Birth Control Choices

rom why the IUD is back and more popular than ever, to questions on whether it’s really safe for a woman to miss her period (oh, and WHEN IS THE MAN PILL coming out), and so much more, Breezy Mama’s favorite go-to OB Dr. Rothbart answered our questions.

Chelsea: I have heard of many OBs recommending IUDs now. Why is this? What’s changed from our mother’s generation when there were lots of problems?

Dr. Rothbart: We have come a long way from our mother’s generation of IUDs. IUDs got a bad rap in the 70’s and 80’s for causing pelvic inflammatory disease. They were made of completely different materials then, and the next generation of IUDs on the market today in this country are extremely safe and effective.

Chelsea: I heard there are two types of IUDs – a bronze one without hormones and a regular with hormones. Can you explain the different types and why one is good for one patient and vice versa?

Dr. Rothbart: There are indeed two types of IUDs. The Copper-T, or Paragard, has no hormones and can be left in for up to ten years, and the Mirena which has mainly locally acting progesterone in it, which lasts up to five years. The Paragard has the unique benefit of having no hormones, which is really important to many women. Women who have sensitivities with mood, weight, bleeding patterns with hormones revel in the opportunity to have contraception non-hormonally. The Paragard is also excellent for women with coexisting medical conditions where hormones are contraindicated, such as uncontrolled high blood pressure, history of breast cancer or history of a blood clotting disorder, to name a few. The main draw back to the Paragard is that it can cause a longer, heavier, and crampier period. The Mirena, on the other hand, has progesterone in it, but very little of it gets into the blood stream, i.e., it mainly acts locally in the uterus. The benefit of this IUD is that it makes the lining of the uterus extremely thin, and therefore makes a very light period that sometimes is just a few days of light spotting. In fact, we often prescribe this IUD for women with very heavy periods for a treatment option to avoid surgery. The drawback of the Mirena is that it does have one hormone in it, and that it lasts five years less than the Paragard.

Chelsea: In all honestly, with IUDs being all the rage again, I know of two people who have had complications and had to go back in to their Dr’s office. How common is this? What exactly happens or can go wrong that would cause a patient to have to return?

Dr. Rothbart: Complications with IUDs are actually very rare. Not knowing the exact nature of why those people had to go back, it’s hard to comment. That being said, the most common reason for a return visit is because of abnormal bleeding/spotting, lingering pain or just a sense that the woman doesn’t like having it in. There is a very rare complication of uterine perforation upon placement, but this usually is discovered at the time of placement.

Chelsea: What birth control pill is currently the favorite among the OB community?

Dr. Rothbart: There never really is a favorite among the community. There are over 60 pills on the market and some OBGYNs have their own favorites, and others have theirs. Some doctors prescribe pills interchangeably, and others pay closer attention to what combination of hormones are in which and would be better for an individual patient.

Chelsea: For those that are sensitive to the extra hormones in the pill, what new pill is out there?

Dr. Rothbart: There are several low dose pills on the market for those women sensitive to higher doses of estrogen.