MARA GORDON, HOST:
I'm Dr. Mara Gordon, and I'm the host of your NPR LIFE KIT about how to choose a method of birth control. We heard from so many of you. It's a decision that is so, so personal.
MARY K MURRAY: We have had a long journey with birth control.
GORDON: I'm a family physician, and I talk about birth control with my patients all the time.
MAKEA KING: I got my first IUD, and I loved it.
GORDON: It's one of the most common reasons people come to the doctor.
CAMILLE EINSTEIN: And I tried a lot of different birth control methods before finding the one that worked best for me.
GORDON: I love helping my patients choose a type of contraception...
LILLIAN DUBIEL: And having menstrual control is so empowering.
GORDON: ...Because it really does allow them to have more control over their own bodies and their own lives.
KAT ZAMBON: I didn't want to have to think about it every day.
ELAN SUDBERG: My wife and I are very happy with our choice for my vasectomy and love our little family of four.
EINSTEIN: I wouldn't be where I am today without birth control. I love my job as an assistant principal, and my husband and I wouldn't have had the time to focus on our careers in our 20s if we'd had a family earlier.
GORDON: But as I do this more and more, I've come to realize that no two patients are alike.
EINSTEIN: I got the Mirena because I don't mind a low hormone dosage. Man, it was incredible.
RIN CHAMBERLIN: I went in for my appointment to get it inserted, and it ended up being the most painful experience of my entire life.
GORDON: They all have different body chemistry, different relationships and different preferences about what works for them.
CHAMBERLIN: Each time I had used a couple different types of the pill, I ended up with symptoms that I didn't like.
GORDON: Choosing a method of birth control is as unique as your DNA.
EINSTEIN: I started with the pill in high school.
KING: I was prescribed the Depo-Provera shot.
DUBIEL: Then in college, I got my first Mirena IUD.
TY SHORT: But then I lost my insurance, and NuvaRing was a little too expensive.
ALEXANDRIA HADD: Tried the pill and other hormonal birth control methods.
GORDON: There are lots of choices, and almost all of them are really safe to use. But sometimes, all of that choice can be super overwhelming and about so much more than just birth control. Some listeners wrote in about wanting a more holistic conversation about all of this stuff, so this episode of LIFE KIT is designed to answer your questions and give you the facts that you need. We should say upfront that while I am a doctor, this podcast is not official medical advice. Nothing replaces a conversation with a health care provider that you trust. We assume that if you're listening, you have some working knowledge of how babies are made and how birth control works. If you want to know more, we'll link on our show page to some excellent online resources with all of the info you need.
Everyone's heard a story about birth control, and it seems like everyone's got an opinion about it. It's one of the most common types of medicines that people use. This also means that there's a lot of myths out there. To help us sort through what's a myth and what's reality, we called up Dr. Maddie Deutsch, a family physician at the University of California San Francisco. That's UCSF. She says that people have all kinds of preconceived ideas about what birth control is, how it works and who it's made for. A lot of people think that it's something that only cisgender, heterosexual women use. I mean, look at the way it's marketed. Here's Maddie describing an ad for an intrauterine device or an IUD.
MADDIE DEUTSCH: It was these very kind of young, spry-appearing, quote, unquote, "traditionally beautiful," pretty intentionally heterosexual women who were very happy and dancing through the street with some males who were presumably supposed to be these, like, supportive males as well and just kind of doing this happy dance that - I've got the contraception that works and fits for me.
GORDON: Contraception is something that people of all genders and sexual orientations use. That's why I'll use language that's gender-neutral, and instead, I'll focus on body parts. You'll hear me talk about uteruses and penises rather than men and women. Of all of people's concerns about birth control, questions about hormones are some of the most common, so our first takeaway is designed to bust some of the myths. Hormones have upsides and downsides. Make sure you know the facts.
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GORDON: So what are we even talking about when we talk about hormones? Here's Maddie.
DEUTSCH: We have many hormones in our body - many. And they all exist in a soup in our body. There are millions of different combinations of ways that a body could metabolize hormones, and so because of this, everybody's response to hormones is going to be a little bit different.
GORDON: In the case of birth control, we mostly mean different types of estrogen and progesterone. When they're using contraception, they basically help prevent pregnancy, and they regulate your menstrual cycle. Maddie is an expert on hormones. She directs UCSF's Center for Transgender Medicine, and she says prescribing hormones to her transgender patients taught her lots about birth control.
DEUTSCH: And that kind of helped me open my eyes to go back to contraception and look at it in a totally different way and really begin to understand how hormones work in the body and how contraception works.
GORDON: Every body processes hormones in slightly different ways. Maddie says that's normal.
DEUTSCH: That is why somebody comes in and says, my best friend is taking this pill, which is a combination of these two hormones, and she feels great, so I want to take what she is taking. And then, you know, maybe that person starts taking it. They say, gosh, I feel awful. And it's - well, your body is - has different chemistry to it.
GORDON: Hormones are used in lots of different types of contraception. That includes birth control pills. In doctor speak, that's combined oral contraceptive pills, which are tablets that have both estrogen and progesterone in them, and you have to swallow them every day. There are lots of different pills on the market, and most of them are pretty similar. It can be super-confusing. Each of them has a slightly different combination of the two hormones. They're also used in the patch, which goes on your skin. And there's the vaginal ring, which is a little plastic ring that you put inside your vagina once a month. There's also a couple types of birth control that only contain progesterone. There's Depo-Provera shots, and those work for three months. And there's progesterone-only pills. There's also an implant that lasts for three years that a doctor or nurse inserts under your arm.
DEUTSCH: The size - it's maybe about an inch-long piece of spaghetti.
GORDON: And there's a hormonal IUD, which stands for intrauterine device.
DEUTSCH: Kind of like a flexible paperclip-shaped thing that is inserted into the uterus through the cervix in a procedure that's similar to a pap smear.
GORDON: Both the hormonal IUD and the implant have much lower doses of hormones than the pill, so they're often really good options for people who haven't had great experiences with hormones in the past. As a quick note, neither the IUD nor the implant protect against sexually transmitted infections. The only form of contraception that will do that is condoms. Now let's talk about some of the most common concerns about hormonal birth control.
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GORDON: When I talk to my own patients, a lot of people say that they just feel off or they feel different when they're taking hormonal birth control. Most people who use contraception are totally healthy, so it's different from a medicine that helps you feel better when you're sick. With birth control, you're more likely to be attuned to exactly how it makes you feel. Many people also worry that hormonal birth control can cause depression or change your personality, but let's look at the science. There's no research that consistently links the hormones in birth control to depression or decreased sex drive. In fact, doctors use birth control to treat a form of depression that's known as premenstrual dysphoric disorder. It's a really severe form of PMS, and the hormones in birth control pills can really help some patients feel better.
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GORDON: Another big concern that we heard from lots of people - weight gain. There's lots of research that shows that the hormones in most types of birth control do not tend to cause you to gain weight, with the major exception being Depo-Provera shots. The hormones also won't affect your ability to get pregnant once you quit. Most people can get pregnant within a few months to a year of stopping. If you're having a hard time conceiving after you've been on the pill or the IUD, it may be because of a serious medical condition, and you should definitely see a doctor about it. Maddie also says that for transgender men and transmasculine patients who have a uterus, they can safely use hormonal birth control to prevent pregnancy even if they're taking testosterone.
DEUTSCH: Taking hormonal contraception that includes estrogen is not going to have any kind of negative effect or slow-down effect on the process of masculinization from using testosterone.
GORDON: There are some serious risks to using hormonal contraception, and it's really important to be aware of them if you have certain medical conditions. In particular, the types of birth control that contain estrogen - they can be dangerous for people who smoke or people who have high blood pressure. These methods can also put you at risk for blood clots and other types of heart disease. It's especially important to talk to your doctor if you've had a clot in the past or if you've had a stroke or a heart attack. You should also avoid certain types of birth control if you're being treated for breast cancer or endometrial cancer.
All of this sounds really scary, and it's important to remember that the risk of having a serious medical problem caused by hormonal birth control is actually really low, especially if you're healthy. And, of course, we recommend talking to your health care provider about your full medical history before you start any form of contraception. So we've talked about the risks of hormonal birth control, but there are benefits, too. Hormones can help clear up acne, and they can reduce your risk of ovarian or uterine cancer. The hormones can also make heavy, painful periods much, much lighter or make them go away completely. And this is totally safe. Here's Maddie.
DEUTSCH: There is no medical reason for anyone to ever have a period when using any form of hormonal contraception.
GORDON: As a doctor, I'll often see patients who have conditions like fibroids or endometriosis, and for them, I'll often recommend the hormonal IUD or birth control pills. These methods can help treat their pain, first of all, but they can also reduce the risk of serious medical problems that can come from heavy periods, like anemia. But even though there's lots of research to show that hormones are usually safe, you know your body the best. Pay attention to the way that you feel if you're using birth control, and keep a diary of what you experience and when so that you can start to see patterns. And if you're feeling something that you don't like while you're using a particular method, you can switch. That's what's so great about all the options we're talking about.
DEUTSCH: Everybody's response is individual, and so what that means is we may need to try it and see how you feel. And if you don't feel good when taking this, you should let me know immediately, and we can try something else.
GORDON: There are also lots of options that have no hormones at all. We'll talk more about them later in the episode. The bottom line - the hormones in birth control have upsides and downsides. Make sure you know the facts, not the myths.
When we asked LIFE KIT listeners what was on their minds about contraception, we heard from a lot of people who felt pressured into using a type of birth control they didn't want by their friends, their doctors or their partners. We also heard from folks who had a hard time getting the type of birth control that they did want to use. Here's listener Bernal Vershar.
BERNELLE VERSTER: I don't want children, and I've been asking to be sterilized since I can remember - like, from the very beginning. But doctors kept saying I'm too young or I'd change my mind, et cetera, et cetera. And then eventually, they just go, well, it's too invasive or it's too long recovery time or something. Like, what - if I want control over my body and I don't want to have children, is it really such a big deal? Why can't I just have it?
GORDON: As a doctor, these kinds of stories break my heart. I want to help my patients have more control over their bodies, not feel like someone else is controlling them. That's our second takeaway. Be your own advocate, and do what's right for your body. With contraception, the stakes are really high because it has a controversial history. It's been used as a tool for eugenics and to sterilize people with disabilities and people of color, and even today this history still looms large. To learn more about this, we talked to Mariotta Gary-Smith. She's a cultural sexologist and sex educator who helped found the Women of Color Sexual Health Network.
MARIOTTA GARY-SMITH: I'm a third-generation social justice agitator. I pride myself on being someone who is really engaged and passionate about black sexuality and sexual health and sexual education.
GORDON: Mariotta and I talked about a lot of stories throughout history where people weren't given full control over their choices about contraception. Some of them are pretty recent. Here's an infamous example. There was a civil rights activist named Fannie Lou Hamer who was a black woman who went to the hospital for surgery on a tumor. This was back in the early 1960s - so not exactly ancient history.
GARY-SMITH: She went in to see her doctor. She had a procedure and ended up having a hysterectomy that she didn't ask for.
GORDON: This wasn't an isolated case. Many other black women had their uteruses removed without their consent, too.
GARY-SMITH: And it was coined the Mississippi appendectomy.
GORDON: There are more subtle examples, too, and they're really common even today. I've met people who are pressured into getting IUDs because they had been teen parents, and then on the other hand, I've met people who are turned away from getting their tubes tied because doctors were worried that they might change their mind. Mariotta says that when she was growing up, people had lots of racist preconceptions about why they thought she needed to be extra-vigilant about using birth control.
GARY-SMITH: For me as a black woman, my own personal history - I had experiences as a young adolescent, as a person who was defined by white society, white culture as someone who was hypersexualized because of various ideas of how - of who - what black women were - you know, early pregnancy, not finishing high school.
GORDON: Now Mariotta dedicates her activist work to a philosophy called reproductive justice.
GARY-SMITH: Reproductive justice is being able to control and determine for one's body the right to parent or not, the right to bear children or not, the right to engage in sexual behavior or not. Those decisions are made with autonomy and full consideration for the person by themselves for themselves as they see fit.
GORDON: To feel more in control and empowered about your contraception choices, the first step is to be prepared. Do your own research before your doctor's appointments, and write down a list of questions. Mariotta recommends checking out websites sites like Advocates for Youth and bedsider.org.
GARY-SMITH: Take ownership of your body. Take, you know, ownership of your personhood, and be able to share with the medical professional, the doctor. These are the things I'm concerned about. These are the things I want ask questions on. These are the questions I have for you.
GORDON: Mariotta also suggests that you bring someone you trust your appointments to help act as an advocate and talk to other people in your life who can help you make a decision. But remember, what's right for your friend may not be right for you.
GARY-SMITH: I have a bit of shade in my background. I'm a third-generation shade tree person. So I get my information from my friends, and then I check it out. So just, you know, check it out. Check it out with your friends. That way, everybody can be informed.
GORDON: I like that. Everyone can fact-check together. So remember, takeaway No. 2 - do what's right for your body, not what someone else tells you to do.
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GORDON: We've talked about some of your biggest concerns about birth control. Now let's get back to basics.
MELISSA GILLIAM: You will always do best with the method that you'll use.
GORDON: That's Dr. Melissa Gilliam and one of the country's leading contraception researchers. She's an adolescent gynecologist at the University of Chicago, and she has learned a lot from talking to thousands of teenagers about birth control.
GILLIAM: I really looked at adolescence as this pivotal moment. It's this very fruitful and exciting time for young people.
GORDON: When she helps her patients think about contraception, she starts by just getting to know them.
GILLIAM: What works for them? What are they looking for? How do they - what motivates them? And what do they hope to both achieve, but also, what do they plan to experience?
GORDON: You should ask yourself those same questions. This is our third takeaway. Think about how different types of birth control might fit into your life. Melissa says it's helpful to think about two categories of methods - the ones that require you to do something every time you use them and then the methods that you can forget about. For example, when you're using the pill, you have to remember to take it every day. Otherwise, sadly, it doesn't work. I tell my patients to set a recurring alarm on their phone so they don't forget - same thing with fertility awareness, a method where you track your menstrual cycles and then abstain from sex during the times of the month when you're most likely to get pregnant. That method can work well for people who don't want to take medicine, but others find it hard to avoid sex completely when they're most fertile. This kind of decision-making is a topic of Melissa's research.
GILLIAM: One of the things that is also really important is what we call use behaviors, what it feels like to use a different method each day.
GORDON: Take another example - condoms, either condoms that go on a penis or inside a vagina. They are hands-down the best method for preventing sexually transmitted infections, but you have to use them. And if you know you won't remember to carry them in your bag, they may not be right for you. If you're someone who loves routines, one of these short-acting methods may be great, and Melissa says that they have a lot of benefits. We've already talked about some of the perks of hormonal methods - that they can make your periods later and improve acne. Another big advantage - and this one's super important - is that you can stop the method whenever you want if you don't like it. If you don't think these methods will work in your daily life, there are lots of long-acting types of birth control - more on those in a minute.
So to recap, Melissa suggests that you ask yourself some tough questions about your habits and routines. That's takeaway No. 3. Think about how different methods of birth control will fit into your life.
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GORDON: We know that people use contraception for lots of different reasons. We've talked about heavy periods and acne. But if preventing pregnancy is your goal, Melissa has another helpful set of questions for us. This is takeaway No. 4. Think about if and when you want to become pregnant or help your partner become pregnant.
GILLIAM: Do I want to be pregnant in about six months? In that case, I want a method that can stop really quickly. If I want to be pregnant in five years when I get through college, then have a longer-acting method.
GORDON: If you're thinking that it's going to be at least a few years before you want to have a baby or you know for sure that you don't want to be pregnant ever, she recommends that you think about some of the long-acting methods.
GILLIAM: So the IUD is one of the most effective methods of birth control. It takes out all of that remembering. You can just forget about it, and you can forget about it for years.
GORDON: Both the IUD and the implant do have some downsides. They require a procedure. It's not a surgery, but it's done in a doctor's office. Some people don't like the idea of a little device in their bodies, but these methods work well for lots of people because they're so easy to use. If you forget about it, it's OK. It still works. Now, the question, when do you want to get pregnant, can be a really stressful one. And if you don't know the answer, don't worry. That's normal. This isn't a hard-and-fast rule. You can use a short-acting method for years, and you can use an IUD for only a few months. But planning for pregnancy can be a really helpful framework as you find a birth control method that works for you. That's our takeaway No. 4. Think about if and when you might want to become pregnant or help your partner become pregnant.
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GORDON: I always tell my patients that you have the right to stop a method of birth control just as you have the right to start one. If you don't like it, if you don't feel good using it, you can quit it and find another method. It's your call.
GARY-SMITH: So it's about really being clear around how contraception allows you to make decisions for yourself and to protect yourself and to honor your own body.
GORDON: That's Mariotta the sex educator again. Her recommendation is our final takeaway. Make a plan for what you'll do if you want to stop your birth control. When my patients come to see me, sometimes they tell me that they don't want to get pregnant, but they also tell me that they want to stop their birth control. When this happens, I always try to do a little troubleshooting, and you can do this with yourself. Maddie, the UCSF doctor, says you should try to pinpoint exactly what's bothering you so that you can talk to your doctor about your alternatives.
DEUTSCH: And the goal for that is - I don't want the patient to leave with something that makes them feel crummy and then they just stop taking it and then they're not using contraception.
GORDON: Here's an example. Sometimes we can use a medicine to minimize side effects. A lot of people have spotting between their periods when they first start using the hormonal implant. We'll give patients a few weeks of birth control pills that they take in addition to the implant, and it can often make it go away immediately. But if you're done with a method, you're done, and that's your choice.
I will say stopping a long-acting method like the IUD or implant does take a little advance planning. You will have to see a doctor to get it out either when it expires, when you want to get pregnant or if you decide you don't like using it. The removal procedure is almost always quick and uncomplicated, but occasionally, it does require an ultrasound or a referral. If you're worried that you may lose your insurance and need a backup plan to get your IUD removed, you can always go to your local Planned Parenthood or community health center. There you can usually get it out for a very low fee even if you don't have insurance. And please stay in touch with your health care provider. We want to help, and there may be other options that meet your needs.
GARY-SMITH: People have the right to make their decisions as they see fit. Keep asking questions. There is no dumb question. There never will be a dumb question. And make sure that your circle is full of trusted folks who can help get you where you want to be.
GORDON: That's our final takeaway. Make a plan for what you'll do if your birth control isn't working for you.
We've covered a lot in this episode. There's a ton to know about contraception, and all the misconceptions out there don't make it easy. We want you to feel empowered to do your own research and ask questions of your healthcare provider. It's your body, after all. So let's recap our takeaways. Takeaway No. 1 - the hormones in birth control have upsides and downsides. Make sure you know the facts, not the myths.
GILLIAM: People often overestimate the risk associated with contraception.
GORDON: Takeaway No. 2 - do what's right for your body, not what someone else tells you to do.
DEUTSCH: Everybody's response is individual.
GORDON: Takeaway No. 3 - think about how different methods of contraception may fit into your life.
GILLIAM: You will always do best with the method that you'll use.
GORDON: Takeaway No. 4 - think about if and when you might want to become pregnant or help your partner become pregnant.
GARY-SMITH: If you don't want to be pregnant, what is it that you need to do to prevent that right now in this moment? And if you do want to be pregnant, what is it that you need to do to take care of yourself right now in this moment?
GORDON: Takeaway No. 5 - make a plan for what you'll do if your birth control isn't working for you.
GARY-SMITH: The patient is the one that gets to make that choice.
GORDON: Birth control is super-personal, and we hope that this episode of LIFE KIT helps you find a method that's right for you.
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GORDON: For more NPR LIFE KIT, check out our other episodes. We just had a great one on how to make friends as an adult and also how to have a good weekend. It's really fun. You can find those at npr.org/lifekit. And if you love LIFE KIT and want more, subscribe to our newsletter. And here as always, a completely random tip - this time, from NPR employee Shannon Boerner.
SHANNON BOERNER, BYLINE: One thing that I like to do to organize my stuff better and to reuse plastic as much as I can is when I buy clothes and I get the baggie that's attached to the tag that has the extra button on it, you can use those baggies to help organize things. So I've started using them to organize my jewelry.
GORDON: If you've got a good tip, leave us a voicemail at 202-216-9823 or email us at firstname.lastname@example.org.
This episode was produced by Audrey Nguyen. Meghan Keane is our managing producer. Beth Donovan is the senior editor. A big thank you to Rob Stein, Nyasha George, Ayiti-Carmel Maharaj-Best, Loretta Ross, who gave us great feedback. Our digital editor is Beck Harlan, and our project coordinator is Clare Schneider. And special thanks to the folks that you heard at the top of the episode - Mary K. Murray, Makea King, Camille Einstein, Lillian Dubiel, Kat Zambon, Elan Sudberg, Bernelle Verster, Rin Chamberlin, Alexandria Hadd and Ty Short. I'm Mara Gordon. Thanks for listening.
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