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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

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.


Should You Stop Smoking to Start Birth Control?

Monday, November 26th, 2012

You already know that smoking is bad for your health. If you’re a smoker, you’re already making the choice to ignore certain health warnings that could significantly alter your health for the rest of your life, and that’s a choice that no one else can make for you.  My telling you about all of the risks associated with smoking cigarettes would be a waste of time. However, I do feel it’s important that you know the increased risks associated with oral contraceptives for women who are smokers.

For the most part, modern oral contraceptives are safe. Even problems that have been tied to birth control for decades are now less common as the medicine improves and doctors work towards making the pill safer and with fewer side effects. However, by smoking while taking contraceptives, you’re increasing your risk for complications in multiple ways. Blood clots and stroke are both much more common in women taking birth control and smoking, especially in women who are 35 years old or older.  In fact, there is a ten-fold increase of death attributed to cardiovascular disease and the use of oral contraceptives in women who smoked above the age of 35 years.  [Link:]

The biggest risk for women who are smoking while on the pill is any cardiovascular complication and you’re increasing your risk by simultaneously restricting your blood vessels with the tobacco. The exact mechanism is not known as to the etiology of the increased risk, but according to a recent study, the risk of death due to such complications is low for women under 35 years old. Women who smoke while taking birth control are at a higher risk for heart attacks, high blood pressure, and increased blood vessel tension.

I’m not going to tell you to stop smoking, though as a physician, I certainly think you should. However, I urge you to take a closer look at the risks and benefits when it comes to combining your birth control with tobacco. If you feel that you need to continue smoking while taking your  oral contraceptives, consider looking other types of birth control that don’t use hormones, such as an intrauterine device or even the old tried and true diaphragm.

 – 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.

Free Birth Control Coverage is Now the Rule

Wednesday, August 3rd, 2011

In keeping with the Institute of Medicine’s recommendations that free birth control be made available to all under their insurance policies, a new rule from the White House mandates birth control coverage without co-pays or deductibles. The new rules also cover domestic violence screening and breastfeeding assistance without co-pays or deductibles.

Starting Aug. 1, 2012, new health insurance plans will be required to cover women’s preventive care without charging a co-pay or deductible. The new guidelines require health insurers to provide FDA-approved birth control, including emergency contraception such as the morning-after pill, HIV screenings, and well-women visits, among other services.

The guidelines also include an amendment that allows religious institutions that offer insurance to their employees the choice of whether or not to cover contraception services.

– Yvonne S. Thornton, MD, MPH