Season 1 - Episode 6

Helpful Links

This podcast was inspired by Free the pill foundation. 

Support this organization here: ⁠https://ibisreproductivehealth.networkforgood.com/projects/155281-free-the-pill

Transcript

Hello, welcome to mirroring medicine with Kodi and Isabel! Today we will be discussing birth control, the mechanisms of action and some important hormonal cues to pay attention to when choosing the option right for you. This podcast is meant to provide an overview of how birth control prevents pregnancy however this information does not constitute medical advice. If you would like to explore options for preventing pregnancy please talk with your doctor or reproductive health provider, such as an ob/gyn.

Kodi: What is Birth Control?

Birth control is defined as preventative health care interventions or practices that aim to prevent the fertilization of an oocyte by a sperm cell. These can be classified as permanent and non-permanent, and hormonal vs non-hormonal.

What are some ways that men can prevent gestation and fertilization?

Well, according to WebMD, there are some ways that men can prevent the fertilization of the egg in the fallopian tube to then prevent pregnancy by these factors. This includes condoms, spermicide, spermicide condoms, vasectomy, abstinence, and withdrawal (pulling out) [1]. Today, we will go over what they are and the pros and cons of these options. 

To start off: 

Condoms are made of a latex or polyurethane polymer to prevent the sperm going into the vagina. This is 98% effective for preventing conception. Conception is the joining of the egg and sperm. Condoms are placed over the penis to form a protective layer-like glove. Condoms protect you from sexually transmitted diseases, or STDs, like herpes, chlamydia, genital herpes, syphilis, etc. Condoms are available in most stores (including convenience stores) and they are relatively inexpensive. However, condoms can rip and slip off if not put on correctly or do not fully fit. Condoms can become damaged by light/heat. When undergoing light/heat damage or through expiring, they can tear during use which these condoms aren’t as effective anymore. This also includes if either of you have a latex allergy, this can run into problems like itching or swelling.

Spermicide/spermicide condoms is a chemical preventing pregnancy by killing sperm so that fertilization in the fallopian tube cannot be undergone. The only spermicide available in the US is a chemical known as nonoxynol-9 (aka N-9). It is found usually as a foam, jelly, tablet, cream, suppository, or dissolvable film. This is usually inserted into the vagina and wait 10-15 minutes prior to intercourse. Then leave it in approximately 6 hours after sex. However, this does not prevent transmission of STDs, unless using the spermicide condoms. It is approximately 70-80% effective. However spermicide condoms in typical use could prevent pregnancy around 87% of the time. A downside is that there could be irritation, wrong application, messiness, and side effects. 

Vasectomies are a surgical procedure in which a surgeon cuts/seals off the tubes that your sperm pass through to reach testicles. It is the most effective birth control option for men besides abstinence (which means abstaining or not having sex). It is a simple, cheaper, and better option than female sterilization. You can go home the same day of surgery. Does not change the way sex/ejaculation feels for either people engaging in intercourse. This also does not change the look, smell, or sense of intercourse. It is usually more than 99% effective at preventing pregnancy. And does not change your testosterone production or sexual drive. However there are some downsides to this option along with others mentioned before. This includes vasectomies which are meant to be permanent meaning that the procedure could be reversed however if you want children later in life, this probably would not be the best option for you. This also includes some bruising, swelling, and pain after the procedure. STI or STDs can still occur. It usually has 8-12 weeks before a vasectomy starts to provide contraceptive protection. Additionally, many insurance plans like medicaid, cover the cost of vasectomy. Without insurance, you probably would look upwards of $300-3000 for this procedure. 

Pulling out is the least effective. This includes pulling the penis out of the vagina before ejaculating. This has no side effects and costs nothing. However, this only works around 78% of the time if you perform it and does not prevent getting an STD. 

Additionally, there are some current male birth control pills going through current clinical trials. This includes 11-beta-methyl-19-nortestosterone dodecylcarbonate and dimethandrolone undecanoate. However, further testing needs to be done in order to be released to the public according to the healthline. [2]

The Charity of this Podcast: 

This podcast was inspired by Free the pill foundation. This organization’s is a “coalition is a group of more than 200 reproductive health, rights, and justice organizations, research and advocacy groups, youth activists, health care providers, prominent medical and health professional associations, and others who share a commitment to ensuring more equitable access to safe, effective, and affordable birth control to people of all ages, backgrounds, and identities in the United States.” If you would like to donate and support this foundation you would be supporting the work to increase contraceptive access through over-the-counter birth control pills.

https://ibisreproductivehealth.networkforgood.com/projects/155281-free-the-pill

Isabel: What are some ways that women can prevent gestation and fertilization?

I want to quickly recap the menstrual cycle as there are some key hormones that are used to prevent pregnancy. We mentioned in our human reproduction episode that the menstrual cycle is divided into two parts the follicular phase and luteal phase. The follicular phase has a rise in estrogen that is slowly increasing day by day. There is a peak of luteinizing hormone and a small peak of follicle stimulating hormone. The luteal phase is categorized by a slow rise and fall of progesterone and a smaller rise and fall of estrogen. This occurs over the period of roughly 14 days. 

Tubal Ligation/Tubal Block:

• Have you ever heard someone say that they have had their “tubes tied?”

• Tubal ligation or also known as tubal block is the surgical procedure of having fallopian tubes cut and tied surgically for the purpose of preventing eggs from travelling from the ovaries to the uterus. This also prevents sperm cells from travelling to the fallopian tube where fertilization occurs. This is a form of permanent birth control (Mayo Clinic, 2024).. The procedure does not affect your menstrual cycle, because there are no reported hormonal changes because of tubal ligation. (Mayo Clinic, 2024)

Intrauterine Device (IUD): 

• Intrauterine device is a small device that is placed into the uterus of a reproductive aged woman for the purpose of preventing pregnancy. This device can either act hormonally or non-hormonally. 

• Paragard - copper IUD. Only type of non hormonal IUD in the U.S. It was first introduced in 1967 and later FDA approved in 1976 (Higginbotham, 2018).  

• Intrauterine devices create an inflammatory environment in the uterus which is not ideal for implantation, being that it is a foreign object in the uterine cavity and therefore will lead to some immune response. 

• Beyond that sperm cells are killed via copper ions in the copper coil, which are cytotoxic to sperm cells and prevent motility (Women's Health, 2022). 

• Some side effects include increased cramping during menses and increased menstrual bleeding from the increased inflammation. This birth control can be used for 10-15 years after insertion.

• The pregnancy rate is >1%, but it is highest during the first year after insertion and decreases to less than >1% (Cleveland Clinic, 2024).

• There are also hormonal IUDs, which utilize progesterone to prevent pregnancy. Let's recall what I mentioned a few moments ago, in which the luteal phase is categorized by a rise and fall of progesterone. This endogenous progesterone is released and made by the corpus luteum, which is formed following ovulation from an ovary after releasing the egg cell (Britannica, 2024). 

• Progesterone does few things that act to prevent pregnancy.

• Thinning the endometrium which reduces likelihood or implantation

• Inhibit ovulation by inhibiting the release of gonadotropin releasing hormone (hypothalamus) and will decrease release of the FSH and LH from the pituitary gland (Cleveland clinic 2024). 

• This also increases the thickness of cervical mucus which inhibits the passage of sperm.

What are the progesterone based IUDs?

• Mirena: releases 20 micrograms of levonorgestrel, a synthetic form of progesterone, per day (Women's Health, 2022). Can last up to 7 years (Mirena, 2024). 

• Side Effect: No period or light period (Women's Health, 2022)

• Liletta which releases 19.5 micrograms per day. Can last up to 6 years (Liletta, 2024)

• Kyleena (releasing 17.5 micrograms a day). 5 years (Kyleena, 2024)

• Skyla (14 micrograms a day). 3 years (Skyla, 2024)

• Are there estrogen based IUDs? No.

Implant: An implant is a small, flexible rod that is inserted underneath the skin of the inner upper arm.

• This acts in a very similar manner as the progesterone based IUD as it releases a steady dose of progestin daily.

• Nexplanon is the brand name of this device.

• First 5–6 weeks after implantation (60–70 micrograms (mcg) of etonogestrel).

• After 1 year (35–45 mcg of etonogestrel per day).

• End of second year (30­–40 mcg of etonogestrel per day). End of third year (25–30 mcg of etonogestrel per day).

• 99% effective

• Source: Medical News Today, 2023

Shot:

• Depo-Provera is the brand name for the injection of progesterone like hormones that act to prevent pregnancy.

• 150 mg once every 3 months (13 weeks) in the gluteal or deltoid muscle. (Drugs.com, 2023)

Vaginal Ring:

• NuvaRing is a flexible ring that is inserted into th evagina for 21 days out of the month, and removed for 7 days. This form of birth control can last up to 1 year or 13 menstrual cycles.

• Contains progestin, etonogestrel and an estrogen, ethinyl estradiol 

•  0.120 mg/day of etonogestrel and 0.015 mg/day of ethinyl estradiol over a three-week period of use. (Dailymed, NIH, 2024)

Patch:

• Many names Xulane, Ortho Evra (DSC)

• Norelgestromin (150mcg) /ethinyl estradiol (35mcg) per 24 hour

• Use is One patch applied to skin each week x 3 weeks (days 1, 8, & 15), then off for 1 week (days 22-28); repeat cycle (Medscape, 2024).

Pill: 

• Monophasic pills: Monophasic oral contraceptive pills contain a constant amount of estrogen and progestin in each active pill.

• Suppresses ovulation by maintaining consistent levels of estrogen and progestin, which inhibit the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

• Think of it as a standstill in regards to the state that you are in in the menstrual cycle. Preventing ovulation that way

• Biphasic pills: Biphasic oral contraceptive pills deliver the same amount of estrogen each day while progestin dose is increased halfway through cycle.

• The biphasic dosing mimics more closely the natural menstrual cycle’s hormonal changes, potentially reducing side effects related to progestin.

• Prevents ovulations.

• Triphasic pills: Triphasic oral contraceptive pills have 3 different doses of progestin and estrogen that change approximately every 7 days.

• Mimic cycle even more closely

• Provides more gradual changes in hormone levels to maintain ovulation suppression.

• Four-phasic pills Four-phasic oral contraceptive pills provide 4 different doses of progestin/estrogen during a 28-day cycle.

• Most complex dosing and schedule. Mimics the cycle. However, it continues to prevent ovulation.

• Ninety-one-day pills Ninety-one-day oral contraceptive pills provide a constant dose of estrogen and progestin for 84 days, 7 days of placebo or low-dose estrogen pills.

• Suppresses ovulation and maintains cervical mucus thickening and endometrial changes over a prolonged cycle.

• Results in fewer menstrual periods (about four per year).

• Progesterone-only pills (POPs) Progesterone-only oral contraceptive pills provide a constant dose of progestin. Norethindrone and drospirenone require a prescription. Norgestrel (Opill) is available over-the-counter without a prescription. 

• Primarily works by thickening cervical mucus to prevent sperm penetration.

• Suppresses ovulation in some individuals but not consistently in all users.

• Alters the endometrial lining to reduce implantation likelihood.

This is for individuals who cannot take exogenous estrogen due to some clotting disorders.

Source: Medscape, 2023

Overview: As of Feb 2024, there were 260 birth control options noted on Drugs.com. I did not go through all of these forms of birth control, rather provided some overviews of the types available.

• Risks of progesterone based BC?

• Irregular menstrual bleeding/spotting

• Acne

• Breast tenderness

• Decreased libido

• Depression

• headaches/nausea

• Ovarian cysts (Mayoclinic, 2024)

• Weight gain (American Academy of Family Physicians, 2000)

• Risks of Estrogen Based BC?

• Weight gain

• Headaches

• Mood changes

• Irregular medium bleeding

• Breast  tenderness

• Nausea

• Dizziness

• Acne

• Decreased sex drive (Nurx, 2019)

Kodi: What are STDs?

Sexually transmitted diseases (STDs) or Sexually transmitted infections (STIs) are conditions in which transmission occurs sexually or through intercourse, either vaginally, anally, or orally. These STIs can be caused by bacteria, viruses, and parasites. 

According to MedlinePlus, there are approximately more than 20 types of STIs including: chlamydia, genital herpes, gonorrhea, HPV, HIV, pubic lice, syphilis, and trichomoniasis, among a myriad of other STIs/STDs. 

In some cases, STDs or STIs don’t always cause symptoms or cause mild symptoms. However, without symptoms there could be harmful damage that occurred. This includes some unusual discharge from penis or vagina, sores/warts on gential area, painful frequent urination, itching, redness, blisters or sores in and around the mouth, abnormal vaginal odor, anal itching, soreness, or bleeding, abdominal pain, and/or fever. This could be prevented through contraceptives like condoms. Testings could be done to prevent the spread. Some potential cures or preventions are through immunizations, vaccines, medications, etc. 

Conclusion:

Today we went over birth control, male birth control and contraceptive options, female birth control and their corresponding birth control options, as well as some information on STDs/STIs. This includes the topic of inspiration for our podcast which is free from the pill foundation. According to this website, “The Free the Pill coalition is a group of more than 200 reproductive health, rights, and justice organizations, research and advocacy groups, youth activists, health care providers, prominent medical and health professional associations, and others who share a commitment to ensuring more equitable access to safe, effective, and affordable birth control to people of all ages, backgrounds, and identities in the United States. Coalition members support over-the-counter (OTC) birth control pills that are affordable, fully covered by insurance, and available to people of all ages. To express their commitment, coalition members sign on to our statement of purpose. The coalition (formerly known as the Oral Contraceptives Over-the-Counter Working Group) has been working since 2004 to build the evidence in support of OTC birth control pills in the United States. Housed at Ibis Reproductive Health, a global research organization, the coalition’s activities are guided by a steering committee of individuals representing research, health, and advocacy communities.”

While this podcast is meant to educate the public on their options in the field of family planning, we do not provide medical advice and we recommend you visit your doctor and reproductive health provider to get care tailored to you and your partner. Thanks for watching and tune in next week!

Citations

1. "Male Contraceptives." WebMD. ⁠https://www.webmd.com/sex/birth-control/male-contraceptives⁠. Accessed 28 Nov. 2024.

2. "Male Birth Control Options." Healthline. ⁠https://www.healthline.com/health/birth-control/male-birth-control-options#male-birth-control-pill⁠. Accessed 28 Nov. 2024.

3. "Tubal Ligation." Mayo Clinic, ⁠https://www.mayoclinic.org/tests-procedures/tubal-ligation/about/pac-20388360⁠. Accessed 28 Nov. 2024.

4. "IUD." Women’s Health Magazine. ⁠https://www.womenshealthmag.com/health/a19944755/iud/⁠. Accessed 28 Nov. 2024.

5. Higginbotham, Victoria. "Copper Intrauterine Device (IUD)." Embryo Project Encyclopedia, 5 July 2018, ⁠https://hdl.handle.net/10776/13079⁠.

6. "ParaGard." Mayo Clinic, ⁠https://www.mayoclinic.org/tests-procedures/paragard/about/pac-20391270#:~:text=Less%20than%201%20percent%20of,who%20use%20ParaGard%20remains%20low⁠. Accessed 28 Nov. 2024.

7. "Corpus Luteum." Britannica, ⁠https://www.britannica.com/science/corpus-luteum⁠. Accessed 28 Nov. 2024.

8. "Contraceptive Implant." Cleveland Clinic, ⁠https://my.clevelandclinic.org/health/articles/24564-contraceptive-implant⁠. Accessed 28 Nov. 2024.

9. "Nexplanon Dosage." Medical News Today, ⁠https://www.medicalnewstoday.com/articles/drugs-nexplanon-dosage⁠. Accessed 28 Nov. 2024.

10. "Depo-Provera." Drugs.com, ⁠https://www.drugs.com/depo-provera.html⁠. Accessed 28 Nov. 2024.

11. "Depo-Provera FDA Label Information." DailyMed, ⁠https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=7e6f14df-1ce5-43fa-ad21-90bc4d74bc6c⁠. Accessed 28 Nov. 2024.

12. "Xulane (Norelgestromin and Ethinyl Estradiol)." Medscape Reference, ⁠https://reference.medscape.com/drug/xulane-norelgestromin-ethinyl-estradiol-342765⁠. Accessed 28 Nov. 2024.

13. "Contraception." Drugs.com, ⁠https://www.drugs.com/condition/contraception.html⁠. Accessed 28 Nov. 2024.

14. "Contraception Overview." Medscape, ⁠https://emedicine.medscape.com/article/2172310-overview⁠. Accessed 28 Nov. 2024.

15. "Minipill." Mayo Clinic, ⁠https://www.mayoclinic.org/tests-procedures/minipill/about/pac-20388306⁠. Accessed 28 Nov. 2024.

16. "Estrogen and Birth Control Pills." Nurx, ⁠https://www.nurx.com/blog/estrogen-and-birth-control-pills/⁠. Accessed 28 Nov. 2024.

17. "Contraception in Women Over 40." American Family Physician, American Academy of Family Physicians, 15 Oct. 2000, ⁠https://www.aafp.org/pubs/afp/issues/2000/1015/p1849.html⁠. Accessed 28 Nov. 2024.