What’s the Best Birth Control Option For Me? with Dr. Hoosna Haque

Faith: Welcome to Health Matters, your weekly dose of health and wellness from NewYork-Presbyterian. I’m Faith Salie.

Sixty five percent of American women of childbearing age are using some form of birth control. With many options available, how do you know what method is best and safest for you? 

Joining me this week is Dr. Hoosna Haque, an OBGYN at NewYork-Presbyterian and Columbia. Dr. Haque explains what’s important to know about hormonal birth control and demystifies the various birth control methods. She also dives into concerns people may have about weight gain, mood swings, or impacts to fertility.

Faith: Dr. Hoosna Haque, thank you so much for joining us on Health Matters.

Dr. Haque: Thank you so much for having me. I’m really excited to be here.

Faith: Let’s start with a quick primer: What are the most common birth control options?

Dr. Haque: So there’s a lot of different forms of birth control and we like people to feel confident that despite any medical concerns or personal concerns, we’re usually able to find something that’s going to work well for that person and that they’re going to be happy with.

Probably the most commonly used category, is going to be the combined estrogen progesterone options, and those are commonly called the pill. But the pill and the combined estrogen progesterone can also be given in other forms, like a patch that you change every week, as well as an intravaginal ring. And they work the same way, it’s just different ways of getting the same hormones into your body to provide contraception. 

The next group after that is going to be the barrier methods. And that includes condoms, also diaphragms. 

And the other one I want to mention is emergency contraception. Emergency contraception is used within a short window of having unprotected sex. Plan B is probably one of the more popular options. There is another pill form called Ella, the nice thing about Ella is it’s a little bit more effective than the Plan B and you can use it up to five days after having unprotected sex. Plan B you want to use within three days of having unprotected sex. 

Faith: So you mentioned hormonal approaches. I think people have lots of questions about those. How do estrogen and progesterone work when it comes to birth control?

Dr. Haque: With the hormonal birth control, the main way that they work is by suppressing ovulation. And that’s why it’s a consistent daily use – the hormones are in your system just for a short period of time. That’s why you want to avoid missing pills because that can result in, kind of, escape ovulation or the egg being released and not getting that contraceptive benefit.

Some other ways that the hormones can work is in the hormonal IUDs. It can prevent ovulation, but the main way that it works is by keeping the lining thin so that the pregnancy can’t implant. Also makes it less hospitable to sperm. Thickens the mucus of the cervix. So it makes it harder for sperm to penetrate into the uterus. So it works by a few different ways. 

Faith: And then there are copper non hormonal IUDs, right? 

Dr. Haque: Mhm. So with the copper IUD, it works in a little different way. It works by producing inflammation. It also makes the sperm less motile. And that’s how it prevents the egg and sperm from meeting and from implanting in the uterus. The lining of the uterus, what we usually tell people is that you might have a little heavier menstrual period.

Faith: How long do implants and IUDs last?

Dr. Haque: So the arm implant, the Nexplanon, lasts three years, and it is probably one of the most effective reversible forms of contraception. It’s a small arm implant, it’s about the size of a matchstick, and it gets implanted in the upper arm, usually in the non-dominant arm. It’s very superficial, so you’d be able to feel it under your skin, but no one’s really able to see it. 

Faith: And once someone chooses to remove an implant or an IUD, is there some kind of transition period before they could start being actively fertile and trying to get pregnant?

Dr. Haque: That’s one of the questions that comes up frequently. So we usually say, if you want to have it removed beforehand, use something else for contraception until you’re ready to actively start to get pregnant.

The hormonal IUDs can really change people’s menstrual cycle and make it much lighter and less painful. And that’s one of the reasons people use it for medical reasons even if they don’t need it for contraception, they might use it to decrease their amount of bleeding or pain and cramping, especially in conditions like fibroids or endometriosis.

It can be really effective treatment for those things. It may stop your periods. So some people may choose to have it removed a little bit earlier just to see their cycles come back and for timing purposes. But really, for return of fertility, it should be pretty immediate. 

Faith: So let’s talk a little bit about people’s concerns about hormonal birth control. Does it have an impact on mood or sex drive? 

Dr. Haque: So everyone can have their own individual effect. But when we look at large numbers of people, there really isn’t a significant impact on mood and sometimes we use it for people who have severe PMS, or severe mood conditions, premenstrual mood dysphoric disorder. So sometimes people are really sensitive to the fluctuations and changes of the hormone levels throughout the menstrual cycle. And using birth control pills, especially continuous birth control pills, can kinda even out. People who have, say, an underlying history of depression, we always want to take that into account. And some people may be affected by hormonal birth control pills, combined estrogen, progesterone pills.

One thing to take into account, some of the progesterone only methods may have more of an impact on the mood or someone with an underlying mood disorder. So we maybe want to stay away from those, or be more cautious of that, and steer someone who has big concerns about the impact of hormones on their mood to one of the newer generation combined estrogen progesterone pills, or a non hormonal option. Something like a hormonal IUD, because it has less of an effect all over your body, it acts more locally, may impact mood a little bit less.

Faith: What about sex drive?

Dr. Haque: Libido is a very complicated thing. So there are some real physiologic reductions or decrease in the amount of male hormones in both men and women, the male hormones are kind of responsible for the sex drive. But that level doesn’t seem to be decreased to the extent that for everyone, it’s going to decrease their libido. There’s still enough male hormones around that you should be able to have normal, um, sexual function. Some people do experience things like vaginal dryness, which can be addressed. Other things are, sometimes people feel more relaxed because they’re not worried about getting pregnant. So that can improve the libido. So that’s a very individual thing. 

Faith: You know, it seems like every birth control option comes with a kind of thick booklet of potential side effects. And many mention things like blood clots, which I know are rare, but obviously can be really dangerous. So what are some of the things to look out for if you’re using hormonal birth control?

Dr. Haque: So, you know, there’s going to be certain groups of people that we want to avoid estrogen-containing contraception. It’s usually estrogen that we’re worried about in that situation. Most people can safely use a progesterone-only method. One is, have you had a history of a blood clot before?

And that could be something like a deep vein thrombosis or blood clot in your legs, or blood clot that goes to your lungs, or something like a stroke. Also people who have certain types of migraines. So, they’re very specific migraines that might be associated with neurological signs. So, it could be, seeing dark spots or weakness, numbness in your face or upper extremity. That kind of signals that your blood vessels may be more sensitive to fluctuations in the hormone levels or estrogen, and it can increase your risk for stroke.

Another thing is if you have high blood pressure, if you have blood pressure that’s difficult to control. Those are situations where estrogen containing birth control can increase your risk for blood clots. One thing to keep in mind with blood clots is that we want people to be aware of it and look out for any signs, pregnancy puts you at much higher risk than using hormonal birth control.

So hormonal birth control might put the average person at slightly increased risk, but pregnancy is going to put you at a much higher risk. So there’s going to be some offset of protection there by avoiding pregnancy. 

Faith: Can you walk us through some of the most common side effects of hormonal birth control?

Dr. Haque: Probably one of the big questions that we get is weight gain. And what we usually tell people with hormonal birth control, it’s plus or minus five pounds a year.

Usually weight gain will kind of stabilize after the first three months or so. And that’s, you know, again, everyone’s an individual, but when we look at large groups of people, there’s not a significant weight change with it.

One caveat to that is the Depo Provera, which is the contraceptive injection. That tends to be associated with the most amount of weight gain, and it can be up to 5 to 10 pounds a year, kind of almost accumulatively. And that tends to affect teens more. 

But the other ones tend to be overall weight neutral. And what we tell people, the main impact it can have is on your appetite. So if you notice an increase in appetite, trying to increase your activity level to balance that out, or trying to eat things with more fiber in it so you feel full longer.

Faith: Are there any good side effects of hormonal birth?

Dr. Haque: Yeah, definitely good side effects, and probably the one that we use it very commonly for is just painful periods. So we know that the hormonal birth control can reduce the pain and cramping and the amount of bleeding by about 50%. And the hormonal IUD can reduce it up to 90%.

So those are really positive benefits. Say, someone has a bleeding disorder, something that makes them more prone to bleeding after procedures or things like that. And as a teen has really heavy menstrual bleeding, it can be an option to kind of reduce that. 

Another really helpful benefit for a lot of people is, by reducing the circulating amounts of male hormone, it can help acne. It can also help excess body hair and facial hair, in people who have conditions associated with excess male hormones. So in women, about 50 percent of the male hormones come from the ovaries.

So by suppressing that, we’re reducing the circulating amounts of male hormone. And that, on the flip side, is the way that it can also affect libido since testosterone is kind of responsible for libido in both men and women. So it can have an impact on that too. But usually not to the extent that people don’t want to have sex at all, you know.

And then just irregular bleeding or irregular menstrual cycle. So it can really help to make periods lighter, and more regular as well and more predictable. Also another benefit is, we had mentioned it briefly before, is for people with severe PMS or PMDD that really impacts their functioning or relationships during the weeks before their period. It can help to even out the hormone levels and also by doing continuous ones, you can avoid your period altogether and that can be beneficial for some people.

Faith: How do you help patients decide what the best method is for them?

Dr. Haque: So really, it’s a, you know, shared decision making model. We really want to find out what their priorities are, taking into account any underlying medical conditions that they may have, any plans for future fertility in the near future, and kind of how long they want to use the contraception. And also if they’re considering something like sterilization, how certain they are that they’re done with their childbearing. 

And I really like to emphasize whatever you use and it’s going to work for you is going to be the most effective thing. So if you have trouble remembering to take pills we want to find something that you don’t have to worry about taking a pill every day. Something that’s going to be one of the possibly longer acting methods or a different way of getting the medicine into your body. Also sometimes people have concerns about various side effects. You know, sometimes people have concerns about things like weight gain or what effect it might have on their libido or impact on future fertility. Also, family history of cancer risk. So these are all things that we want to have a careful discussion about.

Faith: Dr. Hoosna Huck, thank you so much for explaining all these choices to us.

Dr. Haque: Thank you for having me! I’ve really enjoyed it.

Faith: Our many thanks to Dr. Hoosna Haque. I’m Faith Salie.

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