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The Hobby Lobby Debate: Should Your Employer’s Faith Influence Your Options for Medical Treatment?

Monday, May 12th, 2014

It’s amazing to me sometimes how politicized women’s health has become. Case in point: Republican Mike Huckabee’s recent comments calling women who rely on birth control “victims of their own gender” and saying that the “Obamacare” contraception mandate “insults women… by making them believe that they are helpless without Uncle Sugar coming in and providing for them a prescription each month for birth control because they cannot control their libido or their reproductive system without the help of the government.”


Hobby Lobby, a company with 28,000 employees, must agree: they are trying to convince the Supreme Court that they should not have to provide insurance coverage for certain contraceptives for women, ostensibly because it goes against their CEO’s religious beliefs.

In an interesting side note, Hobby Lobby seems to have a problem with sticking to those beliefs consistently anyway, as while they deny IUD coverage to their female employees, they have no problem investing in companies that produce the contraceptive devices.

But this is not about tearing Hobby Lobby down; it’s about building women up, protecting them from tyrants and people who think that they can make medically sound choices for women based on religious faith rather than medical knowledge.

Birth control is one of the most common medications used by women, and protects them and their families from myriad health and financial risks. Exempting birth control from insurance coverage because of personal objections on the part of the CEO of the company is nothing short of ludicrous. Providing coverage for a necessary health service does not communicate religious agreement with it; it communicates compliance with a common-sense health policy.

Make no mistake: what’s at stake in this case (and the many that are sure to follow should Hobby Lobby come out on top) is the health of women and their families all over the country. The billionaires who run Hobby Lobby may not see an issue with forcing women to shoulder the financial burden of birth control on their own, but thousands of low-wage hourly employees will certainly have a different view.

What we’ve got here is not people who are simply trying to do the right thing, but rather people who are completely out of touch with the reality of the economic and health concerns many working families face. Emergency contraception is another method Hobby Lobby doesn’t want to cover, but I’m betting they aren’t going to step in and support those unplanned children when their families cannot provide for them adequately.

Policies involving women’s health (and all health policies, for that matter) must be grounded in medical fact, and not political ideology. Why should you or your daughters or her daughter have to make tough choices about medical care because of some politician or CEO’s personal religious beliefs? As doctors, it’s our job to advocate for women’s health, and that includes having options for birth control.

– Yvonne S. Thornton, M. D., M. P. H

Why Aren’t IUDs More Popular?

Thursday, January 30th, 2014

The IUD is one contraceptive device that seems to not be getting a fair shake. Birth control pills, contraceptive implants, condoms, and surgical sterilization are all more popular, despite the fact that most of these methods are either permanent or require perfect usage by the woman – in other words, remembering to take the pill every day at the same time, or being able to consistently use a condom in the heat of the moment. (Disclaimer: you should always use a condom if you aren’t in a monogamous relationship, but if you are, and you know that you are both free of STIs, a contraceptive method that frees you from having to use condoms can be a welcome change.)

An IUD is a small device shaped like a T which your physician must insert into your uterus. There are copper IUDS available as well as hormonal IUDS which release progesterone; both kill sperm and make the lining of the uterus inhospitable to fertilized eggs. Once inserted, an IUD can be left in place and forgotten for five to 10 years, depending on the type of IUD used. (However, it can also be removed at any time the woman chooses.) The IUD’s string hangs out through the cervix to enable the woman and her doctor to occasionally check that the device is still in place correctly.

IUDs may be a great option for sexually active teens, because they don’t require the same level of attention that birth control pills do – you can’t forget to use your IUD. In fact, IUDs are an excellent choice for any woman who may want to become pregnant eventually, but who knows she is a long time away from being ready. In addition, IUDs are extremely cost-effective when used for a period of several years.

The use of IUDs does not interrupt foreplay the way some methods can; it also does not require the cooperation of your sexual partner. IUDs are perfectly safe for women who are breastfeeding, and when an IUD is removed, fertility returns immediately. The bottom line is that IUDs are extremely effective, extremely safe, and extremely easy to use.

In spite of these benefits, less than 4% of women choose IUDs as their birth control method. Why is that? Part of the issue may simply be that doctors are not recommending IUDs with great frequency, and therefore many women may not even be aware of the availability or the benefits of IUDs. Surveys show that many doctors (about 30%) have doubts concerning the safety of IUDs, such as the possibility that IUDs may increase the risk of infection or jeopardize fertility. These were common concerns when IUDs first appeared on the market, but it is now understood that these fears are unfounded and IUDs are safe for use.

– Yvonne S. Thornton, M. D., M. P. H.

Teachers Required to Give Students False Information

Monday, August 12th, 2013

In a prime example of why parents must stay informed about their children’s school curriculum, North Carolina governor Pat McCrory signed a bill in July requiring that middle school students must be taught that abortion is a preventable cause of preterm births. Incidentally, this comes after McCrory’s promise not to sign any bills regarding abortion, period. But McCrory did not act alone; 73 state senators agreed that it was okay to give students erroneous information in the classroom.

I realize that this is a hot button issue for many, but let’s focus on the real issue here: middle school teachers required by law to lie to students. Is lie too strong a word? Absolutely not, and here’s why: There is no scientific evidence that abortions cause preterm labor. Let me say that again. There is no scientific evidence to support the idea that abortion causes preterm labor. This seems to be just another thinly disguised attempt to limit women’s ability to make choices for their own lives.

Proponents of the bill point to recent studies that show a limited risk of preterm births following abortions, but these studies and the recommendations made based on them are flawed. For one, they did not distinguish between successful medical abortions and those requiring surgery. In addition, they did not distinguish between induced and spontaneous abortions. Furthermore, legislators ignore the fact that the studies showed no increase at all in preterm births after abortions from 2000 onward, a fact probably contributable to modernized abortion methods.

In fact, David Grimes, a North Carolina professor of obstetrics and gynecology, called the bill “state sponsored ideology,” and pointed out that “the World Health Organization, the CDC, the American College of Obstetrics and Gynecologists, the American Academy of Pediatrics… and the American Public Health Association have all concluded that abortion does not cause prematurity.”

So why would these legislators support this bill? Do they have their own agendas, or do they just not understand the facts? Who knows – just do your part by staying informed, thinking for yourself, and getting your facts from the experts, not the politicians. Have a conversation with your middle school kids about this and other sex education topics. Don’t leave it to the schools.

To close, let me be crystal clear on this. This issue has nothing to do with how anyone may feel about abortion. It has only to do with the integrity of our schools’ curriculum being compromised by untruth. Be the voice of accuracy at home. Teach your kids how to find reliable information. You are free to teach your children about your moral beliefs. But at least tell the truth about the facts so that they are free to develop their own morals and form their own conclusions based in reality, not folklore.

– Yvonne S. Thornton, M. D., M. P. H.

Ease of Use Most Important Factor in Contraceptive Method

Thursday, May 16th, 2013

A wide variety of women use contraception in the modern day, whether they are simply putting off having a child for the time being or they have decided not to have a child at all. The type of contraception that a woman chooses can have a big impact on her life, and is one of the most important decisions that she can make. One study examined the contraception methods used by a variety of women, across both age and social lines, to determine what factors were most important in determining the type of contraception used.

Not surprisingly, one of the most important factors used by women in determining their method of birth control is its ease of use. The birth control pill can be notoriously difficult for some women to keep track of. It must be administered at the same time, every day, to be effective. That is why an increasing number of women are turning to other contraceptive methods, such as IUDs, to prevent pregnancy.

However, as a doctor I feel it’s my duty to urge women to think a little bit more about what contraception is best for them. There are a number of other factors besides ease of use to consider when choosing a method of birth control, from the permanence of the method you want to use to biological issues which may play a huge role in determining the efficacy of your chosen method. For example, an IUD may be best suited for a woman who has already had children and is looking for a more long-term solution to prevent pregnancy. Before making a decision about your birth control, be certain you engage in a dialogue with your doctor to determine what solution is best for you. There are so many options out there that it is easy in this day and age to find something tailored to your individual needs.


– Yvonne S. Thornton, M. D., M. P. H.

Can A Low-Dose Birth Control Help Control PMS?

Monday, April 29th, 2013

Being a woman is tough, especially when you have to deal with the monthly effects of premenstrual syndrome. PMS can have a range of effects, as every woman knows, and while for some it may be nothing more than a minor annoyance, for others it can be pretty difficult to get up and go while they’re dealing with symptoms such as moodiness, aches, pains, and bloating. I understand that, and part of my job is making sure that women have all the resources they need so they can live healthy, comfortable lives, no matter what their bodies are putting them through.

While birth control and other drugs been used for years to deal with the more serious symptoms of more severe cases of PMS, or even premenstrual dysphoric disorder, (PMDD), both women and physicians hesitate to give full doses of birth control to women who don’t need or want it. The birth control pill comes with a lot of side effects, as any woman who has taken it knows, and this can cause a lot of concerns for women who are already dealing with the effects of PMS. Fortunately, low-dose birth control can do a lot to regulate your menstrual cycle, and it comes with far fewer side effects than its more estrogen-heavy counterpart. Studies show that it can also help to alleviate the symptoms of PMS, so it may be an option for women who are trying to deal with the worst symptoms of their oncoming menstrual cycle.

If you think your PMS symptoms are bad enough to warrant medical intervention, make sure you bring it up during your next appointment with your doctor. It’s important to have a dialogue with the person in charge of your health about what is going on with your body, and what can be done to make you more comfortable, and your life a little easier. It’s also important to trust your doctor’s judgment when it comes to low-dose birth control, or any other form of treatment. They will know what is best for your body, and can talk you through your options.


– Yvonne S. Thornton, M. D., M. P. H.

Do Failed Emergency Contraceptive Result in Birth Defects?

Monday, December 31st, 2012

As I’ve discussed before, emergency contraceptives should never serve as your main form of birth control. In certain circumstances, the morning after pill is perfectly acceptable. Maybe your usual form of birth control didn’t work, or maybe your sexual encounter was unplanned, or—worse yet—unwanted. Occasional use of emergency contraceptives such as the Plan B pill is fine, especially if it will prevent the birth of a baby that cannot be properly cared for. However, these pills are not always 100% effective in preventing pregnancy. If you took an emergency contraceptive but still got pregnant, you’re probably wondering how the hormones might negatively affect your baby’s health.

Luckily, the creators of the emergency contraceptive already thought of that, and they are designed in a way that will not harm a developing baby should the hormones be ineffective at preventing pregnancy. One study in particular showed that emergency contraceptives had absolutely no effect on the likelihood that a woman would have an ectopic pregnancy. Ectopic pregnancies are extremely dangerous for the woman having it, and most are aborted so that the mother can live through them. They occur when the fetus is growing outside the uterus. If you took an emergency contraceptive and it failed, you are just as likely to have a normal, healthy baby as if you hadn’t taken anything at all. Preventing pregnancy with an emergency contraceptive is just as safe as preventing it with regular birth control, even though “morning after” pills such as Plan B give you twice the amount of hormones as a high dose birth control pill.

While you’ll have a perfectly safe pregnancy if an emergency contraceptive fails, you should absolutely never rely on it as your only birth control. If you know that you are going to be having sex, you should already be on birth control to prevent pregnancy. On top of that, you should be using a condom if you aren’t sure of the sexual history of your partner. Doctors aren’t entirely sure what the long-term effects of high doses of hormones are, so taking pills like Plan B regularly could easily lead to blood clots or strokes. If you need to take an emergency contraceptive in a true emergency, rest assured that it will probably work. If it doesn’t, you’ll soon be the mother of a healthy new baby.

 – Yvonne S. Thornton, M. D., M. P. H.


What Causes Breakthrough Bleeding?

Monday, December 24th, 2012

Vaginal bleeding outside the schedule of your normal menstrual cycle is always disconcerting. Many women feel a rush of panic when they notice blood on their underwear during a random trip to the bathroom, and rightfully so. Bleeding is usually a sign that something is wrong with us internally. If you’re not on birth control, you should see your physician immediately to make sure nothing is wrong and also to receive a pregnancy test. If you’re bleeding randomly and you are on oral birth control medication, this is probably breakthrough bleeding or spotting. Though it’s frightening, it’s actually not something you should be overly concerned about. It’s common, and it’s a harmless side effect of contraception. Of course, it will still be a surprise when you notice it, so learning the cause might help you feel less worried when you do notice a bit of abnormal bleeding while taking contraception.  As always, with breakthrough bleeding, abstinence or an alternate form of contraception is in order.

Studies show that breakthrough bleeding on contraceptives is caused by the hormones they produce, such as lower dose progestins, which are forms of synthethic progesterone. Since the 1960s , the estrogen dose in oral contraceptive has decreased from more than 150 mcg of ethinyl estradiol to 35 mcg or less. The reduction in dose of the hormone has reduced the incidence of venous thrombosis and clots but also increased the incidence of breakthrough bleeding because of the lower dosage.  Without enough hormone to stabilize the lining of the uterus, the lining prematurely sheds causing breakthrough bleeding (metrorrhagia).  Progesterone-only implants and vaginal rings particularly have an increase in the prevalence of breathrough bleeding, specifically with the active component of etonorgestrel.  To solve this problem, many women find it helpful to go on a different type of contraceptive with a different ratio of hormones to see if their body might react differently.

If you do notice large amounts of blood outside of your normal menstrual cycle, you need to contact your  gynecologist. Though it might be normal spotting caused by your birth control, there is also a chance that it could be a sign of something more serious, or even pregnancy. If you find out it is in fact caused by your contraception, speak with your gynecologist who may switch brands, doses or types of hormonal contraception. In addition to making you worry, spotting and breakthrough bleeding is extremely inconvenient, so the sooner you solve the problem the better off you’ll be.

You can read more about abnormal bleeding and contraception in my women’s health book, INSIDE INFORMATION FOR WOMEN, now in paperback.

 – Yvonne S. Thornton, M. D., M. P. H.


Is Your Birth Control Making You Gain Weight?

Thursday, November 1st, 2012

All medications have side effects. From Advil to Zantac, every medication we need for common ailments might have a drawback. For women, birth control can be a bittersweet prescription. On the one hand, women who take it will be protected from pregnancy. However, those same women might experience some unwanted side effects such as moodiness, fatigue and a change in their sex drives. One of the major concerns about birth control—especially for women in the United States—is the potential for weight gain as a side effect. We all try to maintain a healthy weight, so adding birth control into the mix of challenges can be disheartening. Luckily, recent studies show that weight gain might not actually be a side effect of modern birth control.

Every birth control is different, but they are all combinations of the same hormones. They either contain progestin and estrogen, or progestin on its own. However, the levels of each are low, and they have no real effect on weight gain or weight loss. So, why do women think birth control causes weight gain? Many brands list this as a side effect to cover themselves, but the notion started in the 1960’s when birth control became available. The pills back then contained almost 1,000 times the amount needed to prevent pregnancy, so side effects ran rampant.

The hormones themselves might not cause weight gain anymore, but that’s not to say the weight you gain while taking a contraceptive isn’t related to the pill, ring, or patch. Birth control has many other, real side effects that could easily affect your weight. For example, the hormones might cause changes in your mood, which could leave you feeling down in the dumps more than usual. If you’re like most women, you might eat when you’re sad, so weight gain will be inevitable in that scenario. More bad days will lead to more overeating, which will lead to weight gain. You might feel (and act) like a bottomless pit at every meal. Most pills also cause water retention in one form or another, so you might feel especially bloated.

If you notice significant weight gain and feel that it’s related to your birth control, talk to your doctor about switching brands. The hormones alone do not do it, so there’s a good chance your side effects are especially strong. Different brands affect people differently, so try your luck with another.

– Yvonne S. Thornton, M. D., M. P. H.

Just Because You’re On the Pill, Doesn’t Mean You Won’t Get Pregnant

Monday, May 28th, 2012

With contraception so much in the news lately, it seems that we have heard all there is to say about it.  A recent study regarding birth control though, has something quite different to say that definitely deserves our attention.  It’s evident from the attention that political contraceptive debates received that there are a lot of women in the US who take the pill or some other form of birth control.  According to the American Journal of Obstetrics and Gynecology though, many of those women wrongly assume that their contraception is infallible.

According to the Guttmacher Institute, 99% of women of reproductive age who have had sex use contraception.  That’s a lot of women, but Researchers at Washington University in St. Louis found that a shocking 45% of those women believe that contraception can prevent pregnancy 100% of the time.  With so many people taking birth control under this false assumption, it’s obvious there’s a need for education and media exposure.  While the pill, which is the most popular form of contraception, is mostly successful at preventing pregnancy, it can indeed fail between 2%-9% of the time.  And that’s the failure rate if you remember to take it every single day.  The failure rate can increase when women miss pills, are in their first month of taking the pill, switching dosages, or taking medications like antibiotics, migraine medications, or antidepressants.  Condoms have an even bigger failure rate of 15%-24%. This is why it’s so important for women to discuss their birth control options with their physician, and that discussion should include how effective each option is.  The rates of contraception failure with respect to perfect use and average use are outlined in my health book, Inside Information for Women.  Hopefully, that chapter will give you a better understanding of the types of contraception offered, their effectiveness and their applicability to your lifestyle.

This information shouldn’t make anyone panic, because as a whole, birth control is fairly effective, especially when compared to not using any contraception at all, which has a failure rate is 85%! However, knowing more about failure rates should make people aware of the actual risk involved in being sexually active, even while taking birth control.  This information probably won’t cause people to think again before having sex, and it may not prevent unintended pregnancies.  At the very least though, it gives parents like me yet another reason to teach our children that sexual activity does have consequences and is better saved for a time in our lives when we are ready to be responsible for our actions.


– Yvonne S. Thornton, M. D., M. P. H.

Jobs Should Provide Health Insurance, Not Moral Judgment

Thursday, May 17th, 2012

The debate over health insurance has certainly been heated over the past few years, and most of those arguments stemmed from concerns over financing and constitutional rights.  More recently though, it seems they have decided to narrow their focus to something a little more personal for women, and that’s contraception.  Although employers rarely want to know what you’re using your health insurance for due to privacy concerns, some would like to prevent their female employees from using their insurance for birth control.

The arguments behind this have been few.  Some claim that cutting birth control out of their health insurance plans would save money.  While this is somewhat true, in the grand scheme of things, it’s a bit ridiculous.  Birth control is easy to produce and access, and with so many competing contraception options and companies, the price is affordable.  Additionally, when female employees take birth control, they prevent pregnancies, which are much more costly for health insurance plans in the way of prenatal check-ups, hospital stays, maternity leave, and eventually, another family member to add to the plan.  In the long run, employers would actually save money by giving their employees access to contraception.

Money isn’t the only argument though.  There are religious organizations that don’t want to provide birth control to their employees out of religious, or moral, concerns.  Although the foundation of their organization stems from a particular religion, they employ people who are not necessarily a part of that faith.  There are religious hospitals, private schools, and nonprofit organizations for example, who have hundreds of staff members from all walks of life.  They feel that they have a right to impose their moral judgment on all of their employees. If they must abide by the same antidiscrimination laws that prevent them from firing someone because of their religion, race, or sexual orientation, then why should they be allowed to discriminate when it comes to health insurance?

Obviously, as a physician, I believe that the gift of life is precious.  That’s also why I believe though, that women need to be ready to receive that gift.  It takes a huge commitment to raise a child, and even more to develop that child into an intelligent, caring, and well-balanced person.  Our jobs are there to give us the opportunity to provide for our families, both in terms of money and health insurance and in terms of allowing a woman, mother or not, to feel as if she is self-sufficient, contributing and using the talents that she has developed over a lifetime. Mothers especially need an outlet other than their children.  Our jobs have no right to decide when we start that family though and by no means do they have the authority to judge the morality of our decisions.

– Yvonne S. Thornton, M. D., M. P. H.