Contraception (birth control) browsing by category


United States Pregnancy Rates Continue to Drop

Monday, May 26th, 2014

For decades, pregnancy rates in US women have been sliding, and this is largely thanks to a steep decline in teen pregnancies, according to a new report.

The study showed that teenage pregnancies reached a historic low in 2009. For all US women between 15 and 44 years of age, the pregnancy rate in 2009 was 102.1 per 1,000 women, down 12% since 1990. The only time it has been lower was in 1997, and even then, the difference was slight. The birth rate for married women is 72% higher than for unmarried women; the abortion rate is five times higher for unmarried women than for married women, and has also dropped overall.

For women across all categories, unintended pregnancy accounts for almost all abortions, so the decline in abortion rates is closely correlated with the decline in unintended pregnancies, and this has been seen in all groups including married women. Increasing options and education are clearly beneficial for all women.

Pregnancy rates are down in every category except women over 30, the only group with a continually increasing incidence of pregnancy. Women in their 20s represent the largest group of pregnant women, but even their rates have dropped.

The data stopped at 2009 because the complete set of more recent data is not available yet, but newer statistics do suggest that pregnancy rates continue to decline, although at a slower pace than the dramatic drop from 1990 to 2009.

The recession that began in 2007 probably has had an impact. Birth rates plummeted during the Great Depression of the 1930s; a similar effect is probably taking place now. In addition, women have been having fewer children than their mothers and grandmothers, and more women are waiting until their 30s to start their families, waiting for either the economy or their personal financial situations to stabilize.

While the levelling-off of the decline in most categories may be a sign of the recession’s abating impact, the teen birth rate shows no signs of slowing its striking drop. In 2012, the teen birth rate was less than half its 1992 peak of 62 birth per 1,000 girls, making this the group with the largest decline. The data show that fewer teenagers are having sex as well as a significant increase in contraceptive use among the ones that do. The exact reasons for the decline may not be clear, but those teaching both abstinence and sexual health, including contraceptive use, are probably on the right track.

Even with the decline, the pregnancy rate in the United States is still among the highest in the industrialized countries. The countries with the ten highest birth rates worldwide are all located in Africa.

– Yvonne S. Thornton, M. D., M. P. H

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

Trying to Conceive? Read This

Monday, March 17th, 2014

Making the decision to have a baby can be overwhelming and frightening, but it can also be extremely exciting. Most people are able to conceive without difficulty. For some women, it happens very quickly, but for others it can take longer. Around 30% of women trying to conceive will do so within one month; 75% will succeed within six months. For some women, it can take as long as a year.

The first thing you should do is schedule an appointment with your gynecologist and inform him or her that you are planning to become pregnant. Talk to your doctor about any medical conditions you may have and how they may affect your pregnancy, such as diabetes, high blood pressure, heart problems, or a family history of any hereditary conditions such as sickle cell anemia.

Be sure to discuss any medications you are taking with your doctor, and do not stop taking them without talking to your doctor first, particularly if you are taking them for a medical condition. Obviously, you should not be taking any recreational drugs if you are trying to get pregnant; you should also avoid alcohol and tobacco, as should your partner.

Once you stop using contraception, your fertility will return to normal, as will your periods. There may be a short delay in ovulation after you stop hormonal contraception, but after this, your fertility will not be affected by these methods of birth control. It’s also fine if you get pregnant very quickly after stopping a hormonal method of birth control. This is not dangerous to your baby.

You can improve your chances of getting pregnant by making healthy lifestyle choices – both you and your partner.  I have found in my practice that if a woman is having difficulty conceiving and she is obese, the first order of business is to lose weight and to attain a normal body mass index (BMI = 18.5–24.9;kg/m2 ) before she pursues pregnancy.  One of the most important things you can do is to make sure you are eating a healthy, balanced diet. Eat a wide variety of fresh, whole foods to help ensure that you get all the vitamins, minerals, and other compounds you need. You should also have a pre-conceptional visit with your gynecologist and most likely (s)he will recommend you start taking folic acid (0.4 mg per day) – and not just an all-purpose multivitamin.

Some patients want to know when they can expect to be fertile. I personally believe that this is a recipe for disaster, i.e., trying to calculate when you are fertile rather than enjoying your partner and having intercourse at least three times a week.  My dictum is, “A watched ovary never ovulates.” Nonetheless, you may want to be familiar with your menstrual cycle. The “average” length of the menstrual cycle is 28 days, but this can vary pretty significantly from woman to woman and still stay within the realm of perfectly normal. The key is to know your individual cycle. Count the first day of your period as day one. If you haven’t already, start keeping track of this on a calendar (a menstrual calendar). After a few months’ worth of counting, you will get an idea of the timing of your menstrual cycle..

This is important, because ovulation will occur somewhere around 14 days before your next period starts, so this can give you an idea of when you will be most fertile. I am not a fan of patients sticking their fingers into their vaginas in order to assess their cervical mucus.  But, some are compelled to do so.  The character of the cervical mucus  changes with the timing of ovulation: around the time of ovulation, it becomes clear, slippery, and stretchy (Spinnbarkeit). At other times it may be creamier and thicker.  Whether thick or thin mucus, a patient should engage in sexual intercourse frequently throughout the month if she wants to conceive.

If patients want to get the Cadillac of tests detecting ovulation, they purchase an ovulation kit. These kits are used to test the urine for the luteinizing hormone, which will increase a day or so before you ovulate. If your partner feels forced into intercourse based on these ovulation kits (“performance anxiety”), then there needs to be a serious discussion about the ovulation kit’s effect on the dynamic of the relationship.  Many women find that these kits are unnecessary and that getting to know their own bodies and menstrual cycles is enough.

Despite their best efforts, many women aren’t able to get pregnant within the first few months of trying. Several factors can affect whether or not you conceive, including whether or not you ovulate (see your doctor if you think you might not be ovulating), whether implantation takes place successfully, your weight (obesity is a deterrent to conception, as is severe anorexia), your age (women over 35 may find that it takes longer to conceive), and the quality or quantity of your partner’s sperm.

If it seems to be taking too long for you to conceive (a year for most couples, six months or so if you are over 35), talk to your doctor about the possibility of fertility testing (for both you and your partner) to determine whether there is a physical problem that may need to be addressed. Finally, if you do conceive but have a miscarriage, the odds of you having a successful pregnancy in the near future are still very good.

– Yvonne S. Thornton, M. D., M. P. H.

Should Birth Control Pills Be Available Over the Counter?

Monday, February 17th, 2014

It’s a hot debate topic: should women really be required to obtain a prescription for birth control pills? Shouldn’t the most popular form of birth control be available over the counter (OTC)?

Proponents of making oral contraceptives prescription-free say that more access to the pill would lead to fewer unintended pregnancies. To be sure, there are women who would take birth control pills if they didn’t have to see a physician to get them and if the overall cost were lower. Women commonly site access, convenience, and cost as reasons why they do not use a consistent contraception method.

Those in favor of OTC oral contraceptives also say that the benefits of making them more available outweigh the risks, as these pills are widely prescribed and generally safe. There is no argument that access to birth control is very important. Unintended pregnancy has devastating emotional and financial effects on a woman’s life, often ensuring poverty, inability to continue her education, and much more.

However, the risks of taking birth control pills without medical advice are substantial. If they were to start being sold without prescriptions, it’s a safe bet that many women would not receive important medical counseling. For example, one of the reasons birth controls require prescriptions is that they have known drug interactions and potentially dangerous side effects.

For example, antibiotics can interfere with the effectiveness of the pill. Physicians counsel women on drug interaction dangers like this when they dispense prescriptions. Women who buy the pill over the counter may not realize that if they also take an antibiotic, they need a backup method of birth control that month. In addition, birth controls pills are completely useless against sexually transmitted infections (STIs). They are not a replacement for condoms.

And if a woman doesn’t have to see her doctor to obtain a prescription for birth control pills, might she be more likely to skip seeing her doctor altogether for longer periods of time? This certainly would not be an issue for all women, but the ones who go to the doctor only because they must to get the pill would encounter the additional risks involved in not obtaining regular preventive checkups, which can reveal health problems such as STIs and some cancers in their early (and treatable) stages.

In addition, women who smoke and take birth control pills have a much higher risk of strokes, heart attacks, and death.

Birth control pills are a great option for contraception. They are easy to use, can’t be neglected in the heat of the moment (although they be forgotten earlier in the day), are noninvasive, and do not have lasting effects on fertility. However, the risks of using them and the need to use them properly call for medical advice before beginning them, at the very least.

You can find more information on birth control pills and other contraceptive methods in my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

Can You Safely Buy Medications Online?

Monday, February 10th, 2014

In a study of internet users conducted recently by the FDA, researchers found that while 20 percent of the participants had used the Internet to buy prescription medications, 29 percent reported being unsure of how to buy medicines online safely.

Medications can be bought safely online, but the patient must be aware of the dangers and be able to determine which Internet pharmacies are legitimate and which ones are not. The stakes are high, since if you put your trust in the wrong website, you could end up with a medicine (over the counter or prescription) that isn’t safe to take.

Making this determination isn’t as easy as it seems. Websites that sell potentially dangerous drugs often have a very professional and legitimate look. However, no matter how professional a website looks, it could be run by an illegal operation, which may sell drugs that are unapproved, contain the wrong ingredients, contain too little or too much of the active ingredient, or even contain dangerous ingredients.

So how can you avoid these risks while taking advantage of the convenience of online shopping? For starters, the pharmacy you choose should be located within the United States. It should be licensed by the state pharmacy board in the state where the website is operating. You can find a list of boards here. A licensed pharmacist should be available to answer questions, and the pharmacy should not be willing to sell you prescription medicines without a prescription. Finally, the website should provide contact information and you should be able to contact a live person by phone if you need to.

Another way to protect yourself is by being sure to check the appearance of the medicine before you take it, including its shape, size, color, and packaging, as well as its smell and taste. Some medications found online may be too strong or weak, past their expiration dates, labelled incorrectly, shipped incorrectly, or outright counterfeit.

Counterfeit drugs present a special danger because they are often difficult to identify and there is often no way for the buyer to know what is in them. They may not be effective for their intended purpose, or they may contain the wrong amounts of ingredients or even the wrong ingredients, period. This can be extremely dangerous and lead to harmful side effects. The fake packaging on these types of products can look quite legitimate. This is why it is so important to make sure to buy medications online from a trustworthy source.

And if you need one more reason not to trust online pharmacies without thoroughly investigating them first, how about identity theft or credit card fraud? Never give any website your personal information, such as credit card information, medical history, or social security number, unless you are sure the website is legitimate and will protect your information.

The take-home message from this blog entry is that I strongly discourage buying ANY prescription medications online.  Your local pharmacist has your history and is aware of any potential interactions with other medications that you have been prescribed, which could be life-saving.   Are you willing to risk your life to save a few dollars?   Think about it.

– 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.

Multiple Births on the Rise

Monday, January 20th, 2014

If you feel like there are more twins, triplets, and more around than ever before, you’re not imagining it. Multiple births have increased since 1980, when one in every 53 babies born was a twin; in 2009, that number had risen to one in every 30. That’s a 76% increase in twin births in roughly 30 years.

One (smaller) reason for the spike is older maternal age. Older women are more likely to release more than one egg at a time (with or without fertility drugs), making multiple gestation a possibility more often. Incidentally, this does not pertain to identical twins, who are formed from a single fertilized egg.

Another reason, one which is responsible for a larger share of the increase, is the use of fertility drugs in women trying to become pregnant. Fertility treatments have attracted some attention in recent years following the birth of eight babies by the so-called “Octomom.” In that case, 12 embryos made from an IFV treatment were implanted into the woman’s uterus and the result was eight viable fetuses.

This was a clear case of poor judgment. Most cases of infertility are not treated with IVF, but rather with drugs that stimulate the ovaries to produce eggs. These drugs encourage hormone production, which aids in conception but also increases the chances of multiple gestation.

When women are undergoing treatment via fertility drugs, their doctors routinely monitor, via ultrasound and blood tests, how many eggs are being produced so that the couple can avoid trying to conceive during a month when there are too many. However, in some cases the monitoring is not done, or the couples disregard the advice given to them. Often doctors who have been demonized for “allowing” a woman to become pregnant with more than one or two babies during fertility treatments have actually given the woman advice that would have prevented the multiple pregnancy, had it been followed.   

There are good reasons to avoid having twins (or other multiples) whenever possible. Twin pregnancies are considered higher-risk pregnancies, and are usually more difficult for the mother than singleton pregnancies – especially older mothers, who no longer have the energy they had in their 20s. In addition, caring for more than one newborn baby at a time is exhausting, even when plenty of help is available. The exhaustion and expense factors increase exponentially with each additional newborn. It’s also extremely difficult to maintain social and emotional health during those early years with twins or more.

If you do find yourself pregnant with twins or more, take steps as soon as possible to maximize your odds of a healthy pregnancy and delivery, and learn all you can about ways to make taking care of multiples – not just as newborns, but through the challenging toddler and preschool years as well – as simple as possible.

– Yvonne S. Thornton, M. D., M. P. H.

Doctors Not Spending Enough Time Talking to Teens about Sexual Health

Thursday, January 16th, 2014

The sex lives of adolescents is a topic which many parents – and, apparently, doctors – would often prefer to avoid. But since almost half of high school students have had sex, we can’t pretend the sex lives of teenagers are nonexistent, nor can we neglect to teach adolescents about being responsible for their sexual health. Unfortunately, a recent study showed that only about 65% of physicians are talking to teens about sex, and when they do, the conversation lasts only an average of 36 seconds.

None of the 253 teenage patients in the study brought up sex themselves during their office visits, meaning that if the doctor did not initiate the conversation, it did not take place. The doctors were more likely to raise the topic with female patients. It may be true that girls are the ones who get pregnant, and must learn to protect themselves, but adolescent boys also need to know that they share equal responsibility when it comes to safe sex. Besides unexpected pregnancy, both girls and boys must be taught how to avoid contracting and spreading sexually transmitted infections.

And teens can’t count on learning the information they need at home or at school, either. Many sex-ed classes in schools fall short of comprehensive, and the subject is never brought up at all by many parents. For this reason, it is important for doctors to realize the magnitude of this need and be sure to talk to their adolescent patients about sex.

Parents can assist by not being present in the room during the exam – unsurprisingly, the study showed that doctors were much more likely to bring up the topic of sexual health when parents were absent. Longer visits were also more likely to include conversations about sex, one of many reasons why taking enough time with each patient and giving them individual, personal attention is so important.

Whether the doctors were uncomfortable talking about sex with teenagers, were concerned about making conservative parents angry, or were just too rushed isn’t clear. What is clear is that we can’t expect teens to make good choices if we don’t make the effort (uncomfortable as it may be) to educate them and provide them with the tools to make those good choices.

And since teens don’t bring up sex on their own during doctor appointments, it’s vital that we open up the conversation and give them a chance to ask any pressing or embarrassing questions they may have. Otherwise they will likely turn to their friends or the Internet, and there is far too much incorrect and downright dangerous information out there to neglect the job of teaching kids the facts and giving them the opportunity to talk to a trusted, knowledgeable adult about sex.

– Yvonne S. Thornton, M. D., M. P. H.

Male vs Female Sterilization: Which Partner Should Get It?

Monday, December 30th, 2013

Sterilization is a procedure for men and women that stops them from being able to conceive. It works by creating a barrier so that the egg and the sperm cannot meet. In women, the fallopian tubes are cut or sealed off to keep the egg from travelling into the uterus. In men, the vas deferens is cut and sealed off to keep the sperm from moving from the testicles into the penis. This is also called a vasectomy.  

As sterilization is permanent, it should be used only by couples who are completely sure that they will never want to have children, or who do not want to have any more children. When this is the case, sterilization offers a great solution – not having to worry about birth control ever again is a great thing. For many couples, the only real question they have about sterilization is: which partner should get it?

One significant issue is the fact that male sterilization is safer than female sterilization. At least 14 deaths are attributable to female sterilization in the US each year; in men, that number drops to zero. Complications are also less common with male sterilization. For many couples, this fact alone is enough to help them make up their minds. However, this is far from the only factor for most couples, and even though female sterilization comes with a few more (remote) risks than male sterilization, it is still extremely safe.

Couples should consider and discuss all of the factors involved in making this decision. Perhaps one partner has the time available to take off from work and recover properly. Perhaps one partner is deathly afraid of surgery while the other has no problem with it. Whichever partner is chosen for surgery should understand and be okay with the fact that this type of sterilization is permanent. Yes, there are reversal operations, but they are extremely expensive and often do not work.

Male Sterilization

Vasectomies are done using local anesthetic. The operation takes only about 15 minutes. The scrotum may be bruised, swollen, and painful for a week or so; wearing tight-fitting underpants helps with support. Strenuous exercise must be avoided for several weeks. Most men find that the pain they experience is very mild. Men can have sex as soon as the doctor gives the green light, which is usually as soon as it is comfortable. However, there may still be sperm in the semen for a while after the operation. Men must have a semen test eight weeks after surgery to make sure that the sperm are gone before having unprotected sex.

Female Sterilization

There are several different ways of blocking fallopian tubes: cutting, tying, clipping, and more. This may be done under general or local anesthetic. Because this is a more invasive procedure than is involved in male sterilization, and because it often involves general anesthesia, women may find that they feel uncomfortable and unwell overall for a few days. Women typically need to take it easy and get plenty of rest for a week or so. They may experience pain as well as slight vaginal bleeding. Women will need to continue to use contraception for several weeks after the surgery.

With either male or female sterilization, patients should follow the doctor’s instructions for post-surgery care. Patients should also understand that neither option is 100% effective, although 99.9% comes pretty close. Couples should discuss all of these issues and decide what is best for them.

– Yvonne S. Thornton, M. D., M. P. H.

It Is Okay to Decide Not to Have Kids

Thursday, August 15th, 2013

For many women, the choice to become a mother is an easy one. To these women it feels natural; they look forward to it and, usually, love it once it happens. For other women, the choice is also clear – the choice not to become a mother. For many women, this is an easy choice to make, but not such an easy one to share with their loved ones. After all, we still live in a culture that expects women to become mothers. A girl becomes a woman, gets married, and has kids. A woman who deviates from this plan is somehow “wrong.” Women have fought so hard over the years for equal rights, including the right to make choices for themselves – so why are we still so hard on women who make the choice to remain child-free?

Lately, the ranks of childless women have been speaking up in a big way. They are making themselves heard loud and clear: We don’t want kids. Period. Not, we don’t want kids now, but we realize we might change our minds later. Not, we can’t have kids. But we don’t want them. It is not going to happen.

These women will not be made to feel guilty because so many women want kids but can’t have them. Nor will they buy into the idea that they are selfish or bad because they choose freedom over babies. And they do not accept the premise that they somehow do not understand their own desires or “will change their minds later.” They are bravely claiming for themselves lives of free time, solitude at will, career immersion, or vacations at the drop of a hat – basically, they are choosing to do what they want to do, when they want to do it.

Unfortunately, an “us and them” mentality has begun to take shape around this issue. Moms, understandably, get defensive when they feel like their choices are being disparaged. Childless women feel ostracized by moms. This is a disturbing trend that we should nip in the bud, because women can potentially be such a great support system for each other.

And let’s be honest: the fact of the matter is that no matter what you choose, you are going to be judged for it. You are either fat and lazy or thin and stuck-up. You are either poor and uneducated or rich and mean. You are either a bad mother with too many kids or you are a selfish, close-minded woman with no kids. You can’t please everyone, and sometimes, you can’t please anyone but yourself. So please yourself. Life is short; how you live yours must be your own choice.

As women, it’s time we stop tearing each other down and start empowering each other to make individual choices – and supporting each other in those choices. It’s not “us and them.” We are all still women, with dreams and plans and feelings. Let me empower you: it’s okay not to have kids – and it’s okay to have them. No one can make the choice for you but you.

– Yvonne S. Thornton, M. D., M. P. H.