Katy MacDonald, a Nurse Practitioner at the University Health Center’s GYN Clinic, joins Lauren to talk about the five things you need to know about birth control, including a brief history, options for birth control and their effectiveness, and what happens when it doesn’t work.
*We would like to acknowledge that while the terms “woman” and “female” are used often in this episode, this information is still applicable to anyone who menstruates or can become pregnant.
To contact JMU’s GYN Clinic click here.
For more information about JMU’s Pharmacy click here.
To contact the Shenandoah Women’s Health Care Center click here.
Intro: Hey there, welcome to Well Dukes. This podcast is brought to you by UREC Health Promotion. Tune in every other Wednesday for conversations that we hope challenge what you know, think or do in regard to your own health and wellness and helps you be well dukes.
Lauren: Hello, Dukes and welcome back to the Well Dukes Podcast. I am your host Lauren Shutt and today we are going to be talking with Katie McDonald. Katie, would you like to introduce yourself to everybody?
Katy: Hi, my name is Katie McDonald. I am the part time Women's Health Care Nurse Practitioner at the JMU’s GYN clinic. I work with Dr. Phyllis Matthews, who is our full time NP. So we have a full running GYN clinic all year round.
Lauren: Amazing. So today, we are going to be talking to you about the five things you need to know about birth control and contraception. We're going to kind of start off with a brief history so everybody kind of gets to know how birth control came to be.
Katy: The history of birth control is fascinating. You can go back to Persia and China. And if you're interested, I would tell you to do that. There was a big thing about a lot not letting camels get pregnant. So if it worked for camels must gonna be working for women anyway. But the most fascinating story is an American story. The birth control pill was invented by two doctors in 1960. And one of the doctors was Dr. John Rock, he was a devout Catholic. And he thought, if he could make the birth control pill, like a woman's natural cycle, the Pope would see it as natural family planning and condone it. Well, the Pope didn't. And poor Dr. Rock died in his 90s, a bitter atheist. So it's an interesting story. So if you're interested in that, you know, do read up.
Lauren: The second thing we kind of want to really, really push and let people know is there's a multitude of different reasons to go on birth control. So maybe the Pope should have known that. So bringing in at number two, could you kind of give us a brief explanation about the different reasons that people go on birth control, because it's not just one.
Katy: So believe it or not, the number one reason menstruating women go on birth control is to actually control their periods, they have horrible long periods with bad cramps. So two years after you have had your menarche is a great time, if you're having horrific periods to use birth control, it's hard for women to bleed all the time, it cuts into your social life, your sports life, you can get anemic. So that is the number one reason to use birth control is just to control the period. The number two reason, of course, is to prevent pregnancy. So those are basically the two reasons for using contraception.
Lauren: So along with using contraception, there are not just a few options that we have. So could you give us a little insight at number three as to the options that people have and how effective they are?
Katy: Okay, I'm going to give you a list of all the contraceptive methods that are available. And I'm going to go from least effective to most effective, so the least effective method is using nothing. Next is the withdrawal method. And people who use the withdrawal method are called something. Do you know what that is, Lauren?
Lauren: I do not. What is it?
Katy: They're called parents. The next method, thank you to the Pope, is natural family planning. And the reason why that can be ineffective is that very few… I think they say less than 10% of the menstruating population has 28 day cycles. So natural family planning is based on a regular cycle. So if you don't have that, it's tough to use. The next thing is vaginal spermicides. This is the sponge thank you to Seinfeld, the film, foam and suppositories. So these are vaginal contraceptives that you put in just before penis and vagina intercourse. And they are about 60% effective. Next is condoms. Condoms alone are 80% effective. And just if people use a vaginal spermicide and a condom, so she's putting it in the vaginal spermicide while he's putting on the condom and you guys use those together, they are as effective as the birth control pill in preventing pregnancy. So combination things are good. Then there is the progestin only pill, the progestin only birth control pill, this is used for women who have a well, one a medical reason where they can't use estrogen. So that's like a blood clot or a stroke or migraine headache with aura. Also, some women, you know, we have two female hormones progesterone and estrogen. Estrogen is maybe the hormone that we have more side effects from, like breast tenderness, headaches, things like that. So for some women who are just sensitive to estrogen, the progestin only pill works for them. So that is only at 97% effectiveness. And the reason is, it has to be taken the same time every day, 365 days a year. So that's why that is less effective than the other pills. Okay, so after the progestin only pills, we have the combination birth control pills. So that is estrogen and progestin birth control pills. And really, from everything I'm going to mention from now on, all of these methods are 99%. When used correctly, so combination birth control pills, the next things, there's the birth control skin patch. So that is a patch that you can put anywhere on your body except near your breasts. And that has to be changed weekly. So you wear it for three weeks in a row. So one patch one week, another patch another week, another patch the third week, then nothing the fourth week, that's your period week. So that is more effective than birth control pills that you have to remember to take the same time every day. The vaginal ring. So this is more effective than the skin patch. Because it is a ring that goes in the vagina. And it's there for three weeks. And then you take it out and use nothing for a week. So things that you don't have to think about become more effective. The skin patch and the vaginal ring are the birth control pill hormones, but they are delivered instead of through your digestive system like the pill, they're delivered through your skin, or your vaginal mucosa. And that's how they are effective. All these methods stop ovulation and that's what stops you from getting pregnant. Okay, next thing is the Depo Provera shot. It is also a progestin only method. It is the shot that you get every 12 weeks, it almost always makes your periods completely stop. It is also the only method of birth control that we really do know there's weight gain on it's five pounds a year. But I've been doing OB GYN nurse practitionering for over 30 years, and I have lots of people on depo who never gained an ounce. So it's not the worst thing if you want to try it for a little bit. Okay, so that's a shot you have to get every 12 weeks, so it's about three / four times a year. The next thing is nexplanon that is an implant that goes in your arm. It is also progestin only. It is good for three years. Big side effect is irregular bleeding. I'm just gonna be honest, I hate it. I don't see the people out there who are happy with it. I know there are people out there happy with it. But um, they don't come and see me. Next things are there's hormonal IUDs. There's Skyla, Mirena, Liletta, Kyleena. They are good for anywhere from three to seven years. Progestin only so you get the same irregular bleeding side effect. Although you see a lot less bleeding on IUDs than you do Nexplanon for the majority of people, everybody can be an outlier and have an opposite effect. There is a copper IUD that is good for 12 years, it is non hormonal. So another good method for people who have a reason that they cannot use hormones. The copper IUD works because copper kills sperm. So that's how it prevents pregnancy. But its side effects are heavier, longer, crampier periods. And for some people, we don't know why. But they will get some bleeding at the time of ovulation like a day or two of red spotting. So that's the downside of that. The next method is sterilization. That's a vasectomy or bilateral tubal ligation. And that means you cannot have children. Although sometimes people do get pregnant after those things happen. So it's not 100%. So the only thing that's 100% is abstinence. But that is all the methods of birth control in a long, long list.
Lauren: With all of those options. I think the most important thing for our listeners as a mostly JMU audience to know is number four, which is the options we actually have available here at JMU.
Katy: So we have everything available at JMU. Because you know we have a very good GYN clinic. So you can come in, you can see Phyllis or I will give you any method you want. In the health center, we have a Safer Sex Center. So you can get vaginal condoms, regular condoms. It's a process to get an IUD or a Nexplanon, you have to have insurance to get those. For those things, you have to come and see me Phyllis doesn't do them. And what happens is you fill out a form, we take all your insurance information. Your insurance company decides if it's covered device. And if it is, they send it to us when we get it, we call you and we schedule your insertion. It's a process. So the quick I've put in over 100 IUDs at JMU. I'm going to say maybe I've put in five or six Nexplanons, I've taken a lot of Nexplanons out at JMU. It can take anywhere from six days to six weeks to get a device. Sometimes insurances won't participate with JMU or I am not in their network. We send a lot of people to Shenandoah Women's Health Care in Harrisonburg. They're very good and they take care of all the people that we can't. And so if you want any method of contraception, we can get it for you. We send if you just want pills or something like that. We sell them in our pharmacy for seven to $9 a pack. Rings, patches, depo provera shots, we’ll give you a script, go to an outside pharmacy and get if you have insurance. If you get a script and go to an outside pharmacy, most contraceptive methods are still free. So that's always you know, use your insurance if you have it because you won't have to pay anything. With Nexplanons and IUDS the health center, we do charge I think it's $35 for an IUD insertion, $15 for a Nexplanon insertion and $20, for its removal. I may misquote those but it's around those prices. And that's because we have to use our equipment and things, and we just need reimbursement for using our equipment, sterilizing our equipment, things like that.
Lauren: As far as other community resources you had mentioned, the Shenandoah, Women's Health Care Center. So are there any other community resources? Or is that mainly the one that we send people out to as JMU?
Katy: That's a very good question. So in the olden days before COVID, state health departments would also give free birth control and they would do free IUDs and free, you know, all types of contraceptive methods because of COVID, a lot of you know immunization clinics, family planning clinics within state health departments got shut down. So I do not know and I'm sorry, I should have looked it up before this. So I do not know if any state health departments are doing services for family planning. So if you don't have insurance, I would tell you, you know, check it out, call them and see if something's available for you.
Lauren: So coming in at number five, we want to talk a little bit about emergency contraception and what it is. And any myths that we can dispel about it. And if we can access it here at JMU.
Katy: Emergency contraception, number one, I want to say it is not a contraceptive method, it should have a different name, its name should be emergency pregnancy stoppage. Because if you are using emergency contraception, I'm gonna say more than once a month, you need to come and see Phyllis or I, it is not a method of contraception. It is a high dose, progestin pill, and we do sell it at the JMU Pharmacy, you have to walk to the desk and ask the pharmacist for it, it is $10. But I really, like I said, if you are using it all the time, please come and get up better. Not a pregnancy stoppage method, but an actual contraception method. If you are on a method of birth control, because we see this a lot, and I don't know why. But if you are on a method of birth control, and you take that method correctly, you do not ever, never, ever need to use emergency contraception. When you do that, with another method of birth control, it throws off your period. So then we see a lot of people doing extra pregnancy tests and coming in because they're worried, but it can cause extra bleeding or no periods. And that's just going to make you worry. So if you are a good contraceptor, please do not use emergency, you know, pregnancy stoppage contraception, my name for it. So that's the biggest downfall. It does throw off your cycle. It is effective, though. But like I said, if you're relying on that you need to do some research and find something that you think would work for you.
Lauren: So when it comes to the effectiveness of it, I know that certain pills have some weight, not requirements, but like limitations. Could you kind of explain that because I feel like a lot of people don't understand that.
Katy: Yeah. So methods for people with higher BMIs, that may not be as effective. It's birth control pills, no matter what your weight is, are generally very effective. Same with IUDs, same with Depo Provera. The ones that weight can affect are really Nexplanon and the birth control patch. So those two yes, if you and we're really talking very high BMIs. Yeah, if those would be pretty much the only two methods that you would probably want to avoid if obesity was an issue for you.
Lauren: We're going to kind of wrap up with that number five. Is there anything else you'd like to give resources for or anything else you'd like to give as advice? Contact information, anything like that?
Katy: I think the college age population are very astute about how they are protecting themselves from pregnancy. I think most people know we just changed the name from the Women's Health Clinic to the GYN clinic to be more encompassing, but we have everything if there's something that you're interested or you need, you know, come see us but or see you know, the OB GYNs in the Harrisonburg area, or your home OB a lot of people have their own OB GYN from home. That's great, too.
Lauren: Well, thank you so much for joining us today. We really really appreciate it. Wrapping up, just remember Dukes to follow us on TikTok and Instagram @jmuurec you can stay up to date on all things well Dukes and all things UREC through those pages we love our social media, and as always Be Well Dukes