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

I just came across a very good article in Women’s Health called “10 Wayst to Save on Your Birth Control.”  (Yes, I was reading Women’s Health.  It was research, OK.  My wife left it next to my Sports Illustrated and I picked it up by accident…)

Anyway, the article is especially timely because we’re coming up on the end of the year and that means prescription benefits are starting to run out.  We often see students this time of year faced with the frustrating situation of needing just a few weeks of pills but being told that they need to pay out of pocket for a full month’s worth.  Some of the tips in this article might help.

No need for me to rewrite the article, but I would add a couple of things. 

They recommend bargain hunting on online pharmacies.  I would just warn you that buying medicine online is a very risky proposition – sometimes you are not getting what you pay for and in the case of birth control, the results can be disastrous.  If you go online, make sure the site is linked to a real pharmacy that you can actually call or go into, and never buy medicine that they are willing to sell you without a prescription.  Better yet, just come in to our pharmacy to make sure you are getting the real deal from someone who can answer all of your questions.

They make a good point about condoms being a cheaper birth control option depending on how frequently you have sex, but many women take birth control pills for reasons besides preventing pregnancy.  If that’s you, be sure to talk to your women’s health care provider before stopping them.

Another option not mentioned in the article, and one that the we do right here at the Student Health Center, is Implanon.  The wonderful clinical staff in our Women’s Services Department can help you decide which birth control option is right for you, including letting you know which one is the easiest on your purse!  

Now, back to my research.  Oooohhh… 6 weeks to my leanest, hottest body ever! 

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

Q:   Is it safe for me to use an IUD if I haven’t had any babies yet?

A: Even though they’re not as popular as other forms of birth control, IUD’s (intra-uterine devices) are a very safe and effective option for birth control, especially in women who find it hard to remember to take a pill every day or come in for a shot every 3 months. 

In the past, IUD’s were restricted to women who already had children and were in a monogamous relationship because of concerns that women with multiple partners were at a higher risk of getting a pelvic infection that could lead to future infertility.  But as long as a woman doesn’t have an infection at the time of the IUD insertion, her risk of pelvic infection is no higher than if she used other forms of birth control.  Remember – we’re talking about infection due to the IUD here.  IUD’s do NOT provide any protection from sexually transmitted infections, so always keep the condoms handy. 

The American College of Obstetrics and Gynecology (ACOG) recently recommended IUD’s for all women who seek a safe, effective, long-term contraception option – this includes adolescents, women who haven’t had any children yet, even women with a history of tubal pregnancy or pelvic infection.  You don’t need to take antibiotics at the time of insertion and the copper-containing IUD (there are two types) can even be used up to 5 days after unprotected intercourse to prevent unwanted pregnancy.  Again, as long as there is no pelvic infection at the time of insertion, an IUD really is a safe and easy option. 

ACOG also recommends another good option for long-term birth control – Implanon.  Implanon is a small rod that is inserted just beneath the skin of the inner aspect of the upper arm under local anesthetic.  We do it right here at the Student Health Center.  It works by inhibiting ovulation and thickening the cervical mucus and it lasts for 3 years.  It is about the size of a pencil lead and releases a progestin hormone called etonogestrel.  Implanon is safe, convenient and 99% effective.  It needs to be removed after 3 years, but a new rod can be implanted at the time of removal.

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

Ryo Choi-Pearson, MD
Student Health Services
The Ohio State University

Q: Can starting and stopping birth control (pills, patch, etc.) affect fertility?  In what ways?

A: In continuing our birth control theme this week, I have once again gone straight to the experts in our Women’s Services department for the straight scoop. 

The short answer is NO.  As we discussed in our previous post, the hormone levels in birth control medications are just high enough to prevent pregnancy, but low enough that they rarely cause any significant problems for most women who take them.  And once you stop taking them, the hormones leave your system and you return back to your normal state.  There has never been any evidence that stopping and starting birth control has any long term effects on fertility.

However, there is POSSIBLY a rebound phenomenon that takes place right after you stop birth control medication that might actually increase your fertility for a short time.  Basically, the theory goes that once you stop a medication that has been inhibiting your fertility hormones, they’re so excited to get back in action that they overcompensate past their normal levels for a while.  Again, this is kind of theoretical but it certainly can’t hurt to be extra careful with other forms of protection for a couple of weeks after stopping birth control.

As always, if you have any questions about birth control, please make an appointment to see the staff of Student Health Women’s Services.  They are always happy to help you find the option that is right for you.

John Vaughn, MD (OSU SHS)

Q: How long can a woman safely stay on birth control?

A:  To get to the bottom of this question, I went right to the experts at Student Health Women’s Services, and I’m happy to report that the news is good. 

While birth control pills can obviously have side effects while you’re taking them, there are really no lingering adverse effects after you stop, no matter how long you’ve been on them.  So whether you take them for 5 months or 15 years, you’ll be in the same (hopefully good) shape once you stop. 

There used to be a concern that women who were on oral contraceptives for a long time were at a higher risk of amenorrhea – i.e. that their periods wouldn’t start back up normally – but that turned out not to be the case.  The levels of the hormones in newer pills are low enough that they don’t cause any trouble for the vast majority of women who take them.

And don’t forget the positives of being on birth control, which greatly outweigh the risks for the vast majority of women who take them.  In addition to the obvious – keeping you from getting pregnant – birth control pills also have the following positive effects:

• Prevent anemia (low iron levels)
• Improve pre-menstrual syndrome (PMS) symptoms and menstrual cramps
• Lessen the frequency and severity of endometriosis flare-ups
• Lower the risk of Pelvic Inflammatory Disease (PID) and ectopic pregnancies

As always, if you have any questions about birth control, please make an appointment to see the staff of Student Health Women’s Services.  They are always happy to answer your questions and will help you find the birth control option that is right for you.

John A. Vaughn, MD (OSU SHS)

Q: Does the birth control patch have cardiovascular side effects like abnormal or fast heart rates?

A: Not really – or at least no more than oral contraceptive pills.  The patch does deliver more estrogen than oral contraceptive pills, so you tend to get more side effects like breast tenderness and nausea with the patch.  These tend to go away after a few months.

Reasons not to use the patch are the same as those for other forms of birth control that contain the hormones estrogen and progestin: history of blood clots, a tumor that responds to estrogen (like some forms of breast cancer) and liver disease (like hepatitis or cirrhosis).  And obviously, women who have a history of sensitive skin or skin diseases like eczema or psoriasis would probably want to avoid using the patch as well.

Research has shown that the most common side effects of the patch (other than unscheduled bleeding) are:

• Breast symptoms (22%)
• Headache (21%
• Application site reactions (17%)
• Nausea (17%)
• Upper respiratory tract infection (10%)
• Painful periods (10%)

Fewer than 2% of the women in these studies felt that these side effects were bad enough to stop using the patch[1].

The Women’s Services clinical staff at Student Health Services can help you manage all forms of birth control, including the patch.  You can make an appointment to discuss your birth control questions with them any time!

John A. Vaughn, MD (OSU SHS)

[1] UpToDate Online 17.3