The truth about antibiotics and birth control!

Q: I heard that antibiotics interfere with birth control pills, but I’m on the birth control that gets implanted under my skin – will antibiotics interfere with that too?

A: I’m so glad you asked this question!  This is one of the biggest medical myths of all time; one that gets propagated in doctors’ offices, health clinics, hospitals, blogs, magazines – and OK fine, student health centers – every day.  So now, for the first time ever… in print… online… on this blog… the TRUTH!

The only antibiotic that has ever been shown to interfere with birth control levels and effectiveness is a medicine called rifampin which is used to treat tuberculosis.  Rifampin may also interfere with the birth control patch and vaginal ring so if you are taking it, be sure to use a back-up, non-hormonal (i.e. condom) form of birth control.

There are some other medications that can interfere with your birth control, however, and if you are taking any of them you should always use back-up contraception.

  • Griseofulvin
  • Phenytoin (Dilantin)
  • Carbamazepine (Tegretol)
  • Phenobarbital
  • Topirimate (Topamax)
  • St. John’s Wort (herbal supplement)

But in general, your birth control will not be affected by any run-of-the-mill antibiotic that you might be taking for things like sinus infections, strep throat, urinary tract infections, skin infections, acne, etc.  Some people believe that because antibiotics disrupt the normal bacteria in the gastrointestinal tract, they will interfere with the absorption of the birth control pills from your stomach.  But this is not an issue, and even if it were, it wouldn’t apply to birth control methods that don’t involve swallowing pills like the skin patch or the vaginal ring or Implanon.

Now, there are enough women out there who swear that they have little antibiotic babies running around the house that your health care provider will probably still tell you to use back-up just in case.  And birth control doesn’t do anything to protect you against sexually transmitted infections, so using a condom is a good idea no matter what medications you’re taking.  But you can rest assured that your birth control is just as effective when you’re taking antibiotics as when you’re not.

More questions about your medicines?  Make an appointment to discuss them with a healthcare provider, or stop by and visit the SHS Pharmacy.  Our friendly Pharmacy staff will be happy to answer your questions.

John A. Vaughn, MD (OSU Student Health)

Is prolonged bleeding normal after starting birth control?

knol.google.com

Q: Is it natural to have prolonged periods after just starting birth control? I started taking the pill when I started my period and it still persists.

A: Irregular bleeding is the most common side effect of birth control pills.  It is especially common during the first three months as your body adjusts to the hormones in the medication.  However, other things (like sexually transmitted infections) can cause prolonged bleeding too.  If the bleeding is especially heavy (more than a normal period), persists throughout the whole month or occurs only with intercourse – especially if you’ve stopped using condoms – you should see your women’s health care provider to make sure nothing more serious is going on.

The most common cause of irregular bleeding is missed pills, so make sure you are taking the pill every day, and at the same time every day.

Birth control pills can cause a lot of other side effects, especially bloating, nausea and breast tenderness.  Most side effects resolve after a few months, but the clinicians in our Women’s Services Department usually recommend that you check in with your health care provider after your first 3 months on the pill to make sure everything is going OK.  If you have any questions or concerns about birth control, they’re happy to answer them for you.

John A. Vaughn, MD
Student Health Services
The Ohio State University

How soon are you safe after starting birth control pills

Q: I was previously on birth control for almost 2 years and in the middle of April I stopped taking birth control pills. At the begining of June I started back on birth control again. Is it safe to have protected sex now with just the pill and without using another form of birth control, or do I have to wait an entire month after starting on birth control?

A: You will be protected from getting pregnant after 7 days of consistent use of birth control pills.  Consistent use means that you’re taking the pill every day at the same time (plus or minus 2 hours).  So basically, one week of birth control pills is enough to put the ovaries to sleep and keep you from getting pregnant.

However, having the phrases “protected sex” and “without using another form of birth control” in the same sentence makes us a little nervous.  We can not stress enough that birth control pills (or patches or shots or IUD’s) only protect you from getting pregnant.  They do NOT protect you from contracting sexually transmitted infections such as HIV, syphillis, gonorrhea, chlamydia, HPV, etc.  So please, please, please make sure that you are using other forms of barrier protection (condoms, dental dams) to protect yourself from contracting an STI.

Any Ohio State student (even thsoe without Student Health Insurance) can be seen at Student Health Women’s Services.  We now have 3 full-time health care providers (1 doctor and 2 nurse practitioners) who are available to consult with you for any concerns related to your reproductive health.  We encourage you to see us during your time at Ohio State wo we can help you maximize your health!

Li-Chun Liu, CNP – Ohio State Student Health Services

Have you been asked the Five P’s??? – April is STD Awareness Month

GYT - Make your appointment!

Use protection

Let’s say you are going to Student Health or your private caregiver.  In most cases, they are going to ask you a few questions about your sexual health and sexual practices. These questions are very personal, but they are as important as the questions about other areas of physical and mental health. Your answers are kept in strict confidence. 

So, are you ready to talk about your five P’s?  The five “P”s stand for Partners, Practices, Protection from STDs, Past history of STDs, and Prevention of pregnancy.

Partners

  • Are you currently sexually active? (Are you having sex?)
  • In the past 12 months, how many sex partners have you had?
  • Are your sex partners men, women, or both?

Practices

  • What kind of sexual contact do you have or have you had?
  • Genital (penis in the vagina), Anal (penis in the anus), Oral (mouth on penis, vagina, or anus)?

Protection from STDs

  • Do you and your partner(s) use any protection against STDs? If not, why?  If so, what kind”
  • How often do you use this protection? If “sometimes,” in what situations or with whom do you use protection?
  • Are there other forms of protection that you would like to discuss today?

Past history of STD’s

  • Have you ever been diagnosed with an STD?
  • Have you had any recurring symptoms or diagnoses?
  • Have you ever been tested for HIV, or other STDs? Would you like to be tested?
  • Has your current partner or any former partners ever been diagnosed or treated for an STD?

Prevention of pregnancy (Based on partners noted earlier, conception and contraception questions may be appropriate)

  • Are you currently trying to conceive or father a child?
  • Are you concerned about getting pregnant or getting your partner pregnant?
  • Are you using contraception or practicing any form of birth control?
  • Do you need any information on birth control?

Finally, before you move on to discuss other things with your caregiver, consider:

  • Are there other things about your sexual health and sexual practices that you should discuss to help ensure your good health?
  • Any other concerns or questions regarding sexual health in general?

Student Health Services can offer you expert advice, all the current diagnostic and treatment options, and vaccinations that can protect you long term.  Come see us, and GET YOURSELF TESTED

Roger Miller, MD (OSU Student Health)

IUD Insertion Now Available at the Student Health Center!

managingcontraception.com

What is an IUD?

It is an intrauterine device, also called an IUS (intrauterine system).  It is a t-shaped flexible plastic device inserted into the uterus with 2 strings attached to the bottom of the device that hang into the vagina.

Why don’t more women use the IUD?

The intrauterine device (IUD) is highly effective and widely used by women throughout the world, except in the United States.  Here IUDs are used by fewer than 3% of reproductive-aged women. 

In the 1960s and 1970s the IUD was very popular in the United States.  Due to the defective construction of one IUD – the Dalkon Shield – that was introduced in 1970, there was a high incidence of pelvic infection.  Unfortunately, the Dalkon Shield problem tainted all IUDs and ever since, consumers in the United States have inappropriately regarded all IUDs as a cause of pelvic infection.

Recently there has been renewed interest in IUDs as a reversible, long-acting, and effective contraception.  And with careful screening and technique, the IUD is very safe.

I’ve heard that there are different kinds of IUDs?

There are three IUDs approved by the FDA: the copper IUD (Paragard) and two progestin-releasing IUDs (Mirena and Skyla).  IUDs depend for contraception on the general reaction of the uterus to a foreign object.  In addition, the copper of the Paragard is spermicidal, and the progesterone in the Mirena and Skyla IUDs change the cervical mucus and lining of the uterus.

Why would I choose one IUD rather than another?

The Paragard contains no hormones and lasts for 10 years.  For the first several months after insertion, periods may be longer, heavier or more uncomfortable.

The Mirena works for 5 years and is approved by the FDA to ease menstrual bleeding.  Periods become lighter and less regular and less painful.

The Skyla IUD, approved by the FDA in January 2013, works for three years.  It has a narrower inserter and slighter smaller body.  It may be more appropriate for a woman with a smaller uterus or one who has not had a child.

My friend said that the insertion of the IUD is painful.

You may have mild to moderate pain when the IUD is put in, especially if you have never been pregnant.  Talk to your health care provider about ways to make insertion more comfortable.  You can take Ibuprofen 30 minutes before your appointment to help with cramping.

How do I know if I’m a good candidate for the IUD?

Your health care provider will review your medical history and ask you to have a pelvic exam.  The exam will include tests to rule out cervical cancer and sexually transmitted infection.  This testing is done to lessen the chance of infection at the time of the IUD insertion.   You will want to limit sexual partners and use condoms consistently to avoid pelvic infection with the IUD. 

Are there serious complications with the IUD?

It is possible, although rare, that the IUD could pass through the wall of the uterus during insertion.  The health care provider will know this immediately if it happens. 

The IUD can slip out of the uterus.  Sometimes it comes out all the way and sometimes it comes out only part-way.  You may find the length of the strings becomes shorter or longer, or you feel the plastic of the IUD at the cervix.

And it is possible to develop a pelvic infection.  This is most common during the first three weeks after insertion.

How expensive is the IUD?

The IUD only costs money at the beginning and then you have a 3 or 5 or 10-year method.  You will need to check with your insurance company to see how much of the device and insertion are covered.  The cost is usually between $500 – $1,000.  If you have the comprehensive Student Health Insurance or the Wilce Care Supplemental Insurance, the IUD cost will come out of your $2,000 yearly allowance.

If you have any questions about birth control, come in and talk to the Women’s Services staff at the Student Health Center.  We will help you find the best one for your lifestyle.

Beth Askue, MS, CNP
Student Health Services
The Ohio State University

Don’t Drop the Ball this New Year!

Happy New Year’s from Ohio State Student Health Services!

We know many of you probably have big plans for tonight, and those plans probably include alcohol.  While it’s fun to ring in the New Year with a toast or 2, things can get a little dangerous when you overdo it with the booze, especially when you don’t normally drink a lot.

A lot of emphasis is put on the dangers of drinking and driving on New Year’s Eve – which is obviously extremely important – but getting drunk can lead to other kinds of accidents too.  Like having unplanned sex with inadaquate protection, or leaving drunk voice-mails on your ex-boyfriend’s phone, or posting photos on your Facebook page that you really DON”T want your boss/professor to see tomorrow. 

But don’t take it from me, take it from the ultimate authority – Grandma!  On New Year’s Eve, don’t drunk-text your grandma, have a designated driver you can trust, log off of Facebook and back up your birth control!

Student Health Services wishes you a safe and happy 2013!!

John A. Vaughn, MD
Student Health Services
The Ohio State University

Have you been asked the Five P’s??? – April is STD Awareness Month

Wilce Student Health Center

GYT - Make your appointment!

Use protection

Lets say you are going to Student Health or your private caregiver.  In most cases, they are going to ask you a few questions about your sexual health and sexual practices. These questions are very personal, but they are as important as the questions about other areas of physical and mental health. Your answers are kept in strict confidence. 

So, are you ready to talk about your five P’s?  The five “P”s stand for Partners, Practices, Protection from STDs, Past history of STDs, and Prevention of pregnancy.

Partners

  • Are you currently sexually active? (Are you having sex?)
  • In the past 12 months, how many sex partners have you had?
  • Are your sex partners men, women, or both?

Practices

  • What kind of sexual contact do you have or have you had?
  • Genital (penis in the vagina), Anal (penis in the anus), Oral (mouth on penis, vagina, or anus)?

Protection from STDs

  • Do you and your partner(s) use any protection against STDs? If not, why?  If so, what kind”
  • How often do you use this protection? If “sometimes,” in what situations or with whom do you use protection?
  • Are there other forms of protection that you would like to discuss today?

Past history of STD’s

  • Have you ever been diagnosed with an STD?
  • Have you had any recurring symptoms or diagnoses?
  • Have you ever been tested for HIV, or other STDs? Would you like to be tested?
  • Has your current partner or any former partners ever been diagnosed or treated for an STD?

Prevention of pregnancy (Based on partners noted earlier, conception and contraception questions may be appropriate)

  • Are you currently trying to conceive or father a child?
  • Are you concerned about getting pregnant or getting your partner pregnant?
  • Are you using contraception or practicing any form of birth control?
  • Do you need any information on birth control?

Finally, before you move on to discuss other things with your caregiver, consider:

  • Are there other things about your sexual health and sexual practices that you should discuss to help ensure your good health?
  • Any other concerns or questions regarding sexual health in general?

Student Health Services can offer you expert advice, all the current diagnostic and treatment options, and vaccinations that can protect you long term.  Come see us, and GET YOURSELF TESTED

Can switching birth control cause you to have lighter periods?

birth control pills

Can switching birth control cause you to have lighter periods?

Yes.  In general, hormonal birth control methods that contain both estrogen and a progestin (birth control pills, the patch, NuvaRing) decrease the number of days of bleeding and the amount of blood women lose each cycle.  Since these methods all have varying levels of estrogen and progesterone in them, a change from one kind of birth control to another can also change the days and amount of flow.  

During a normal menstrual cycle, hormones cause the uterus to build up a thick lining with a lot of blood vessels called the endometrium to create a welcoming environment for a fertilized egg to attach.  If conception doesn’t happen, the hormone levels drop, the blood vessels shrink and the endometrium sloughs off.  Voila – you have a period!  Hormonal birth control causes the endometrial lining to be thinner than normal, so there is less to shed each month.  In fact, there may be no fresh blood at all.  A period could be just a drop of blood, or a brown smudge.

On the other hand, if you are using a birth control method that contains only a progestin and no estrogen (Depo Provera, Nexplanon implant, Mirena IUD, or “mini-pill”) you are more likely to experience irregular bleeding.  Many women experience either an increased number of days of light bleeding or no bleeding at all.

It’s a good idea to check in with your health care provider after your first 3 months on the pill to make sure everything is going OK.  If your pattern of bleeding concerns you be sure to see her to rule out the possibility of pregnancy, infection or other medical conditions.  Remember, not all bleeding can be blamed on birth control! 

If you have any questions or concerns about birth control, the clinical staff of our Women’s Services Department is always happy to see you!

Beth Askue, MS, CNP
Student Health Services
The Ohio State University

Depo Provera: A primer

about.com

The Student Health Center

Q: Does Depo-Provera lead to permanent infertility? 

Short A: Nope.

Long A:  Depo Provera (“Depo,” “the Shot”) is one of a family of progesterone-only contraceptive products. It is an injectable product-a shot. It is a really effective and convenient way to prevent pregnancy; you only have to think about it 4 times a year and in clinical studies, less than 1% of women get pregnant on it.  (In real life, about 5% get pregnant – probably because in real-life some women didn’t get their shot on time.)

There are a couple of downsides to Depo Provera. It is, as noted, a shot. Ouch. It can be expensive if your insurance doesn’t cover contraception. (On the other hand, a baby is a whole lot more expensive!) Like most hormonal contraceptive products, some women will feel a little bit pregnant-bloated, queasy, weight changes, headachy-on Depo, especially at first. Some women gain up to 5-10 pounds on Depo, although most gain only 3-5 pounds. (While 3-5 pounds ain’t nothin’ it’s still a whole lot less than a baby!)  It can interfere with bone mineralization, making osteoporosis and fractures slightly more likely down the road.

There are some big upsides, though, too. Periods often stop, although for the first few weeks/months of use there can be some irregular spotting. (Are all you men out there going, yuck, gross, icky?)  The incidence of pelvic inflammatory disease, endometrial hyperplasia, endometrial cancer, and endometriosis pain are all decreased.  And there are also specific medical conditions which benefit from Depo-Provera:

  • Because the metabolism of Depo Provera doesn’t change with anti-seizure medicine, it’s a good choice for women with seizure disorders.
  • Women with sickle cell disease appear to have fewer pain crises while on depo. 
  • Peri-menopausal vasomotor symptoms (the dreaded “hot flashes“) tend to be better compared to birth control that has estrogen in it.    

Depo Provera does not appear to increase the risk of liver, breast, or ovarian cancers. It probably does not affect blood pressure or coagulation, making it sometimes an okay choice for women who have had high blood pressure, heart disease, or a history of blood clots. It unfortunately does not protect women from sexually transmitted infections so you still need to get a condom on your partner.

So to finally answer your question, Depo Provera does not permanently impair your ability to get pregnant. It can, though, take a few months off the medication (sometimes up to 18) to become pregnant.

And by the way, if you are pregnant and accidentally get the shot, there is no evidence to suggest that any harm will come to the baby as a result of the medicine.

Student Health Services offers this and other methods of contraception.  Visit our Services tab to see all the health care services we provide. 

Victoria Rentel, MD

When it comes to “perfect” sex, timing is everything!

menstrual-cycle.info

My doctor put me on an antibiotic for a sore throat, and the pharmacist warned me that it is going to interfere with my birth control pills.  Two of my sorority sisters said they use “pulling out” whenever they need extra protection.  Does this really work?  And should I worry about the antibiotic making my pills less effective?

These are two great questions!  Let’s knock out the easy one first – do antibiotics interfere with birth control pills?

We covered this question in detail a few months ago, but the short answer is that as long as you’re taking your pills at the same time every day (give or take 2 hours) then back-up contraception shouldn’t be necessary.  If you’re having problems taking your pills consistently because of your illness – your sore throat is so severe that you can’t swallow them, or you’re vomiting and having diarrhea to the point that your body can’t absorb them, then you should use some back-up protection just in case. 

Now, on to the question of whether withdrawing the penis from the vagina before ejaculation (“pulling out,” “the withdrawal method,” “coitus interruptus”) will prevent pregnancy. 

Whenever we talk about the effectiveness of any form of birth control, we look at two very important statistics: annual pregnancy rates during typical use and during perfect use.

Perfect use is where everything works according to plan and instructions: you never miss a pill; you use a condom every time and nothing slips off or breaks; your boyfriend pulls out in time, every time. 

But as we all know, life ain’t perfect.  So we also look at the typical use rates of pregnancy – how effective the method is in the real world, where condoms slip and pills get skipped and guys forget to retreat.

For women counting on the withdrawal method alone, 4% will become pregnant each year with perfect use while 27% will become pregnant each year with typical use.  To give you a comparison, 2% of women using condoms alone will become pregnant with perfect use while 15% will become pregnant with typical use. 

As you can see, the withdrawal method isn’t very good.  It puts tremendous pressure on the male partner.  He has to be able to reliably tell when he’s going to ejaculate and have the control to pull out.  This is difficult under the best conditions; throw in extenuating circumstances like alcohol or drug consumption and it gets even harder (no pun intended).  

The big question you have to ask yourself is, “What would a pregnancy mean to my life”?  If it is not an option, then make sure to take your pills consistently, keep a box of condoms close by and forget about withdrawal.  Or better yet – tell your boyfriend to get you some hot soup and himself a cold shower.  You need to take it easy until you feel better!

Beth Askue, MS, CNP
Student Health Services
The Ohio State University