Monday, January 20, 2014

Long term birth control

No hassle birth control

Although there are several contraceptive methods currently available to women, most are unaware that there are long-term birth control options which are: extremely effective, convenient and well tolerated. Oral contraceptive pills can be an effective form of birth control but it can be a hassle to remember to take a pill each day. Patches and rings are effective as well, but there are many women in whom this method is not desirable. The three month progesterone injection (Depo Provera) is effective in preventing pregnancy, but there can be several significant side-effects related to this method. So, where do women turn to find a methdod of contraception that can offer higher effectiveness as well as convenience? The answer is that it may be time to try a LARC.

LARCs (long-acting reversible contraceptives) are either contraceptive implants or intrauterine devices that are effective from 3 to 10 years. As the name implies, LARCs are reversible, but what you may not know is that they are equal or more effective than a sterilization procedure. I will spend a little time briefly explaning each method but you can discuss these methods with your doctor in more depth.

Implanon, and the newer implant called Nexplanon (original I know), are both implants that are inserted under the skin in the upper, inner portion of the arm. They are both good for 3 years. The implant is inserted under local anesthestic (lidocaine, etc.) and is done in the office. Insertion is quick and easy however the removal can be a little more difficult depending on depth of insertion and scar tissue.

There a three intrauterine devices currently available in the US. Mirena (effective for 5 years) and Skyla (effective for 3 years) are the two IUDs that have a hormonal effect to your monthly cycle and both contain progesterone. Although Skyla is a newer product, Mirena has been used for years. In addition to being highly effective in preventing pregnancy, the progesterone containing IUDs can decrease the amount bleeding during your cycle (80% by 3 months and 90% by 6 months). There is a small chance (about 20%) that women using a progesterone containing IUD may not have a period at all! Just as the implant, the IUD is inserted in the office.

Paraguard is a non-hormonal IUD. Some women wish to have a hormone-free form of birth control and this presents an excellent, and effective, method for contraception. For women with heavy periods the Paraguard is probably not the best option as it does not reduce the amount of bleeding.

As you can see, there are 3 basic forms of LARCs available. Each one has it's pros and cons, but if a long-term, reversible option for birth control interests you, talk with your OB-GYN about your choices.

Thursday, January 9, 2014

Understanding hot flashes

Hot flushes (aka "hot flashes") are one of the most commonly reported symptom from women who are "going through menopause". The word menopause means "the end of monthly cycles" and typically begins in the middle ages of a woman's life (late 40's to early 50's). While there are other symptoms associated with menopause such as insomnia, irritability, irregular periods, painful intercourse, etc. hot flashes are probably the most common complaint from women in this age group. According to the American College of Obstetrics and Gynecology up to 75% of menopausal women in the US will experience hot flashes.

So, what are hot flashes? To answer this I have to first explain what causes menopause in the first place. As menopause nears, the ovaries start to produce less estrogen. The lack of estrogen causes a spike in a several other hormones which, in turn, cause the symptoms of a hot flash (sudden feeling of heat that rushes to the upper body and face lasting a few seconds to several minutes). Hot flashes occur when blood vessels in the skin of the head and neck open more widely than usual, allowing more blood to shift into the area, creating heat and redness. Researchers believe that this vascular shift is due to changes in neurotransmitter activity that are not fully understood, occurring in response to rapidly changing hormone levels.
The good news, there are several options for the treatement of hot flashes! Hormonal therapy includes etrogen plus or minus progesterone (depending on whether you still have a uterus). In addition to treatment of hot flashes, estrogen therapy is also beneficial for vaginal dryness, urinary tract problems, prevention of bone loss and reducing the risk of colon cancer. There are potential risks associated with hormone therapy and should be discussed before starting these medications. Specific to hot flashes and mood changes associated with menopause, there was speculation that that a class of medications called SSRI's may help. These medications theoretically stabalize the thermo-regulatory centers of the brain. There is a new medication in this class marketed and approved specifically for menopausal women. There are also certain blood pressure medicines that can relieve symptoms of hot flashes.

Ask your doctor for more information on treatment options available for menopausal symptoms.