I move on from pill, patch ring to another form of a long acting type of birth control, which would be the injectable or the shot. So here we are, we're still talking about hormone based contraceptives, but more long acting. So pill, patch ring, we went from daily to weekly to monthly. And now we're going to something that happens every three months. And that's the injectable that most people know as Depo or Depo-Provera. And they know it as, oh, that's the injection I have to get every three months. It's a type of progestin and it blocks pregnancy like all the other progestins would.

Touseef Mirza:
So the ovulation part?

Dr.Sophia:
So the ovulation part, one of the ways it also works is it thins the lining in the uterus as well as helps to thicken up the cervical mucus. So it's actually working in multiple ways to block pregnancy. But one of the nice things about it is that it's every three months. So again, you don't have to think about it once you get it and it's effective and it's very, it's a very effective form of birth control outside.

Touseef Mirza:
Do you need to go see the doctor to get the shot?

Dr.Sophia:
You do. So one of the downsides is that you do have to go in to be seen in order to receive the shot. Whether it's a nurse or the doctor, it is a prescription. And so it does have to be administered

Touseef Mirza:
Like in the arm?

Dr.Sophia:
Yeah. In the arm and the buttocks and some muscular places, typically where we would inject. So a lot of people like that. Another one of the side effects actually of it is that over time with each injection, you tend to lose or decrease your period or the bleeding from your period, if you get it at all. So some people really like that, that with over long-term use of using depo, that they don't get a period anymore.

Now we move on to the even longer term. Now I go into a different zone here, the implant, something called Nexplanon, and then IUDs or intrauterine devices for which there are two kinds of, when we think about the schools of the IUD, there's a hormonal IUD and then there's the non-hormonal IUD. So when we go into the implant, what I like about it is that it goes into the upper arm. So it's an implant. It's exactly as it sounds. It is implanted and placed in your body, typically in your upper arm.

Touseef Mirza:
So what do you mean by that implant? Like literally there's something that is a piece of something that-?

Dr.Sophia:
It's a little skinny piece of plastic. I want you to imagine maybe the diameter of the inside lining of your pen. Maybe like the tip, not the tip, but rather like the part that holds the ink. So if you took apart a pen and looked-

Touseef Mirza:
At like the straws that are in the juices-

Dr.Sophia:
The juice box?

Touseef Mirza:
Juice box, the small juice box.

Dr.Sophia:
Yeah. Maybe a little.

Touseef Mirza:
Little smaller than that?

Dr.Sophia:
It's definitely smaller than that. So it's really small and it is implanted just underneath the skin and your upper arm on the inner side. So let's say where your bicep is, on the inside of your bicep, so right in here is where your implant would sit. It's very easy to place. we do give you some numbing medicine at this level of the skin in order for it to be placed. Once in place, it can stay there for up to three years. And it's even been approved for up to five years now. So initially it was up to three years and now it's been approved for up to five years.

Touseef Mirza:
And so it's, it's an incision basically.

Dr.Sophia:
It's a small incision. And then after the small incision, we placed a small piece of plastic that has hormone around it that is slowly released over that timeframe. And with that slow release, the hormone that is in it is progestin. And it is great because again, pretty discreet, no one would ever have to know. The other thing is that it's long term, so you don't have to think about it.

Touseef Mirza:
I mean, you never think about it.

Dr.Sophia:
Right. If it's three-

Touseef Mirza:
To five years, like you just-

Dr.Sophia:
It's not on your mind. I would say that the one thing that is a little bit more common with it is the unscheduled bleeding that can happen. So irregular spotting, it's not like you're getting your period. So you don't, it's not like you can say, oh, okay, every 28 days I'm gonna get my period and so therefore let me carry a liner or pad with me. And for some women, they don't actually get a period. So it's kind of individual, you don't really always know what it's going to look like.

Most women don't necessarily quit the method. because even if they have unscheduled bleeding, it's so typically light. And so women are able to use it. They don't necessarily stop because of it. And oftentimes they come back when the time is up, they come back and say, hey, I want to do this again.

So that's definitely an option. And it's hormonal. It's the progestin the same that would be in the Depo shot. And also the same that would be, or the same type of hormone that would be in the hormonal IUD. So the hormonal IUD or intrauterine device is probably one of my faves. I'm not trying to push it though, but certainly one of my favorite forms of birth control. The one thing, a couple of things actually about it, it has to be placed by a doctor, just like the implant has to be placed by a doctor or a provider, I should say can be someone who's trained in order to place the implant.

Touseef Mirza:
Can we just name the ones that we went through?

Dr.Sophia:
Sure.

Touseef Mirza:
Just so we know where we are right now.

Dr.Sophia:
Because you're getting a little lost.

Touseef Mirza:
No, we're like, you know, going here and then coming back a little bit. So just to make sure. So the pill, I'm literally talking to you like a patient right now, aren't I? The pill, the patch, the ring, number four-

Dr.Sophia:
The depo shot.

Touseef Mirza:
The depo shot number five.

Dr.Sophia:
The implant.

Touseef Mirza:
The implant. And now we're at number six.

Dr.Sophia:
The hormonal IUD.

Touseef Mirza:
Okay. Please continue.

Dr.Sophia:
The hormonal IUD, there are a couple of different brands on the market. Overall, the thing to know about it, it's placed by your doctor in the office and placing it. I'm not sugarcoating this at all, it can be uncomfortable. So you have to be mentally prepared to have it placed. When placed, it goes inside of your uterus. So imagine getting a pap smear and think of it as a souped-up pap smear. Meaning that you have to kind of be in that position for about three to five minutes. And you definitely will feel something

Touseef Mirza:
More than when we do a pap smear?

Dr.Sophia:
More than when we do a pap smear. And typically will cause a cramping sensation at the time of placement because-

Touseef Mirza:
The uterus is like what, what is going on?

Dr.Sophia:
Right, like what is happening? But it's relatively quick. It's really quick.

Touseef Mirza:
It's three to five minutes.

Dr.Sophia:
It really is like three to five minutes in terms of placement in everything that we need to do in order to get it to, to put it in literally three to five minutes. And so what I like to tell patients is this, if you can come with the right expectations, then most of the time it will be tolerable. I also typically tell patients to take some Motrin, Aleve or ibuprofen, all very similar in how they act and help to relieve cramping. I usually tell them to take it on their way to the appointment. So figure about half an hour to an hour before. And that will definitely help with some of the discomfort that one would feel during placement and after placement. Because like you said, your uterus is like, hey, what the heck is going on here? We need to maybe try to get rid of this thing that you just put inside.

Touseef Mirza:
But eventually, they make friends.

Dr.Sophia:
Exactly. I love that. Eventually, they make friends. They become friends. They get used to each other. That is exactly right. Okay. I like this analogy. What happens is, after you've placed your IUD, a hormonal IUD specifically is up to between three to six months, you can have some irregular spotting. Typically the spotting is very light, but it could be anything. It could be today, you have it tomorrow, you don't, it could be a week. You have spotting for a week, you don't for up to three to six months. Typically, we like to say up to six months because we don't want anybody to have the expectation that, oh, that's it. I put it in and I'm fine. Yes, you put it in and you're fine in the sense that you are covered from the sense of pregnancy, but the irregular spotting may persist.

Touseef Mirza:
So let me ask you, how big is that? How big is the actual IUD? Is it like the size of your-

Dr.Sophia:
Your palm? Your whole uterus? No.
Touseef Mirza:
So how many inches?

Dr.Sophia:
It would maybe be one-inch. Because

Touseef Mirza:
It's one inch. That's it. Yeah. Okay. It's true. Your uterus isn't that big.

Dr.Sophia:
The average uterus is just the size of your fist. And so the IUD sits inside of your uterus. And it's very small in comparison to your actual uterus itself. I usually have something in the office like the tip of the brush that we use when we do something like a pap smear. And I typically have the patient hold it in their hands and make a fist so that they can kind of get an idea.

Touseef Mirza:
I understand what's happening. Yeah. We think it's like super big, but-

Dr.Sophia:
It's really not.

Touseef Mirza:
It's really small.

Dr.Sophia:
It's very small.

Touseef Mirza:
Then how long can the IUD stay inside?

Dr.Sophia:
So the IUD, we have different ones that are on the market. Some with a little bit more hormone, some with a little bit less hormone. There are different tiers in terms of how many milligrams of the progestin are inside of the IUD and even the size. So there are some that are even smaller. Just understand that you can ask your provider for the smallest hormonal IUD and that one typically stays in for about three years.

Touseef Mirza:
Three years. Okay. So similar to the implant.

Dr.Sophia:
Similar to the implant in terms of timeframe. For most women, their periods become super light. So after the three to six months, you know, kind of adjustment period is what I like to call it, that the moment of adjusting to having the IUD, then you fall back into your regular pattern. So if you were someone who got a period every 28 days, well you'd still get your period every 28 days, but it would be significantly lighter. And for some women that is life changing.

Touseef Mirza:
So we're talking about IUDs and that you have options not just in terms of timeframe, but whether it's hormonal or non-hormonal. So let's say that I really don't have any mental issues. What should I take? What is better for me in terms of how to choose whether I should go hormonal or non-hormonal?

Dr.Sophia:
Well, non-hormonal, you're gonna be exactly who you are. So non-hormonal options. And if we're gonna go back to just the IUD for a second, the non-hormonal IUD again is the copper IUD. And it used to state we initially had it effective for 10 years, but now we know that it's effective for up to 12 years. So I actually really love this because for those women who again, need a non-hormonal method or would like a non-hormonal method, but a very long-term method, or for women who say, I really don't know if I'll ever want kids and want a method, that's something that's really gonna be highly effective and long lasting, but reversible.

And let me just say that one more time. It's the concept of it being reversible. That means when you take it out, your fertility is just a function of your age. Meaning if you are 25 when you put it in and you are now 37 when you take it out, well it has not changed your fertility, but your age has. So you're now-

Touseef Mirza:
You've already had it inside, but it's like you never had it inside?

Dr.Sophia:
Exactly. It's like you never had it inside. You are now a 37-year-old woman though, who may be deciding you'd like to have a kid.

Touseef Mirza:
So for the non-hormonal IUD, which is the copper IUD, since it's non-hormonal, how does it work to prevent pregnancy?

Dr.Sophia:
Great question. Oh, look at you Touseef. Okay.

Touseef Mirza:
I'm a very curious person.

Dr.Sophia:
Non-hormonal, IUD. How does it work? It actually works twofold. One of which is by thickening the cervical mucus. And the second, which is actually pretty cool, it is spermicidal. So the copper itself can kill the sperm and the copper. IUD is the only IUD that we can place and use as emergency contraception. So kind of like the way women think about something like plan B, meaning if you've had an accident where you've had unprotected sex and you think, oh my gosh, this would be life-changing or detrimental if you got pregnant, well, if you went to your provider the next day, you could place a copper IUD, it would be effective as emergency contraceptive or emergency contraception. And once placed, now you're protected, you're protected against pregnancy for a long time.

Touseef Mirza:
So it means you continue to ovulate.

Dr.Sophia:
Yes, you do.

Touseef Mirza:
But the sperm just can't live in that environment.

Dr.Sophia:
That is correct, a completely different approach.

Touseef Mirza:
Then do the women need to come on a regular basis to make sure that it is in the right position, in the right place?

Dr.Sophia:
Or, so we typically have women absolutely come back in after it's been placed about a month later to confirm that the placement is where it should be. And not everybody is gonna be a candidate for an IUD. If you have some other anatomic issue or problem with your uterus, it may not be the best option for you. If you have a very large uterus, again, it may not be the best option for you, in terms of IUDs, hormonal or not. So from that standpoint, you have to select the right candidate. But overall, barring all things, you’re normal, you're healthy, your uterus is normal, then these are the methods that I usually discuss with my patients.

And let's not forget condoms, and sterilization. So condoms prevent pregnancy, they're amazing. They also prevent almost all STDs. And even if they don't prevent them one hundred percent of the time, they pre-prevent them a lot of the time.

Touseef Mirza:
But that goes back a little bit in terms of the lifestyle question, right? So if you're in a monogamous relationship, then maybe the condom is not necessarily needed from an STD perspective.

Dr.Sophia:
That's correct. From an STD perspective, but what I like to remind people is that it really does prevent pregnancy when used correctly. And what does that mean? That means using it with every sexual act. And actually for some women, if it's just a matter of pregnancy, then you can use it in combination with ovulation tracking or understanding your period, understanding your cycle, and understanding when you ovulate. So you may use condoms just around that week when ovulation is suspected to happen. So a few days before, during, and a few days after in order to for sure not get pregnant. That's definitely a very viable way to avoid pregnancy and non-hormonal. and you can get it over the counter. You don't need a prescription, you don't have to go to a doctor's office.

Touseef Mirza:
You can get it at the bar sometimes.

Dr.Sophia:
So what I like about it is that it prevents STDs. With someone who is not necessarily in a monogamous relationship or it's just single and having a really good time in life, let's not take, I wanna take away any type of stigma or anything that could be associated with that. The bottom line is just being responsible. And if you are someone who knows that they don't want a pregnancy, using condoms and using them appropriately will be effective.

Touseef Mirza:
But also, I know some friends of mine that even if they're monogamous, they still use a condom because it's the easiest thing.

Dr.Sophia:
That's true. It's the easiest thing. It's over the counter. For some women, oddly enough, they may like, they actually like using condoms because they don't like the feeling of it in them. For example, I've had that as a conversation as to a reason why they prefer neven to use condoms. And so there are so many other reasons why we could even expand on this. Now there is a newer form of birth control that is also non-hormonal. So one of the things about condoms is that condoms are kind of in the man's hands. It's up to them to put it on, even if a woman can be very creative. But we have to make sure and convince the guy to use the condom. And sometimes that conversation can be uncomfortable or just a buzz killer.
And so thinking about that and having that in mind, it's nice to know that there is a new non-hormonal method that is equally effective when used appropriately. It is used with every sexual act, and it's called PhexxiTM.

Why do I love this method? Non-hormonal, but in the woman's hands, it is a gel. It is a gel that's inserted into the vagina and can be inserted into the vagina up to an hour before sex. So what does that mean? It means that when things are starting to get a little hot and heavy, you can think about it and say, I'm just gonna go to the bathroom really quick and put it in. You'll be protected against pregnancy, but you don't have to necessarily use a barrier method such as condoms.

Touseef Mirza:
And it's basically you apply it like with an applicator?

Dr.Sophia:
With an applicator, kind of like if you were putting in a tampon.

Touseef Mirza:
Or when you have a yeast infection or something?

Dr.Sophia:
Exactly like that type of applicator. The gel is then put into the vagina and it kind of like bathes the walls of the vagina during sex. It prevents pregnancy because it also blocks the sperm. It works, it functions by blocking the sperm.

Touseef Mirza:
So it's not like a spermicide?

Dr.Sophia:
It's very similar to how you would consider a spermicide in the sense that the effect is on the sperm.

Touseef Mirza:
But it's not a spermicide, I think that kills the sperm and this is more of a barrier?

Dr.Sophia:
It's going to be lowering the vaginal pH and that in turn actually decreases sperm motility. So it's more like what we would consider as being sterile or static.

Touseef Mirza:
So it's not like the sperm are, they're like hitting a wall. They just sort of, they just become-

Dr.Sophia:
Slowmo. They can't move.

Touseef Mirza:
They can't move, yeah. They're just kinda stopped in their tracks. They just can't move anymore.

Dr.Sophia:
They can't move anymore. They're stopped in their tracks. And like we said, it does lower the vaginal pH.

Touseef Mirza:
And then since we talked about, just for a second about spermicide, what do you think about that one?

Dr.Sophia:
Spermicide is typically used in combination with some other method. So typically with something like a diaphragm or something that used to be in existence, also called the sponge. And those were two forms that women would use. They would put that inside of them before sex. But you'd have to code it with a spermicide.

Touseef Mirza:
So you can't use a spermicide by itself?

Dr.Sophia:
There's nothing on the market that we would use alone. Spermicides are also actually used in combination with condoms. So many condoms actually come with a spermicide also.

Touseef Mirza:
Okay. So that makes seven with the Phexxi.

Dr.Sophia:
With the Phexxi, seven

Touseef Mirza:
With the Phexxi

Dr.Sophia:
If we had to talk about one more, I would go back. Let's talk about sterilization. Sterilization means tying your tubes or sterilization, meaning even on the man side, if we're gonna talk sterilization, we have to mention the fact that there are two forms or it can affect both men and women that either one of you, in terms of a partner and a couple can decide that they would like to go through sterilization, meaning to block permanently.

And let me say that one more time. Permanently block pregnancy because you permanently block either sperm from getting out, which is a vasectomy, which happens to men versus a tubal ligation or whatever we do to the tubes in order to block the egg from reaching the uterus. And so those procedures are permanent procedures. Patients come to me and ask me about that. Especially if they've already had children.

They're just like, I cannot consider another pregnancy. I'm sure I'm clear. And I like to make sure that women have an opportunity to really think about it because of the fact that it is permanent and you have to go through surgery in order for it to happen, in order to do the process. So a little bit more serious, but definitely long-term. But for some women, that's exactly what they want. They're like, I don't wanna think about this at all ever. And I don't wanna remember to take a pill. I don't wanna have to put in an IUD don't wanna have to. You just don't wanna think. Don't think about it. Don't want about it at all.

We do what one and done. And so that is what sterilization can afford women. And even if I had to think about women who are like, I never want to be pregnant, I never want to have a child.

Touseef Mirza:
Like even if it's a younger patient, you mean?

Dr.Sophia:
And even if it is a younger patient, I have to admit that the number one side effect of sterilization is regret. And so I counsel women on all the options. But when it comes to sterilization, I really do sit on that just a little bit because I really want whoever is considering it to be 100% sure. Just because once it's done, there's no reversing it.

Touseef Mirza:
There's really no reversing it. Okay. So that makes eight. That was eight.

Dr.Sophia:
Eight ways to block pregnancy.

Touseef Mirza:
Yes. That's a lot of options.

Dr.Sophia:
That's a lot. Way more than that. More than just the pill.

Touseef Mirza:
More than just the pill. And I think, and when I was in my twenties 30 years ago, we didn't have these many options. Did we?

Dr.Sophia:
Actually we did.

Touseef Mirza:
We did?

Dr.Sophia:
The only one that we didn't have was Phexxi

Touseef Mirza:
Wow. Okay. I'm sure that there's some women that are listening to this and they're like, wow, that was a, that was a lot of information. And you know, I'm sure they have still more questions. So what can they do when they go see the obgyn like to talk about this? Like is there something that you would recommend on how they would approach their obgyn about this?

Dr.Sophia:
I think it's definitely going with an open mind and having your questions actually lined up. Definitely go with, I am considering birth control. I'd like something whether it's hormonal or non-hormonal, and just have your questions ready when you go. So that way they know exactly how to respond. Thank you for listening. Until next time. Bye.

This is General medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Until next time, embrace your body. Embrace yourself.