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Birth control 101: The pill

[00:00:00] Okay. First up we're gonna talk about the birth control pill, and we're gonna talk specifically about the combined hormone contraceptive pill. You'll learn more if you watch this week, because today we're gonna talk about only the combined one as opposed to the progesterone. Only one. Why do I say combined? 

Because most birth control pills are combined hormones of estrogen and progesterone. There are progesterone only pills, which we'll discuss in the next couple days. There's only two brands of those. When we talk about combined hormone contraception of pills, because there's also patches and rings that we'll talk about later, you need to know that there are. 

Dozens, if not probably now hundreds if you include generic, different brands. Here's some basics. The basic estrogen in all the combined pills, essentially, other than one very new brand is ethanol, estradiol. , the Ethan l Estradiol might vary with regard to the dose in each brand, but it is ethanol estradiol, which is a very specific [00:01:00] formulation of the estrogen that we find in our body. 

The progesterone, on the other hand, will vary from brand to brand. There are a few different types of progesterones and each brand kind of has its own proprietary. Those, some brands will use the same progesterone as well. What further complicates it is that we have brands, for example, ones you might have heard of like Ortho Tricyclic or Yasmin or Lolo, Estrin 24, and then we have generics. 

After several years, any brand will lose its patent and then the generic form of that brand can be made by any other company. Now, interestingly, many generic peak companies will make pills. That have the same formulation as the original brand, but then they'll put a new name on it. So now you have the brand, let's say it was Yazmin, which was ethanol with Sperone as the name of its progesterone. 

Then there will be a generic brand. . Okay. So there'll be another one that is a generic, like I think Nicki might be a generic [00:02:00] of Yasmin, for example. And then there might even be generic, generic where it's just the formulations of the actual F Nyl, estrodiol Sperone with like the dose of medication in it. 

So that can be confusing because I'll have patients say, you know, I really wanted the brand Yasmin, but they gave. Nicki, and then the next month they'll give you just Ethan Estradiol dress barone. Why does it matter if they're all the same, if generics are the same? Well, interestingly, generics can vary from the brand, meaning while it has to contain the same active ingredients, the percentage of the active ingredient can actually fluctuate a little bit. 

This is all important because every time you go to the pharmacy, your doctor is not really the one in charge of who's going to give you the specific medication. In other words, if I write for Yasmin, which is a brand, and I don't write dispense as written, then they. Switch it for whatever the pharmacy might have contracted with your insurance company or your insurance company might have contracted, and that might change each month. 

That may mean that you're gonna have certain side effects, meaning some women can change any brand. Any [00:03:00] dose, they feel fine the entire time. Whereas some women will only respond really well to one particular brand and not the generic. I know that sounds funny, but it is true. Now, can't your doctor just write dispense as written every single time? 

Why not? Well, we could, but it means that your insurance company, again, dictates all this. If I write Yasmin dispense as written, meaning they're gonna give you the brand, they might very well say, great, you can have your ya. , but you're gonna pay full top dollar for it, and that can be sometimes like $200. 

This might have happened to you when you go to the pharmacy. So that is a general background that I think is really valuable to understand about the pill. A couple other really important things about the pill. The pill works very well. 99.7%. When used appropriately and effectively. And what does that mean? 

That means when you take it every single day and ideally at the same time every day. Now some pills are a little bit more forgiving with regard to like, instead of taking it every 24 hours, you could probably skip and take 26, 27 hours, but you don't know that. So you may as well just plan that. You're gonna take it within the same hour every single day at the same time, every day. 

It does not matter if it's morning, [00:04:00] noon. It doesn't matter if it's with or without food, you figure out a time that is going to work for you. I personally find that when I was taking the pill when I was younger, if I put it next to my toothbrush, I would take it every single day. If I saw it right there, the minute it was like in a bag or in a drawer, I might forget it. 

You decide what works for you, so you need to take it every single day. You need to make sure that you understand that it will not protect you against sexually transmitted. I. Not at all. It will not increase your risk other than the fact that if you're using it and that you're four, you think you don't need condoms, then you're more at risk. 

But it will not prevent against STIs. Okay. And you need to know that while the pill is amazing and can work so well, not only for birth control, but also for control of your period with regard to. , how heavy period your period is, how frequent your period is, whether or not you even want a period. And if you have painful periods, it can help for all those things. 

And it can also help for non contraceptive benefits. It decreases the risk of ovarian cancer, uterine cancer, and colon cancer, and it can actually really help control endometriosis. So there are so many good [00:05:00] reasons to be on the pill, and yet it's not for everyone. There are some side effects. Some people do, unfortunately, get dangerous side effects like blood clot, heart attack. 

Rarely increased risk of breast cancer. Okay, those are very real. I don't wanna act like those are so rare. Not a big deal. Those are a big deal, but not so common. And getting pregnant infers a far higher risk of blood clot than the birth control pill. Just so you all understand that. Okay, so if you're planning on not being on the pill and also not being pregnant, you're okay. 

Or if you're using another form of birth control. But just keep in mind that pregnancy alone increases your risk of a blood clot by several times more than the birth control pill itself. What are some other downsides to the pill? It's not always easy to find the right one. The way the pill works is that it's giving you a steady dose of hormones pretty much every day, and when it does that steady dose of hormones, it stops your up and down part of your hormones that basically stimulates your ovaries to get that egg to pop out with ovulation. 

So by stopping ovulation, by evening out your hormones, the beauty is you don't get pregnant. That [00:06:00] means your uterine lining doesn't have to thick up. It doesn't have to shut out. You can safely skip your period if you want. But it also means that with that evening out where your mood might be better, your skin might be better, less acne, for example, less pain during ovulation, less pain during your period, less period, less bleeding, or no period at all if you wanna skip it. 

All good things, including contraception. But the downside of that is some people get moodier, some people do end up getting more acne. Some people actually just bleed irregularly because whatever brand they and their doctor have chosen. Might not work well for them. Now, this is the other problem. There's no magic to picking a brand. 

I actually often say to my patients, what brand are you heard of? What brand did you wanna try? What brand did maybe your sister or all your best friends tell you they loved? Because that might be as good a place to start as any, because we can ask a couple of little questions like, will you remember Take the pill every day? 

Do you wanna skip your period? Or not? A couple little things, but when you read about all the side effects to the pill and you come to me and you say, well, I heard this one does this and that one does that, and I was in a chat room and everyone hated this, or, [00:07:00] I will say to you, great, then I will switch your pill if you want. 

But the honest answer is I might prescribe one pill and I might know that 90% of my patients are gonna love it, but I know full well that 10% will not love it, and that 10% are very vocal. So you have to know this going into it, that it can take a while for your body to adjust to any one pill. I tell patients all the time, give it three or four months before your body will adjust unless it's something. 

Right. Meaning if you have some irregular bleeding, some mood changes, things that are mild but annoying, try to stick it out. If they're aggressive, you're having a lot of pain, heavy bleeding, something really aggressive, sounds like it's going on, then you need to stop and call your doctor. But otherwise, stick it out for three or four months because after a while you'll really find one that works most likely. 

Now that's annoying because that means you have to stop whatever brand you. Go back to the doctor or do an online birth control service and then change your brand again, and then give it another potential three or four months before you're going to feel okay. Now, the last couple minutes I wanna use to say a couple of things about the pill that have been really inflammatory on Instagram and with a lot of [00:08:00] alternative practitioners. 

I am the first one to say that no medical intervention is without risk and no medical intervention is good for. That is true about everything in life. That is true about anything natural, that is true about life, that is true about cars, that is true about having children. That is true about everything in the world. 

Hence the wor, the reason I say miserable and magical for a lot of things that said the pill has been maligned and people are making it seem that it is a shameful and bad thing for you to have ever tried the pill or to take the pill without really offering you a great alternative. Managing your hormones naturally, or only relying on condoms or with. 

Are not a great way to prevent pregnancy and with the potential overturn of Roe v. Wade, where it's going to be affecting even contraceptive care. This is something that you as a uterus owner need to be incredibly mindful of. You need to take control and make sure that you are making decisions for yourself. 

Is the pill right for everyone? No, because not everyone feels good on it. Can the pill have dangerous side effects? Absolutely. Yes. And any doctor will tell you that. None of us would say it's a panacea. None of us would say it's a perfect treatment for anyone, but what we will all say is like [00:09:00] any. That we like, whether it's medical or just the world we live in, like owning a home, there is going to be a lot of great things about it and some not great things. 

So you need to make these decisions in an educated way. Okay, next up tomorrow we're gonna talk about progesterone only pill. We're gonna talk about patch and ring the next day. We're gonna talk about IUDs. We're gonna talk about condoms, diaphragm withdrawal, female condom. and we're even gonna talk about natural family planning a little bit. 

All the contraceptive stuff you need this week. Okay, let's do this. Let's figure out about our health and let's make sure that we are really respecting our own bodies.