These answers are for general informational purposes only and are not a substitute for professional medical advice. Always seek the advice of your doctor/primary care provider before starting or changing treatment.

Birth Control

A: Birth Control pills are really good for those that want/need them. They are FAR more effective than abstinence or condoms for preventing unplanned pregnancies. They can be used to treat acne, anemia, bad cramps, PCOS. They can be used to turn off your periods Did you know that you can skip your periods??? As Dr. Berg pointed out – they can decrease your risk of several cancers.

  • Blood Clots:
    • Blood clots are possible while on birth control, but the risk on birth control of a clot is LESS than the risk of clots when you are pregnant.
    • Information on Blood Clots:
      • Try to cut down on smoking
      • ACHES mnemonic
      • Abdominal Pain
      • Chest Pain
      • Severe headaches,
      • Swelling of 1 leg,
      • These could be blood clots from the birth control. or worsening headaches.
      • It’s unlikely, but I just need to warn you.
      • If you go on long airplane flights more than 5 hours, make sure you drink lots of water, and take a baby aspirin or ibuprofen before the flight and walk around during the flight.
  • Breast Cancer Risk:
    • Studies have shown the risk goes away after 10 years off the pill.
  • Depression:
    • There are different progestins in the different birth control pills you can try. Each woman is different and most do fine.
  • Munchies:
    • Some women get the munchies on the pill, most do not. The research shows that on average, women on the pill weigh one 1 pound less than to women not on the pill.

A: The patch works the same as the pill and ring. The only difference is it delivers the medicine through your skin rather than through your mouth or other part… and you only have to think about it once a week. For more info https://www.bedsider.org/methods/the_patch. We don’t recommend it as much because it has a high hormone level compared to pill or ring. but if it’s the only method you like, then it is better than nothing.

Additional Information:

  • Normal pills are 35 mcg of estrogen and the patch is considered like giving 50mg of estrogen
  • The patch, you have to change once a week. The pill you have to remember to take every day.
  • The patch is only 1 week but the longest you should be using the patch is 3 weeks in a row (3 different patches). More than that, then the estrogen level gets dangerous. You’ll need to take a break during the 4th week to avoid estrogen building up to dangerous clot levels.

A: The best birth control is vasectomy, but that is a permanent method. The next most effective pregnancy prevention method the IUD with hormone.

A: Generics are pretty much the same as name brand and thus you can can save money if they go with the generic. Often times, people think they are on “name brand” but they are really on generic! e.g. Chateal is a generic. Generic has the same active ingredients as the brand name equivalents. The difference is that the “name brand” got the original patent. Check out our blog on the Top 5 Reasons to Chose Generic Over Brand Name BC or watch this video: https://www.youtube.com/watch?v=SOG-8GPryfA

A: Always use a condom, unless you both entered this relationship as virgins. Have some emergency contraception around in case the condom breaks. If you really want to prevent pregnancy, the woman should be on some form of hormonal long term birth control or the IUD. Get tested annually for chlamydia and optionally HIV.

A: The new hot thing for birth control is getting more people to consider the LARCs (Long Acting Reversible Contraceptives) but until then, there will be a business for the pill, patch and ring birth control methods.

A: We only recommend taking the POP if you have high blood pressure, which requires that you take it at the same time every day, if you are late by 3 hours, then you need emergency contraception and to abstain from sex for the next 5 days.

A: Mainly it’s because they missed some pills or they took a medicine that ate up the hormones faster than usual like over the counter cold medicines can do that, St. John’s wort, magnesium. Studies have shown that if you have fewer placebo days, you decrease the chance of pregnancy. So if you are OK skipping the placebo, that should decrease the chance of pregnancy.

A: You can go to a local pharmacy/grocery store. You can go to a fire station – they are supposed to be able to take it and say your doctor told you to ask them if they would help. You can also call the last doctor’s office you went to and ask what your blood pressure was at that visit.

A: If you missed 1 pill, take it as soon as you remember it. If you missed 2 days of pills in a row, take 2 today, and 2 tomorrow.

If you missed 3 days of pills, you’ll probably get your period, you’re are at risk of getting pregnant. Consider taking some emergency contraception (Pandia Health can help you get some – we can call in a prescription to your local pharmacy if you are our telemedicine patient) if you had sex during those 3 days. Use a backup birth control method (condoms) for the next month to be absolutely safe.

Re-start your pills after being off for a total of 5 days (so if you missed your pills for 3 days, stay off for another 2 days and then re-start  your pills).

Talk to your doctor/provider if you have ANY questions or our pharmacist/telehealth partner doctor if you are our telemedicine patient.

A: We recommend and encourage using condoms to protect yourself and your future children from sexually transmitted infections.

A: Yes it’s possible for several reasons: If you don’t take it every day, if you need a higher dose of hormones than you are on. and some people are just really fertile and get pregnant on the birth control pill even if they take it every day. If you think you might be pregnant, you should check a pregnancy test.  However, if you take your medicine everyday and there isn’t any unusual spotting, then it’s unlikely that you would get pregnant. The chance of pregnancy on the birth control pill, if you take it right, is like 3/1000 women. And 9/100 in “normal use” meaning with errors.

There are 2 hormones in birth control pills:

  1. Estrogen – higher doses will increase the risk for blood clots but will also help with breakthrough bleeding or lower doses will also.
  2. Progesterone – causes 2 types of side effects Androgenic (acne), and progestin – higher progestin activity = less chance of bleeding.

Norgestimate does not have a higher dose estrogen  and it’s known for breakthrough bleeding.

Zovia/Demulen has a 50mcg estrogen version and it has a higher progestin effect so will most likely stop the breakthrough bleeding

Medications such a Vyvanse and other ADHD meds rev up the liver and eat up the estrogen and other hormones in birth control so people on those meds sometimes need higher estrogen.

Prescriptions

A: If you take the generic of whatever medication you were on previously that is okay. Generic just means that they were not first to market, but the active ingredient inside is the same. Generics are all interchangeable and you can switch between the pills, as long as you are taking a pill every day, you will be covered.

A: POPs should be taken at the same time each day. Make sure to use condoms or abstain from sex for 2 days if POP is taken ≥3 hours late. Contact a doctor immediately if you experience abdominal pain. Take another pill immediately if you are vomiting within 2 hours of taking your pill because you need to make sure the pill gets into your system.

There is no reason to be on triphasic pill. Triphasic was made to “mimic” the normal cycling of a woman’s cycle. However, the monophasic makes your life smoother and allows you to skip your periods easier if you want to do that.

Yes. Norgestrel = racemic mixture (L and R version). R version does not do anything and may add side effects you don’t need or want. Levonorgestrel = pure L enantomer = fewer side effects. It is the better version.

If you are having the withdrawal bleed/placebo week, just switch to the new pill and try to maintain the same week off pills.

For example if you are on the 1st pill & the week before the sugar pills on your old medicine, start on the 2nd pill & the week before the sugar pills. Make sure to wait until you get to the withdrawal week, have the bleed, and start the NEW medications on the last day of the bleed

Essentially, finish your current pack and start the NEW pack after the placebo week on the current pack. If you are skipping the bleed/placebo pills, just switch to the new pill.

A: Acne should get better on any of the birth control pills but Sprintec and Yasmin are best for clearing up acne. However, we don’t recommend Yasmin unless you have really bad acne and you can drink at least 8 glasses of water a day. Otherwise, you might end up with headaches.

A: We prefer Yasmin to Yaz because Yaz only has 20 mcg of estrogen which is not optimal for women’s bone health. Also, we don’t prescribe Yasmin or Yaz unless the woman can commit to drinking at least 8 full glasses of water a day because it has a diuretic component and we don’t want the woman to be dehydrated and have headaches. Also, if there is any history of kidney disease, Yasmin is not a good option

We don’t recommend it. It increases your risk of cancer and blood clots. But if you are under 35 and you only smoke 1-2 cig a day. It’s ok. But better to cut down/quit!

A: Drosperinone is the progesterone in Loryna. Loryna has BOTH drosperinone (progesterone) and ethinyl estradiol (estrogen). Birth control pills usually contain BOTH an estrogen and a progesterone. And there are lots of different generic birth control with the same active ingredients at the same doses – for example Loryna = Yaz (lower dose estrogen though), Yasmin, Gianvi, Loryna, Ocella, Syeda, Vestura, Zarah.

What you should do:

  • Take a pill as soon as you remember – only take one, even if you’ve missed more than one pill
  • Take the next pill at the usual time – this may mean taking two pills on the same day (one when you remember and one at the usual time), this is not harmful
  • Carry on taking your remaining pills each day at the usual time
  • Use extra contraception such as condoms for the next two days (48 hours) after you remember to take your missed pill, or don’t have sex

If you have unprotected sex during the two days after you miss your pill, you may need emergency contraception – get advice from your GP or contraception clinic

A: If you’re not happy with the birth control pill that you are taking and the effects they have on you, talk to your health care provider. Don’t just give up and stop taking them. Your provider can give you a prescription for a different type of pill. There are many types, and they affect people differently. Some you’ll like, and some you won’t. You may have to try a few different types before you find the one that works best for you. There are also lots of other methods to prevent pregnancy, so you can talk to your doctor about other options.

The Patch

A: Depends where you are on your cycle when you start the patch, if you are on your period and start the patch, then AFTER 24 hrs you should be protected. If you are more than 5 days from the FIRST day of your period, then 1 week.

A: Yes, they do but I would recommend the ring. More information, here. But the patch works as well – the only negative on the patch is that it delivers higher estrogen than other pills and that puts you at risk of blood clots. BUT it is better than nothing. also, if you are NOT good at taking pills by mouth, you can take them intravaginally or you can also stick them in ice cream, yogurt, food, etc. they are really small.  You could also consider the implant but 30% of women will continue to ovulate on the implant, so that might not fix all of the dysmenorrhea. But most of the dysmenorrhea comes from amount of blood, and the implant, IUD, patch, shot, ring, pill ALL decrease the amount of blood you lose and thus, less cramping because less blood to get out.

IUDs

A: Hormonal birth control is actually great for women. You can choose to have NO periods and it helps decrease acne. IUDs with hormones also can cause lighter or no periods. IUDs with copper have more blood and more pain but some women like them because they consider them “natural” because there are no hormones.

So, your intuition to go with the IUD is correct. It is the most effective method. The IUD with hormone (Liletta or Mirena) are actually MORE effective than tubal ligation! and they are easily reversible. They last for 5 years.

Prep for IUD: 

  • Make sure you pre-medicate for pain with 800 mg ibuprofen 30–60 minutes before the procedure with food (to protect your stomach from the high dose).
  • Ask for a cervical block (blocks the pain)
  • Ask your provider if they would use something to “soften the cervix” this usually is a med taken the day before or consider having it put in on the last days of your period when your cervical os (the opening to your cervix) will already be open.
  • Some women have had a warm pack to their abdomen during the procedure and some music or video to distract themselves
  • Resources

A: It should be free under the Affordable Care Act – both the device and the MD visit to insert it. Insurance should cover IUD insertion without co-pay. If people are being charged, they should go to coverher.org

The Ring

If you are LESS than 48 hrs. late with inserting a new ring and you are sexually active:

  • Insert the ring as soon as possible ASAP
  • Keep the ring in until your regular scheduled ring removal day.
  • Emergency contraception (EC) is not usually needed but can be considered depending on day of your cycle.Talk to your health care provider HCP to find out if you should have a pregnancy test or if EC is needed.

If you are MORE than 48 hrs. late with inserting a new ring and you are sexually active:

  • Insert the new ring as soon as possible
  • Keep the ring in until the scheduled ring removal day.
  • Use back-up birth control (condoms) or avoid sexual intercourse until a ring has been worn for 7 straight days.
  • Talk to your health care provider (HCP)  about whether you should take Emergency Contraception (EC) . Let your HCP know the week of your menstrual cycle.

A: Yes. It is safe to use. It can be stored at 77 degrees fahrenheit for up to 4 months. It can be stored up to 86 degrees. AVOID >86 degrees and in direct sunlight.

 

Spotting or Continuous Cycling

A: When you get spotting, that means your body wants to come off the medication. Come off for 5 days, have a bleed during that time and on day 6 re-start ACTIVE pills whether or not you are still bleeding. Hopefully next time you can get out a longer period before the spotting happens. For many women, they get to 3 months, then 6 months, then “home free.” However, other women just always breakthrough at 3 months.

A: If this is the first time that you started birth control pills, then sometimes it takes 3 months for your body to get used to it. Once you start the birth control pills, then you should take a pill everyday. For the spotting, you can try ibuprofen 600 mg up to 3 times a day for up to 5 days WITH FOOD to see if that helps. It would have been better if you started on the LAST day of your bleeding but it’s ok to start when you started.

Birth Control & Vitamins/Medication

A: It’s safe to take it with birth control pills. However, the topamax may make the birth control NOT work. so best to consider the shot, the implant or the IUD with hormone. she can check out bedsider.org for options and for those options she has to go in and see a provider. For providers she can go to familypact.org (if you are in CA)

Multivitamins won’t affect birth control pills. Only if you are on a supplement with high dose magnesium, such as a specific antiacid not just a multivitamin.

A: Actually, high Vitamin C does the opposite. It might increase the effect of the estrogen and increase the risk of blood clots. So watch out for headaches, chest pain, leg pain. If you get any of those, go to the emergency room and tell them you are on the birth control pill.

A: Cold medicines rarely affect birth control. Unless you are on Pseudoephedrine, which revs up your system and chews up the birth control pills’ hormones faster. If you notice spotting when taking your cold meds, then the birth control might not be working. Use a back up method to be safe.

Emergency Contraception

A: There are several options:

  1. The Copper IUD. The most effective Emergency Contraceptive – it can be 99.999% effective even if you have it inserted after the event, within 5 days from the event. Works in women of all weights.
  2. Ulipristal Acetate, known by its brand Ella. Works better in women 176 pounds or greater, BMI of 26 or greater. If you are over 195 pounds, try the copper IUD.
  3. Levonorgestrel 1.5 mg also known as Plan B and has many generic equivalents. This is the typical “morning after pill” available without a prescription, but it may not be as effective as the other 2 options listed above, especially for women with a BMI of 26 or greater.
  4. Yuzpe Method – Take lots of Birth Control Pills. If you don’t have access to the top 3 options, but you have birth control pills on hand, then take roughly 4 birth control pills now and again in 12 hrs. The goal is to reach 100mcg of ethinyl estradiol and 1mg of norgestrel now and again in 12 hrs. Side effects might be: vomiting, irregular periods.

Pandia Health can help you with Options 2 & 3, but you will need to see a practitioner in person for Option 1.

A: It depends where a woman is in her cycle. If she has ovulated, then most likely it won’t work.

It also depends WHICH emergency contraceptive pill. If you take the over the counter one which is levonorgestrel 1.5 mg vs the by prescription only ulipristal acetate – the latter is MORE effective on days 3-5 after an accident and more effective in women who are 177 lbs or more.

Regardless of efficacy, if you have a contraceptive failure or are sexually-assaulted and want to avoid pregnancy and are within 5 days of the event, it doesn’t hurt to try to prevent pregnancy by using Emergency Contraception.

 

All Emergency Contraception(EC)  is not 100% effective.

Levonorgestrel EC has a variable efficacy from 75–95% effective depending where you are in your cycle and also if you weigh 75 -79 kg, Levonorgestrel EC has lower efficacy than if you weigh <75kg. If you weigh 80kg or more, we recommend you use ulipristal acetate or copper IUD and NOT the Levonorgestrel EC.

A: Yes. As part of our high-quality, evidence-based medicine care, we offer all of our patients the option of a prescription for Emergency Contraception in addition to their regular birth control, so you can have it in case of an emergency (like a fire extinguisher). We can also call in or fax the prescription if you need emergency contraception within 1 business day.

We write prescriptions for Ulipristal Acetate (Ella) because it is more effective than Levonorgestrel Emergency Contraception, especially on days 3-5 after a contraceptive accident/failure, and for women who weigh more than 176 pounds or have a BMI>26.

When you take Ulipristal Acetate, make sure you STOP your regular birth control pill for 5 days (use a backup method for those days or don’t have sex) and then restart your regular birth control pill on day 6.

A: There are no dangers (as in death, and the side effects have been covered by the other answers) to taking the morning-after pill too often.

EXCEPT that it might not work and you end up getting pregnant. “The Morning After Pill” is not as effective as “regular contraception” e.g. ring, patch, pill, IUD, implant, shot.

Its efficacy depends on where a woman is in her cycle.

So it is NOT recommended to take too often, simply because we hope you would use a more efficacious form of birth control if you really want to avoid pregnancy.

Side effects of the morning after pill include: nausea, vomiting, menstrual irregularities, dizziness, diarrhea, and/or breast tenderness.

If you have had an allergic reaction to levonorgestrel or “the morning after pill” before, do NOT take it.

A: The 72 hour over the counter emergency contraception pills (ECPs) can actually be used out to 120 hrs per the WHO (World Health Organization). However, they work better if you take them ASAP.

The over the counter ECPs are levonorgestrel which is a progestin. They basically tell the body that you are pregnant so why would you want to ovulate (pop out an egg). Thus, if the woman has already popped out an egg (ovulated), then it won’t work and it’s too late to prevent pregnancy. If a woman is going to ovulate in 5 days, then you have 5 days to throw this high dose progestin to prevent the body from releasing egg.

If you are already pregnant, the progestin will do NOTHING to the existing pregnancy. That is it will not cause the embryo to die nor mutate. It will not cause an abortion.

A: Some side effects include: headache (18%), stomach pain (12%), nausea (12%), menstrual pain (9%), tiredness (6%), and dizziness (5%).

ella® should not be used if you know or suspected you are pregnant, and ella® should not replace a regular method of birth control.

A: Ulipristal acetate may change when the next period comes. If your period is delayed beyond 1 week, you should be checked for pregnancy. Do not use ella if you are breastfeeding. Do not use ella more than once in a menstrual cycle.

Always have some emergency contraception around in case condoms break. It happens to everyone – even MDs, even people who educate other people on how to use condoms… Better safe than sorry.

Key information for AFTER you take ella® (ulipristal acetate)

  1. If you are planning to use hormonal birth control,  wait 5 days after you take ella before you re-start your hormonal birth control. Otherwise the hormonal birth control will BLOCK ella from working and you may get pregnant. If you choose to have sex during those 5 days, use a condom as your birth control.
  2. ella may change when the next period comes. If your period is delayed beyond 1 week, you should be checked for pregnancy.
  3. Do not use ella if you are breastfeeding.
  4. Do not use ella more than once in a menstrual cycle. If you need EC again during that cycle, use the copper IUD or levonorgestrel (aka Plan B or its generics)
  5. ella® does not protect against sexually transmitted infection(s) e.g. HIV.

A: “The morning after pill” is usually levonorgestrel. The way it works is that is “scares your body” with high hormones so it won’t release an egg.

Often with emergency contraception (EC) aka “the morning after pill” it will mess up your period, causing it to come earlier or later. Seems like this is the case here.

See your Doctor if you have any more questions.

A: For Plan B and its generics – it is a progesterone. Progesterone is the hormone of pregnancy. So it tells the body that you are pregnant and thus prevents the body from releasing an egg if it is about to release an egg. And some studies have shown that it blocks the sperm capacitation (getting into the egg). For Ella or ulipristal acetate, it mainly works by blocking the body from releasing an egg. because all of these are one time doses, there are no long term effects. We don’t recommend using these methods as your primary method of birth control because it is a “strong jolt” or “reset” to the normal flow but better this than pregnant. Also, you can use emergency contraception multiple times. We also don’t recommend using these methods b/c they don’t work if you have released your egg or there is lower efficacy. So better to prevent the egg from being released in the first place and that is done with the IUD with hormone, the implant, the shot, the ring, the patch, the pill.

A: ECP is for emergencies. It does NOT work as well as regular birth control – pill, patch, ring, shot, implant, IUD. That’s why it is “Plan B” and not Plan A. It is very jarring to the woman’s body and messes up her periods.

Birth Control Effectiveness

A: It depends which type of birth control pill, and how soon after the beginning of your period you began the medication. If you are on the “regular” combination pill, and you start the pills on your period (within 5 days of the start of your period), you are protected theoretically within 24 hrs. If you are on the “regular” combination pill, and you start the pills NOT on your period, you are protected after 7 days on the pill. If you are on the progesterone only pills, you are protected 48 hrs after starting that pill. However, if you are 3 hrs late taking the progesterone only pill, then you need to use emergency contraception!

Yes. Here are the typical use effectiveness rates vs. perfect use. All are with men ejaculating in the women:

  • Low dose estrogen pills:
    • Of the three COC trials, one had a BMD decrease for the group with gestodene plus EE 15 μg. Another indicated less bone resorption in the group with gestodene plus EE 30 μg versus EE 20 μg.
    • Reference

A: Theoretically, you are covered if you start within 5 days of the 1st day of your period. But to be safe, we recommend using a back up for 1 month. People engaging in sex should always consider using a condom to protect against sexually transmitted diseases. And for women, it’s cleaner to use a condom because no leaking of fluid for the next 24 hrs after sex.

A: Yes. the 1 week placebo was originally established with much higher dose pills specifically 100mcg of estrogen component and now we are at 35 mcg and 20mcg. So, we have seen escape ovulation at day 6 or 7 of placebo in some patients. Thus, to be safer, you could consider decreasing the placebo week to just 4 days or 5 days.

In fact, I suggest skipping the placebo week altogether. There is no need for that week. Read John Rock’s Error 

A: It doesn’t matter WHAT time you take the pill with relations to SEX. It just has to be taken at the SAME time every day. And if you are LATE by 3 hrs, then you need Emergency Contraception and/or abstain/condoms.

Birth Control Side Effects

A: Most people do fine. Some people have nausea but that is only if they take it first thing in the AM on an empty stomach. Some people have irregular periods – but that’s b/c they don’t take it at the same time everyday. Some women notice an enlargement of their breasts like a cup size. most side effects get better/go away by  3 months on the pill.

A: The best way to avoid nausea is to take it right before you go to bed. or with DINNER. try that. and if that doesn’t work, then you might need to go to lower dose estrogen pill.

A: No. In research where they put 50 women on the pill and 50 women not on the pill. The women on the pill LOST on average 1 pound. NOT a pound a week, NOT a pound a month, just 1 pound. I think this is b/c the women NOT on the pill have menses and they bloat up and bloat down and weigh 1 pound more b/c of bloat.

Some women experience the munchies with the pill and others do not. Each individual is different. If you think your pill is making you gain weight, then try a different formulation. There are like 7 different progesterones you can try and it might be the dose of estrogen, which can be lowered.

A: The dose is soooo small that she should be ok. Dr Yen is lactose intolerant and has no problems. A quick internet search shows no one has had problems. If she has problems she can try taking the pill intravaginally because lactose intolerance is not an allergy but a lack of enzyme to digest it. Without the enzyme then the lactose in the gut causes side effects bc bacteria then digest it causing gas diarrhea etc. If she has milk allergy, she should be fine with medical grade lactose bc the allergy is to a protein and not the lactose.

A: Absolutely not. I think the confusion arises in that 1 out of 10 women will have PCOS. PCOS causes irregular periods and those women will have difficulty getting pregnant later. The treatment for PCOS is birth control pills. So we put these women on birth control pills and when they come off, they don’t remember they had PCOS or they weren’t diagnosed with it BEFORE they were put on the birth control pills, so when then try to get pregnant, they blame the pill. When really it was the PCOS that caused the difficulty getting pregnant.

Also, ironically enough, women with PCOS are MOST fertile the moment they get off the pill because that is when their hormones are most normal. Their hormones get more abnormal (more PCOS-y) the more days they are off the pill.

A: The Birth control pills actually DECREASE your chance of endometrial and ovarian cancer. and are the only way to decrease you chance of ovarian cancer (that we know of) other than taking out your ovaries.

If you personally have breast cancer or liver cancer, the pills can make it worse.

There is an association of birth control pills and breast cancer – but that is not certain if that is causation. i.e. Women who delay having kids until they are older increase their chance of breast cancer. Women who are the pill delay having kids. We do know that delaying having kids causes breast cancer, so we think that is most likely what is going with birth control pills and breast cancer.

A: The natural state of a female animal is pregnant and birth control pills, patch, ring mimic pregnancy. But it’s also about risk/benefits. The benefits are – decreased ovarian cancer, endometrial cancer, decreased anemia, better quality of life with less blood or no blood, The risks – are blood clots but we screen for that but it’s a higher risk if you are 35 or older and smoke.

A: Researchers looked at 33 years of studies that included more than 8,400 women taking birth control pills. Of those women, 22% reported a rise in their libido, 15% said they felt less desire, and 63% reported no change at all.

So maybe birth control makes sex better. Less stress from worrying about getting pregnant may = more drive?

Well if it’s not the pill, then what is it?

Could be your health, age, feelings about your relationship, are you physically active, do you drink too much, and how much stress is in your life.

“Regular” birth control pills, and the patch, and ring have 2 types of hormones in them: estrogen and progesterone. The amount of each hormone and type of progesterone varies by the pill. Each woman responds differently to the hormones.

One way the pill, patch, ring works is by blocking ovulation and many women notice a slight increase in libido with ovulation.

If you notice a change, talk to your provider. S/he can check to see if medical conditions or another medication might be causing your mojo to go down. S/he can help you decide whether to change medications. S/he might recommend you see a therapist or other medical experts if something turns up on the tests.

Do a check in with yourself: how is the relationship going? What stressors are going on? Are you eating too little/too much? These are all things that can put you out of the mood.

A: Some pills may be better than others. Very-low-estrogen pills that contain drospirenone, desogestrol or norgestimate seem to have the greatest negative impact on libido and vaginal dryness, so if you’re taking one of these, talk to your doctor about whether it’s contributing to any symptoms you might have. Use a silicone lubricant, and ask your doctor for a prescription for hormonal creams to apply to the opening of the vagina. And know that you are not crazy.

Dr. Goldstein discovered that about 5% of women have a genetic variant that results in a defective or inefficient testosterone receptor. These women require much more testosterone to keep the vulvar and vaginal tissue healthy and for their glands to function normally. The effects are not obvious until testosterone levels become lower than normal, but that happens to every woman who takes the pill.

So, in women with this genetic variant, the problem is threefold:

  1. The pill causes the ovaries to produce less total testosterone and less is in a usable form.
  2. The synthetic progesterone found in newer birth control pills poisons the testosterone receptor at high doses.
  3. The testosterone receptor doesn’t work well, making it extra dependent on high amounts of testosterone being present.

A: It does NOT decrease cervical cancer. It DOES decrease endometrial and ovarian cancer though for the latter not as much as ring/patch/pill. Endometrial cancer by stopping the monthly ebb and flow of the endometrial lining. Less growth/shedding, less risk of cancer. Ovarian cancer b/c it does block ovulation but not as 100% as the ring/patch/pill. again, less frequent damage to the ovary (ovulation) less risk of CA.


b/c people don’t use them correctly (re-use! or old condom, or put it on the wrong side, flip it [but the wrong side already has pre-ejaculate which can have s14% rate of failure with condoms, why?perm] and possibly breakage.

A: Often when people start birth control, it synchronizes when the hair falls out and it seems like you are losing more than usual because it all comes out at once versus slowly over the month, However, your hair will be the same over the entire month. The main factor affecting hair loss is the progesterone and the progesterone

A: 1/10 women have or will develop PCOS, when they come OFF the pill, they will have difficulty getting pregnant (though ironically the first month off the pill is the most fertile for them) but it will NOT be due to the pill but their underlying PCOS.

Also, the pill, patch, vag ring, etc do NOT protect against STDs (sexually transmitted diseases) so if you get Chlamydia and don’t know it, then that would affect your future fertility and again it wouldn’t be the pill causing the issue. So always use a condom.

A: Yes. the treatment options for PCOS are: birth control pill/patch or ring or Metformin. Additionally, weight loss (if you are overweight) can help. You can read more here.

A: Warm pack. Warm bath/shower. But we suggest skipping your periods, that’s the best way to avoid that badness. Or at least going on the birth control pill, patch, ring, shot, implant, or IUD with hormone – all of which will make your periods lighter and hopefully less painful.

Skipping Periods

A: You can skip indefinitely. My ob/gyn professor said, “The Natural State of a woman is pregnant. How many periods does a pregnant woman have? None.” For more information, check out our #PeriodsOptional page

A: It depends what method of birth control you are talking about.

  • Depot medroxyprogesterone (the shot) can take 6–9 months to go back to normal.
  • The pill/patch/ring – in 3 days you go back to normal.
  • The IUD – you can go back to normal within 1 week of removal, possibly sooner.
  • The implant – same as the pill/patch/ring.

A: Periods are optional! The only reason that we build the lining of our uterus every month and pop out an egg (ovulation) is to make a baby. On average in the US, periods start at 12 years old and women have their first baby at 26 y/o. If we aren’t going to make a baby, then why bother with that? Every time we shed our lining and pop out an egg unnecessarily, that adds to the risk of endometrial and ovarian cancer. That’s 14 years of monthly periods for no good reason. So you can turn those off with the ring or pill or IUD with hormones.

It prevents endometrial and ovarian cancer and anemia. Women and physicians have done it since 1960s. And the natural state of a woman is pregnant or breastfeeding and she has no periods during that time. Refer her to the wings of inspired business podcast for more info.

A: Skip your sugar pills and go right into the next pack. you should be able to make it out to 3 months without a period the 1st time, and then 6 months, then 9months. some people are able to go straight into no periods.

A: We always recommend using condoms unless you were both virgins at the beginning and you’ve only had sex with virgins. However, if you were on the active pills  for 3 weeks in a row before the bleeding, you do not need to use back up.

A: No, the lining of your uterus is NOT building up, higher and higher when you don’t have a period on birth control.  It’s just at a steady level which is usually smaller than your “regular period.” When you have a period off your birth control pill, it’s because you were building the lining of your uterus to accept an embryo – so you need lots of blood and nutrients.

When you are on the birth control pill, you aren’t trying to accept an embryo, so you don’t need to and you don’t build as much of a lining. and thus there is less lining to shed, when you do shed it.

A: From my experience, the first time you try it, 3 months. Then each time it goes farther. Indefinitely e.g. years! It will NOT affect your future fertility.

A good read is John Rock’s Error by Malcolm Gladwell on how it’s not necessary to have a period while on the pill. The withdrawal bleed was just put there because one of the creators of the pill was a devout Catholic and wanted to use the pill with the rhythm method.

A: Actually the research shows that women on birth control pills lose weight, about 1 pound on average. Women NOT on the birth control pill bloat up and down. Those on the pill don’t bloat as much. Those skipping the sugar pills, bloat even less.

Lots of doctors have skipped the sugar pills for 10+ years with No problems at all. If you like bleeding each month, go ahead and take those sugar pills, but there is no need to bleed each month.

A: Birth control is a treatment for PCOS, it does not give way for PCOS to develop. When on birth control, periods are optional which is great because skipping periods actually decreases your chance of endometrial ovarian cancer.

Birth Control & Insurance

A: In the state of California, minors have the right to get treatment for the prevention of pregnancy without requiring their parents permission. However, they have to pay for the treatment or they have to sign up for special insurance to cover it or they have to contact the insurance and tell the insurance company that they want “privacy.”

To pay for the treatment, you just need a credit card. (We don’t accept Venmo or other payment yet)

To sign up for special insurance, go to http://www.familypact.org/Get%20Covered/what-does-family-pact-cover and go to the top R and fill in your zip code, and it will give you list of clinics you can go to to sign up for Family PACT insurance which covers birth control confidentially.

To tell your insurance company that you want your birth control treatment confidential, go to http://www.myhealthmyinfo.org and follow the 3 steps there. 2 weeks after you finish those steps, you should be able to use your parents insurance and the insurance has to keep the birth control info confidential.

We encourage minors to talk to their parents, but if they can’t then we want to help young people prevent unplanned pregnancies. It is also important to prevent sexually transmitted infections by using condoms.

A: Yes it should be covered under insurance. Under the Affordable Care Act, all FDA approved birth control must be covered by insurance. If you have any problems getting it covered, contact the National Women’s Law Center 1-866-745-5487 or email coverer@nwlc.org or go to coverher.org

Unfortunately, with pharmacist prescribed birth control, they still require that you have to go into the pharmacy. With Pandia Health, we connect you to our telehealth partner (Pandia Medical Group) , and you can have a doctor’s visit (for $29 for new to birth control, $19 for those already on birth control and their prescription ran out) and get your meds delivered to your door – all done from the comfort of your home or wherever you and your phone currently are.

A: In CA,  if the you want to keep birth control prescriptions and care confidential from your parents and you are on your parents insurance, you should fill out this form, send in by fax or email.  and wait 7 business days before you do anything that you want kept confidential. Your medical records should always be confidential regarding birth control, sex etc even without doing this form. But for insurance/billing/medications, you need to fill out this form.

To find the contact info for your health plan, you can select “find your health plan” on this page or we can help you.

In general, “the holder of the insurance” doesn’t find out about prescriptions filled on the insurance. Our telemedicine visit is out of pocket (you pay by PayPal or credit card), NOT billed to insurance – so “the holder of the insurance”  would never find out about that.

A: The Massachusetts Department of Public Health has providers that can provide confidential and free birth control. Here is a list of providers.

If you don’t have insurance, you might qualify for FamilyPACT – which provides birth control for free! You just need to go into a clinic and sign up. We take FamilyPACT insurance and then can bill that insurance and send you your medications. Check out FamilyPACT here. Enter your zip code in the top R and they will show you the clinics nearest you to sign up for Family PACT. I hope that’s helpful. Please feel to ask more questions if needed.

Telemedicine & Gynecologist Visits

Q: If I get my birth control prescription by telehealth, doesn’t my doctor need to take a pap smear to decide what birth control I need?

A: Yes, you can get an HPV vaccine as long as you are under 26 y/o. if you are 26 or older, then you have to pay and it is expensive. And it is likely that you are already infected with HPV by 26 years old and there is some cross-immunity, so they have deemed it not cost-effective after age 26.

A: Yes. you still need a pap smear every 3 years and if you are not monogamous, then STD testing every year. 

A: How long are your periods? on the birth control pill, they should only be like 3–5 days. If your periods are extra long, you should get a blood test for von willebrand’s disease (a bleeding disorder). If the reclipsen is not good for your acne, you can try a birth control pill with norgestimate. However, the one you are on is pretty good.

I agree that your doctor is not taking your concern seriously after 2 yrs! so perhaps time to find another doctor. also you should check your thyroid to make sure there is nothing going on there. and do you take your pill at the same time everyday? that is important.

A: How long are your periods? on the birth control pill, they should only be like 3–5 days. If your periods are extra long, you should get a blood test for von willebrand’s disease (a bleeding disorder). If the reclipsen is not good for your acne, you can try a birth control pill with norgestimate. However, the one you are on is pretty good.

It may be smart to check your thyroid to make sure there is nothing going on there. and do you take your pill at the same time everyday? that is important.

You can skip your periods altogether if you like. Just skip the sugar pills. usually you can get to 3 months with no periods and then you get some spotting. When you get spotting, come off the pills for 5 days (you’ll get your period) then go back on the 6th day regardless of being on or off your period. Each time you’ll go farther e.g. 1st time get to 3 months with no period, then 6 months, then 1 yr, then no more periods.

Telemedicine & Gynecologist Visits

A: Actually, the pap smear has nothing to do with birth control pills. The Pap smear is to check for cervical cancer. You don’t need a pap smear to decide which birth control to prescribe. In fact, most doctors have 1 pill they prescribe to most patients, if that has bad side effects, then that’s where they change it up.

A: Yes, you can get an HPV vaccine as long as you are under 26 y/o. if you are 26 or older, then you have to pay and it is expensive. And it is likely that you are already infected with HPV by 26 years old and there is some cross-immunity, so they have deemed it not cost-effective after age 26.

A: Yes. you still need a pap smear every 3 years and if you are not monogamous, then STD testing every year. 

A: How long are your periods? on the birth control pill, they should only be like 3–5 days. If your periods are extra long, you should get a blood test for von willebrand’s disease (a bleeding disorder). If the reclipsen is not good for your acne, you can try a birth control pill with norgestimate. However, the one you are on is pretty good.

I agree that your doctor is not taking your concern seriously after 2 yrs! so perhaps time to find another doctor. also you should check your thyroid to make sure there is nothing going on there. and do you take your pill at the same time everyday? that is important.

A: How long are your periods? on the birth control pill, they should only be like 3–5 days. If your periods are extra long, you should get a blood test for von willebrand’s disease (a bleeding disorder). If the reclipsen is not good for your acne, you can try a birth control pill with norgestimate. However, the one you are on is pretty good.

It may be smart to check your thyroid to make sure there is nothing going on there. and do you take your pill at the same time everyday? that is important.

You can skip your periods altogether if you like. Just skip the sugar pills. usually you can get to 3 months with no periods and then you get some spotting. When you get spotting, come off the pills for 5 days (you’ll get your period) then go back on the 6th day regardless of being on or off your period. Each time you’ll go farther e.g. 1st time get to 3 months with no period, then 6 months, then 1 yr, then no more periods.

Stopping/Starting Birth Control

A: It’s to be expected. Any time you miss 3 pills in a row (be it because you are on the placebo/sugar pills of the pack or if you did so by mistake) the hormones drop, and you should expect a withdrawal bleed. You can now get pregnant if you ovulate and obviously if you stop birth control. It’s no big deal unless it is really heavy or goes on longer than 7 days.

A: When you use the birth control pill, patch, ring or shot, implant or IUD with hormone, it keeps the lining of your uterus from growing to the full thickness that it would require to support a pregnancy. This is one of the main mechanisms by which birth control works to prevent pregnancy. If the lining is thin, then there is nothing for the embryo to stick to.

If you usually bleed, 7 days, you can expect it to go down to about 5 days. If you usually use 5 pads, then it might go down to 3 pads, etc.

It is expected and normal for the bleeding to get lighter on the birth control pill, patch, ring, implant, injection, IUD with hormone.

A: Great questions! Yes you can start your pills immediately and yes, you are protected on the placebo pills as long as you took 3 weeks of active pills before the placebo.

A: You can start any time, however, we recommend starting at the end of your period because you will most likely have less spotting. Also, theoretically, it’s effective immediately. vs. other times, you need to use backup for 7 days.

A: You may start the combination pill at any time. If you start within five days after the first day of your period, you are protected against pregnancy right away. For example, if your period starts on Monday afternoon, you can start the pill up to Friday afternoon to be protected from pregnancy right away. If you later than 5 days after the FIRST day of your period, you will be protected from pregnancy after seven days of taking the pill every day. Use a back-up method of birth control like a condom, female condom, diaphragm, or sponge — if you have vaginal intercourse during the first week of starting the pill. Also, the pill does NOT protect against STDs, so always use a condom WITH your birth control if you want to avoid getting STDs.

A: You can stop the pill at any time, just know that your “period” will come and that you will no longer be protected against pregnancy.