How Lovely to be a Woman: Birth Control, Hormones & the Joys that Come with It

Health

Aug 17

Ad campaign for Uniform Advantage scrubs feat. yours truly @juliejberry. Taken by @kc_photog954. MUAH @renatadoddy.

As many woman do, I started hormonal birth control pretty early on in my life due to my acne concerns and heavy periods, so by the time I started pharmacy school, I already felt relatively educated on the matter. What I was surprised to discover was how much I didn’t know and how useful so much of the information was!

So whatever your current situation is—whether you’ve got heavy periods, hormonal acne, PMS, or you’re actually looking to prevent pregnancy—I hope you walk away from this blog having more peace of mind regarding what the options are and feel more empowered going into your next OBGYN appointment.

Disclaimer: This is not a fully comprehensive study on all things birth control nor is it meant to replace seeing your physician. It’s simply meant to arm you with knowledge on the matter so you can discuss it further with your provider. See your OBGYN for more information :)

But first! Storytime…

Fleming Island High’s “Bye Bye Birdie” circa 2007

When my high school theatre department put on their rendition of “Bye Bye Birdie”, Kim MacAfee’s catchy song “How Lovely to be a Woman” quickly became engrained into my brain, especially as my body was undergoing all the changes of puberty. Although there are many lovely aspects to becoming a woman, it certainly doesn’t always feel like it when the bloating, heavy bleeding and the excruciating cramps hit you out of left field. Why doesn’t Kim mention all of those parts of being a woman? Singing “it’s wonderful to feeeeel, the way a woman feeeeels…” has a comically harsh ring to it when Aunt Flow comes knocking on your door. Nonetheless it helped me chuckle through the difficult realities of being a woman.

Like many women, my first and primary exposure to birth control was oral hormonal contraceptives. Although it can be up to 99% effective at preventing pregnancy (if taken perfectly), it can be easy to forget to take it on time or to maybe miss a dose, and so it is likely about 91% effective. And if you miss multiple doses in a row… then you may have an unwelcome, lengthy visit from Aunt Flow.

But the reality of the matter is that although oral contraceptives are one of the most popular options, there are so many other options out there… some of which are more effective, more convenient, and could be better tolerated. They may even be cheaper for you with your insurance. So let’s dive in and see what option may work best for you!

Surprisingly Simple Solutions to the Side Effects

Some of the most common contraceptives out there regardless of sexual activity are oral contraceptives or “the pill”. Despite its popularity, many women experience various unwanted side effects and end up getting their prescription switched up. Although the topic of women’s health is naturally and expectantly complex, I was amazed at how straightforward the solutions were to women’s various issues. If you’re having issues with the pill, chances are you are experiencing either an excess or a deficiency in one or both of the hormones in your prescription.

Many of the oral hormonal contraceptives out there are combination contraceptives, meaning they have two hormones in them: an estrogen and a progestin. (It may also have iron or ferrous sulfate in them—you’ll know because “Fe” will be at the end of the brand name—but that doesn’t affect the concept illustrated here.) The estrogen is often ethinyl estradiol, but there are a lot of different kinds of progestins: norethindrone, levonorgestrel, norgestimate, desogestrel, drospirenone just to name some of the most common ones.

When I was on the pill, some of the common issues I kept running into was nausea and decreased libido. Thirty minutes after waking up, I’d be dry heaving in the bathroom as if I was pregnant! I would run late to events... it was horrible. The libido wasn’t an issue for me when I wasn’t sexually active, but of course when I got married, that was a different story! What I discovered is that my two major issues both pointed to the same problem: too much estrogen! Most combination oral contraceptives have 0.03 mg, 0.02 mg, or 0.01 mg of ethinyl estradiol. Mine had 0.02 mg so after seeing my OBGYN, I was promptly changed to a contraceptive with 0.01 mg of estrogen and later was switched to a contraceptive with no estrogen, but we will get to that later ;)

Check out the chart below if you are experiencing side effects to figure out what your solution may be!

May the Odds Ever Be in Your Favor!

If you are looking to prevent pregnancy, do you know what the odds are for each birth control method? Outside of abstinence, there is no 100% effective birth control option out there. However, the options are NOT all created equal. Check out the chart below to see which options are the most effective!

Image credit: The American College of Obstetricians & Gynecologists. Click here to read more.
Additional info: About 22% of women get pregnant in a year with the withdrawal method (or “pulling out” during ejaculation).

In terms of efficacy, I’m a HUGE advocate for getting either the implant called Nexplanon or an intrauterine device (IUD). They are both more than 99% effective at preventing pregnancy and depending on type, tend to be well-tolerated.

As someone who has tried so many kinds of oral contraceptives and had issues getting the doses just right for me, I could not recommend getting an IUD enough! So many of the issues I had with the oral options, I do not experience AT ALL with my IUD! I thought I knew which one I wanted going into my appointment, but this is why talking to your doctor is so important…

With all the side effects I had experienced prior, I thought the best option for me would be the copper IUD (called Paragard) since it has no hormones. After discussing it with my physician, she highly recommended I take a different route. Why? Because of the heavy irregular bleeding that often comes with getting the copper IUD. Although it can be kept longer than other IUDs (up to 10 years), many patients end up getting it removed prematurely because they can’t tolerate the side effects. So she recommended the Kyleena for me!

Kyleena, Mirena, and Skyla are all kinds of levonorgestrel IUDs. Skyla has 13.5 mg of levonorgestrel (the lowest amount of hormone of the four) and can be kept for up to 3 years. Kyleena has 19.5 mg (also a low amount) and can be kept for 5 years. Mirena has 52 mg and can be kept for up to 8 years.

Although each of them can be used regardless of whether or not you have had kids, Kyleena and Skyla are slightly smaller than the Mirena, and therefore more suitable for women who have never had children and could make the insertion more comfortable.

So real talk… what is it like?

So I’m not gonna lie, the Kyleena insertion was painful, but…
It’s a very **fast** procedure. Mine took less than 5 minutes.
There are **meds** you can take to make the experience more comfortable!
It’s a few minutes of pain for up to FIVE YEARS of not just protection, but for me and for so many other women, **little to no periods** (and less cramping too). Can I get a Hallelujah?!
What I’ve told many of my girlfriends is, honestly, it feels like the *ideal way to go through life as a woman*. I don’t have to worry about my period anymore because even if I do get a period, it is very light, and all I need is the thinnest liner. And just in case you are worried, no it will not affect your fertility once you have it removed. *Your fertility resumes as normal.* There have been studies to show that there is no significant difference in the fertility of women on birth control who have a period every month and those who don’t.

Pro Tips for IUD users

I recently had my Kyleena removed because it was approaching its five year expiration date. My husband and I decided that we’d like to wait a bit longer to have kids, and since I loved the Kyleena so much, I decided to get another one! I learned quite a bit this time around, so I’ve got the INSIDE SCOOP for you! Literally… hahaha

I was not offered any medications for my IUD insertion the first time (surprisingly many OBGYN’s don’t), but I was determined to make it a more comfortable experience for myself this time around, and I’m happy to report, after receiving the medications I advocated for, the insertion was much better.

There are several medications you can request before going in for your appointment: misoprostol (Cytotec) to help soften and dilate the cervix, an anti-anxiety medication (benzodiazepine) like alprazolam (Xanax) or diazepam (Valium) to relax you if you’re nervous and provide mild sedation, lidocaine to numb the area, and ketorolac (Toradol) for inflammation and pain.

Misoprostol may be taken orally or inserted in the vagina before the procedure. It is imperative that you are not pregnant when you take this medication because it can cause birth defects or be abortive otherwise. It may cause some GI upset like diarrhea, but it does not last. If needed, you can also take loperamide (Imodium/Anti-diarrheal) to help.

I was pretty nervous going into my procedure so the Xanax I was prescribed definitely helped calm me down. Since it is sedating and the insertion can be painful, I recommend having someone there with you to drive you to and from, so there’s one less thing for you to worry about.

Lidocaine was injected directly into my cervix which sounded really intense at first, but honestly, it was not bad at all. The doctor asked me to cough as he injected it to help alleviate the discomfort.

Ketorolac is an NSAID (Non-Steroidal Anti-Inflammatory Drug) like ibuprofen (Advil/Motrin) and naproxen (Aleve) which treats inflammation and pain. Unlike ibuprofen and naproxen, it is prescription-only. It comes as pills and as an injection. My provider decided to inject it into my arm before my insertion so it would be quick-acting.

The removal process of an IUD is usually quick and relatively painless since they usually just need to pull the strings. My strings were too short so they had to remove mine via scope (hysteroscopy) which made me a little apprehensive about the procedure, especially having my removal and my replacement done all in one go. Although it was a lot to do, I am so happy I took all these meds beforehand because it wasn’t nearly as bad as I thought it would be, and the procedure itself was still really fast—maybe 15 minutes?

Either end of my actual IUD on ultrasound!

A month after insertion, I went in office for an ultrasound so they could ensure it was in the proper place and it was!

Oh and despite me having different insurances the first time versus this time, both times my new IUD was free. The scope procedure was not, but that’s not usually necessary for IUD removal.

IUD not for you? Consider the Nexplanon!

If the IUD option is not for you, the implant, Nexplanon, is also a really phenomenal option! It can be kept for up to 3 years and is one of the most effective birth control options on the market!

I’ve asked my good friend- we’ll call her “C”- about her personal experience with it, so you can hear first-hand what it’s like! Here’s her story:

What the procedure was like…

The insertion of the Nexplanon was not painful, but uncomfortable. Personally, I found it unsettling to be putting a plastic object into my body so although the physical pain was not significant there was a lot of mental struggle during the procedure. There are multiple people in the room for the insertion. The doctor and nurse numbed my left arm which quickly worked. The insertion was fast, and they immediately covered it with a bandage.

Following the procedure, my arm was very sore near the site of the insertion. It took a few days to move it without noticing a slight pain that felt similar to a small cut or bruising.

It cost me about $600 for this implant. When it was offered to Julie as an option, it was going to cost her $100, so it really just depends on your insurance.

What it’s like to have the Nexplanon…

For the first couple months of having Nexplanon and I had on and off spotting near-constantly. I read this was common and decided to wait it out. After about six months I stopped spotting at all. From month six to a year and a half, I had a good experience with Nexplanon. I like to joke that "it was great until it wasn't".

I did not have a normal period while on Nexplanon, but I had a lot of unpredictable spotting and cramping for many months. Eventually I had no bleeding at all. After about a year and a half I had intense fatigue, extremely low libido, bloating and mild cramping (without any spotting). After about six months of these symptoms, I decided it was not worth having anymore and got it removed around the two-year mark.

For reference, most women tend to have it removed around the 2 year mark, with the most common reason for early removal being irregular bleeding.

Removal of the Nexplanon…

The removal procedure involved a shot to numb the area. I kept my Nexplanon card in my wallet that stated the date of insertion, location and doctor for easy reference (pro tip!). It took the doctor several minutes to remove the device. This was due to the fact my body made a "bubble" around the foreign device, which is uncommon. The doctor needed to make additional cuts to remove it. I felt a lot of pressure and tugging, which was very uncomfortable, but it eventually it came out. The recovery involved my arm being very sore for about a week. I still have a very small scar on my arm from the removal and insertion procedures.

My fertility came back almost immediately, with my period starting about a week after the removal.

What about Fertility-Based Awareness Methods?

If you’d prefer to stay away from hormonal contraceptive methods altogether, you may consider Natural Cycles! It’s important to keep in mind several factors before deciding if this option is best for you:

Statistically speaking, Natural Cycles works best for people who had been using non-hormonal options before (condoms for example). If you are switching from hormonal contraceptives to Natural Cycles, your risk of getting pregnant is higher. Click here to read the study.
According to the FDA, the typical use of this app resulted in approximately 6.5% of women getting pregnant in the first year. The failure rate drops to 1.8% if used perfectly. The “perfect use” group involved women who, “had sexual intercourse on a day when the app predicted they would not be fertile or because their contraceptive method failed when they had intercourse on a fertile day”. The “typical use” group involved women who, “sometimes did not use the app correctly by, for example, having unprotected intercourse on fertile days.” User error is a huge factor on the efficacy of this method. Click here to read more.
The clinical trials for this method involved women who used the app for an average of only 8 months. So if you are looking for a longer term solution, this option may not be best for you.
It involves an almost daily commitment. You must preferably track your basal temperature every day in the morning immediately upon waking, and preferably around the same time every day. If your usual wake up time is 8 a.m., you should exclude the temperature reading for that day if it’s past 10 a.m.. They recommend checking your temperature at least 5 days a week for the best accuracy.
For a monthly subscription, it cost $16.99 per month plus $39.99 for the basal thermometer. For an annual subscription, it’s $119.99 per year ($9.99 per month) and comes with a free basal thermometer. Check with your insurance to see if they will help cover some or all of the cost of this option.

So many choices… which is best for you?

When it comes to birth control, it is so important to choose what’s best for you! That’s why I’m a huge proponent of arming yourself with knowledge about what options are out there and weighing out the pros and cons. For me and for many women, it can involve a bit of trial and error, but I hope that this blog can help guide you so you have a better idea of what you want/need before going into your next OBGYN appointment.

Discuss the options with your doctor and ask any additional questions you may have! Be your biggest advocate and choose what’s best for you. I hope you find an option that you are as happy with as I am with mine :)

Dr. Julie Berry

Dr. Julie Berry is an actress, model, and doctor of pharmacy. After completing her graduate program with high honors, she worked as a full-time pharmacist before making the transition to a full-time actress and model.