Latest / Wellness, Actually with Emily Oster & Perry Wilson, MD / Birth Control After Kids: IUDs and vasectomies and tubal ligation, oh my!

Transcript

Birth Control After Kids: IUDs and vasectomies and tubal ligation, oh my! · Wellness, Actually with Emily Oster & Perry Wilson, MD

0:00
Speaker 1: This is parent Data. I'm Emily Oster. So I write
0:05
Speaker 1: a lot about pregnancy and people with little kids, and
0:08
Speaker 1: so sometimes when I meet people, they sort of forget
0:11
Speaker 1: that my kids are old. My daughter's twelve, my son
0:15
Speaker 1: is eight, and I am in as I like to say,
0:18
Speaker 1: the upper part of the first half of my forties,
0:22
Speaker 1: which is like your early forties, but later than that.
0:26
Speaker 1: And one day, about maybe six months ago, I woke
0:31
Speaker 1: up and I'm just going to say it, my nipples
0:35
Speaker 1: really hurt and I totally freaked out, and I'm going
0:39
Speaker 1: to tell you why, which is the last time they
0:41
Speaker 1: felt like that was when I was pregnant with my son,
0:45
Speaker 1: and so I snuck out to the CBS and I
0:49
Speaker 1: bought a pregnancy test and it was negative. And I
0:53
Speaker 1: know for many people it would be exciting to have
0:56
Speaker 1: another baby. I'm not interested in having any more kids.
0:58
Speaker 1: I love my kids too, us go. And I was
1:01
Speaker 1: so relieved that the pregnancy deask was negative. I was
1:03
Speaker 1: so relieved that I check a second one, also negative,
1:06
Speaker 1: just to be very sure. But the thing is that
1:09
Speaker 1: my nipples were still hurting, and then my boobs started hurting,
1:12
Speaker 1: both of them very painful, and I was like what
1:16
Speaker 1: is going on here? And around the same time, over
1:19
Speaker 1: at parent Data, we were interested in expanding out from
1:23
Speaker 1: pregnancy and early childhood into other parts of women's health,
1:28
Speaker 1: into other parts of the fertility and reproductive journey. And
1:32
Speaker 1: a few days after this boob situation, I found myself
1:36
Speaker 1: on the phone with Gillian Goddard talking to her about
1:40
Speaker 1: writing a newsletter for parent Data on peri menopause and
1:44
Speaker 1: on menopause, and I knew what I had to ask her,
1:48
Speaker 1: which was personally, why do my boobs hurt? I used
1:51
Speaker 1: the interview as, let's say, a personal doctor counseling session.
1:56
Speaker 1: And the reason that I knew Jillian would be perfect
1:59
Speaker 1: for writing, perfect to talk to about this is that
2:02
Speaker 1: she was great. She didn't flinch at the fact that
2:06
Speaker 1: in a professional interview I was trying to get answers
2:09
Speaker 1: to my personal health problems, and she was able to
2:12
Speaker 1: give me the answer, which was, in short that as
2:16
Speaker 1: I'm aging, my body really needs to ramp things up
2:20
Speaker 1: a lot to try to squeeze out those last low
2:22
Speaker 1: quality eggs. And her answer was more technical than that,
2:26
Speaker 1: but what I took away was that everything is more
2:29
Speaker 1: or less fine, more or less in the sense that
2:32
Speaker 1: there was nothing wrong, but also was an indication that
2:36
Speaker 1: the next few years aren't going to be the relaxed
2:41
Speaker 1: premenopausal lull that I thought, But in fact, a variety
2:45
Speaker 1: of hormonal changes are still going on, and there's a
2:48
Speaker 1: lot of stuff that maybe I don't know about. So
2:53
Speaker 1: Jillian is now writing a newsletter for parent Data which
2:55
Speaker 1: is all about the post reproductive years, about perimenopause and menopause,
3:00
Speaker 1: and today I've got it on the podcast to talk
3:02
Speaker 1: about one very specific question, which is long term birth control.
3:07
Speaker 1: You're done having your last kid, what is a good
3:10
Speaker 1: form of birth control for the long term? And this
3:14
Speaker 1: conversation I think will be helpful to anyone who's grappling
3:16
Speaker 1: with these questions. We talk about kystectomies, but we also
3:20
Speaker 1: talk about birth control pills, We talk about iud's, we
3:23
Speaker 1: talk about tube time. We talk about a whole range
3:25
Speaker 1: of possible solutions here and why you might value one
3:30
Speaker 1: or the other. After the break, Doctor Gillian Goddard, Jillian,
3:47
Speaker 1: thank you for joining me.
3:48
Speaker 2: I'm so excited to be here, me too.
3:51
Speaker 1: Okay, so you can you start by introducing yourself a
3:53
Speaker 1: bit sure.
3:54
Speaker 3: My name is uh, doctor Gillian Goddard, and I'm an
3:58
Speaker 3: adult endo chronologist in New York City and an adjunct
4:03
Speaker 3: Assistant Professor of Medicine at NYU.
4:07
Speaker 1: Please tell us what an endocrinologist is.
4:10
Speaker 2: So yes, So a lot of people don't know what
4:12
Speaker 2: an endocrinologist is, but most the easiest way to think.
4:15
Speaker 3: About endochronology is we are doctors for all the glands
4:20
Speaker 3: in your body and all of the hormones that those
4:24
Speaker 3: glands make.
4:26
Speaker 1: And when you say you're an adult anterocrinologist, one could
4:29
Speaker 1: be a younger person. So there are also.
4:31
Speaker 3: Pediatric endochronologists, and pediatric endocrinologists tend to deal with different
4:36
Speaker 3: issues because kids have different hormone problems.
4:39
Speaker 2: Than adults do.
4:41
Speaker 1: So I'm very excited about this podcast, but I wanted
4:43
Speaker 1: to say at the top, I'm also excited about other collaborations.
4:47
Speaker 1: So you are the newest newsletter writer for parent Data.
4:50
Speaker 1: You're writing a newsletter called hot Flash, which is about
4:54
Speaker 1: the post reproductive years. And if people are interested, they
4:56
Speaker 1: can subscribe at parent data dot org and read about
4:59
Speaker 1: their boob and all kinds of other really important topics.
5:03
Speaker 1: And we're going to touch on this a little bit today.
5:05
Speaker 1: But welcome to the parent data team, Jilli.
5:08
Speaker 2: I'm so excited to be a part of the team.
5:10
Speaker 1: Okay, so let's start at the beginning, or I guess
5:15
Speaker 1: not at the beginning, because it's in the middle. But
5:17
Speaker 1: when we say the post reproductive years, So your newsletter
5:21
Speaker 1: is going to be about the post reproductive years? What
5:24
Speaker 1: do you mean by that? What's the timeframe? Why would
5:26
Speaker 1: we care about that as a time of life.
5:29
Speaker 3: Sure, so, I think of the post reproductive years for
5:33
Speaker 3: most of us as our very late thirties, forties and
5:38
Speaker 3: early fifties, basically from the time we have our last
5:41
Speaker 3: baby and we're not planning to have a pregnancy again
5:45
Speaker 3: until menopause.
5:48
Speaker 2: And I think.
5:49
Speaker 3: Those years are really important because I think people don't
5:52
Speaker 3: fully understand what's going on with those hormones, with their
5:56
Speaker 3: hormones during those years, and they don't know, I know,
6:00
Speaker 3: quite how to address it. I think we think we
6:03
Speaker 3: have our babies, we trundle along, and then we're like
6:06
Speaker 3: forty eight and we have perimenopause, and then we go
6:09
Speaker 3: through menopause and we're done. Or people think that they
6:12
Speaker 3: go through menopause in their forties, which actually isn't true
6:15
Speaker 3: at all. The average age of menopause is about fifty
6:17
Speaker 3: one and a half. So I think there's just a
6:21
Speaker 3: lot of misconceptions about this time period, and people get
6:26
Speaker 3: really surprised by some of the symptoms that they experience,
6:30
Speaker 3: especially in their early forties.
6:33
Speaker 2: They sneak up on them.
6:35
Speaker 1: Yeah, I think we're kind of used to thinking about
6:37
Speaker 1: the life of our hormones as kind of puberty, and
6:41
Speaker 1: then there's pregnancy if you choose to do that, and
6:43
Speaker 1: then there's menopause, and this idea that things would be
6:47
Speaker 1: fluctuating and changing and doing weird stuff and things would
6:50
Speaker 1: feel weird, this in a period that, like I thought
6:53
Speaker 1: would be relaxed. I thought I was like I had
6:56
Speaker 1: my I did puberty, it was awful. I did pregnancy
6:59
Speaker 1: that was better, And I thought I was liked to
7:00
Speaker 1: chill until menopause, And that turns out to be not
7:04
Speaker 1: always true.
7:05
Speaker 3: I would say that's definitely true. My experience was the same.
7:08
Speaker 3: I thought my forties were going to be this like
7:11
Speaker 3: wonderful nirvana of like health and productivity, and I was
7:19
Speaker 3: surprised when there are I started not feeling so well
7:22
Speaker 3: when I was only you know, forty two or forty three.
7:26
Speaker 1: So let's do a little bit of definitions now, so
7:29
Speaker 1: people have sort of heard of Obviously, people know what
7:32
Speaker 1: pregnancy is and we've going to define that, But we
7:35
Speaker 1: talk about perimenopause and we talk about menopause. Do those
7:38
Speaker 1: have specific definitions?
7:41
Speaker 2: They do, So I.
7:44
Speaker 3: Think it's interesting to think about sort of four different
7:47
Speaker 3: stages from your very typically from your very early forties
7:51
Speaker 3: through your fifties. The first stage is something called the
7:55
Speaker 3: rate late reproductive phase, and that most women.
7:59
Speaker 2: Enter between forty and forty five.
8:02
Speaker 3: This is the time when we're still having regular periods,
8:06
Speaker 3: but we can start to get symptoms like hot flushes
8:10
Speaker 3: around our periods, and our periods can get closer together,
8:14
Speaker 3: they can be heavier, and we can have other changes
8:17
Speaker 3: that can really make us not feel so great.
8:19
Speaker 2: Sleep disruption, sore boobs, headaches.
8:25
Speaker 3: That continues typically until you get to early perimenopause. Early
8:31
Speaker 3: perimenopause is when your periods become more variable in length.
8:35
Speaker 3: So we said our periods got a little shorter, so
8:38
Speaker 3: maybe they went from twenty eight days to twenty six
8:40
Speaker 3: days or twenty four days. Now they're forty five days,
8:44
Speaker 3: and then they're thirty days, and then they're fifty days,
8:48
Speaker 3: and then they're twenty two days.
8:50
Speaker 2: That's early perimenopause.
8:52
Speaker 3: But you're still having a period relatively frequently. It might
8:56
Speaker 3: be every other month, it might be more frequently, but
8:59
Speaker 3: you're still having fairly regular periods, and that's early perimenopause.
9:05
Speaker 3: And women, we used to think you moved through these
9:07
Speaker 3: stages sort of sequentially, but a lot of women will
9:10
Speaker 3: seesaw back and forth between the late reproductive phase and
9:14
Speaker 3: early perimenopause. Late perimenopause is when you start going six
9:19
Speaker 3: months or more without a period, and this can go
9:23
Speaker 3: on for quite a while. So you'll have a period,
9:26
Speaker 3: you'll have go six months, then you'll have like two
9:28
Speaker 3: normal periods, then you'll go nine months, then you'll have,
9:32
Speaker 3: you know, four months of normal periods, and it just
9:35
Speaker 3: can be kind of all over the place, but it's
9:38
Speaker 3: characterized by these long stretches with no period. And then menopause,
9:43
Speaker 3: by definition, is when you go twelve months without a period,
9:48
Speaker 3: and so you can't actually say you're in menopause until
9:52
Speaker 3: you've gone twelve months without a period, and then you've
9:54
Speaker 3: been in menopause for a year, so it's a little
9:56
Speaker 3: bit of a retrospective look back.
9:59
Speaker 1: So we're going to talk about birth control today. That's
10:01
Speaker 1: our primary topic, but I think it's worth than asking
10:05
Speaker 1: in this long period that you're talking about, you know,
10:07
Speaker 1: the sort of late reproductive perimenopause, early perimenopause, late perimenopause,
10:12
Speaker 1: can one still get pregnant.
10:15
Speaker 3: So we used to think that when you're having an
10:20
Speaker 3: ovulatory cycle, so cycle in which you ovulate, you have
10:24
Speaker 3: to be having relatively frequent periods. And we thought that
10:28
Speaker 3: if you were going six months or more without a period,
10:32
Speaker 3: you probably weren't ovulating, you know, before that period, so
10:39
Speaker 3: then you wouldn't then you wouldn't be able to get pregnant. Right,
10:42
Speaker 3: if you don't ovulate, you can't get pregnant. So the
10:45
Speaker 3: key here is whether we're ovulating or not. However, there
10:49
Speaker 3: are some studies that show that more than twenty five
10:52
Speaker 3: percent of cycles that are six months in length or
10:57
Speaker 3: longer actually are ovulator or cycles, meaning that fourteen days
11:02
Speaker 3: before that period, whenever it is, you actually did ovulate.
11:07
Speaker 2: And so.
11:09
Speaker 3: You really need to think about contraception as being something
11:15
Speaker 3: you have to continue to use until you're in menopause,
11:19
Speaker 3: because if you can ovulate, it's possible for that egg
11:22
Speaker 3: to get fertilized and for that fertilized egg to implant
11:25
Speaker 3: in your uterus. And remember, by the time we're approaching menopause,
11:31
Speaker 3: the eggs that we're ovulating are sort of the last
11:33
Speaker 3: on the bench. They're not always the best, the best
11:38
Speaker 3: quality eggs. They can often have chromosomal abnormalities, and so
11:44
Speaker 3: not only can they be fertilized and you can conceive,
11:47
Speaker 3: but then you can also miscarry, and so that's not
11:50
Speaker 3: a very pleasant experience and it's also hard on our bodies.
11:53
Speaker 1: So all right, so that's a good segue because we're
11:56
Speaker 1: going to talk about I know I need birth control,
11:58
Speaker 1: what kind of birth control? And this is something of
12:01
Speaker 1: course most of us have been familiar with and thinking
12:03
Speaker 1: about since let's say our early twenties, but I think
12:09
Speaker 1: the way that we think about it is differently, right, So, initially,
12:12
Speaker 1: the way that I thought about birth control was like,
12:14
Speaker 1: how can I definitely not get pregnant? And then there
12:16
Speaker 1: was a period sort of during the time I was
12:19
Speaker 1: having kids, in which I thought about birth control but
12:21
Speaker 1: more as a kind of spacing spacing pregnancy experience. And
12:26
Speaker 1: now sort of post kids, I'm going to think about
12:28
Speaker 1: what is the best long term birth control solution that's
12:31
Speaker 1: going to get me from whenever is my last kid
12:34
Speaker 1: to you know, menopause, And so I want to talk
12:36
Speaker 1: about what is the best kind of this and why
12:39
Speaker 1: it's a vasectomy. I'm just kidding. I'm just kidding sort of,
12:43
Speaker 1: although we'll come we'll come back to that, but let's
12:45
Speaker 1: start by by sort of laying out the landscape. So
12:48
Speaker 1: in the space of long term birth control options, what
12:50
Speaker 1: are my options?
12:53
Speaker 3: So you already mentioned one, which is vasectomy. You can
12:57
Speaker 3: have a tubal ligation, or you can have your tubes removed.
13:03
Speaker 3: That's called a bilateral salpingectomy. You can use an IUD.
13:09
Speaker 3: There are two main types of IUDs. There's progestine eluding
13:13
Speaker 3: IUDs and there are copper IUDs. Both last progestin eluding
13:19
Speaker 3: IUDs last up to seven years depending on the type,
13:21
Speaker 3: copper ten years. And then you know, things that you
13:26
Speaker 3: might have used in the past, like birth control pills
13:29
Speaker 3: might also be an appropriate option.
13:32
Speaker 1: So what like a big range of other things. So
13:37
Speaker 1: what about something like an implant?
13:40
Speaker 3: Sure, so there are progestine eluding implants.
13:44
Speaker 2: The most well known one is n explanon.
13:47
Speaker 3: It is a small piece that's inserted in your arm,
13:52
Speaker 3: and it secretes progestines, which are like progesterone, into your
13:57
Speaker 3: circulation and blocks you from ovulating and also blocks the
14:02
Speaker 3: buildup of uterine lining, so there's not really anything for
14:05
Speaker 3: an embryo to implant in.
14:08
Speaker 1: So the other thing that people will sometimes talk about
14:10
Speaker 1: is we're not supposed to call it this. So I
14:13
Speaker 1: grew up calling this the rhythm method, but that's not
14:16
Speaker 1: what we're calling it anymore. But like a natural family
14:18
Speaker 1: planning approach, I would have thought of a spoiler. I
14:22
Speaker 1: would have thought, based on what we said earlier in
14:23
Speaker 1: the conversation, that that's not a great approach, that that's
14:26
Speaker 1: relying a lot on knowing a lot about your cycles,
14:28
Speaker 1: and when they become more regular, it might fall down
14:31
Speaker 1: in its acceptability. But I'm curious if that's right.
14:35
Speaker 3: So I would say, in general, natural family planning is
14:39
Speaker 3: among the least reliable options, and so and yes, it
14:46
Speaker 3: absolutely relies.
14:47
Speaker 2: On you being very aware of when you.
14:51
Speaker 3: Are ovulating, because the goal is essentially not to have
14:55
Speaker 3: vaginal intercourse around the time of ovulation, So you have
14:59
Speaker 3: to be very very aware of when you're ovulating, and
15:03
Speaker 3: as our cycles are going through all these changes, some
15:06
Speaker 3: of our usual signs that we're ovulating can change a
15:10
Speaker 3: little bit and be harder to miss. It's also, you know,
15:13
Speaker 3: if you're having a period every six months, sometimes I
15:16
Speaker 3: think it's easy to like kind of quit looking for
15:19
Speaker 3: signs of ovulation over time, and so I do think
15:24
Speaker 3: that accurately executing a natural family planning method during this
15:30
Speaker 3: time would be much more challenging.
15:33
Speaker 1: So I want to think about these sort of four
15:35
Speaker 1: probably the most common long term solutions people are going
15:38
Speaker 1: to use, and just talk through a little bit like
15:41
Speaker 1: both when would they be useful, but also people hear
15:43
Speaker 1: a lot about that sort of like what is the
15:45
Speaker 1: risk of this. It's going to have this downside or
15:47
Speaker 1: this downside. So I actually really want to like get
15:49
Speaker 1: into some of those. So before I really want to
15:51
Speaker 1: focus on our birth control pills, iud's tubal ligations or
15:55
Speaker 1: the other word you use that I'm never going to
15:57
Speaker 1: be able to say. And this actomies. So let's talk
16:00
Speaker 1: about birth control pills. A large share of people will
16:03
Speaker 1: have used birth control pills as a sort of earlier
16:05
Speaker 1: life birth control option. I think we all understand. You
16:08
Speaker 1: take them for twenty eight days in a cycle, and
16:12
Speaker 1: they sort of enforce a period or not, depending on
16:15
Speaker 1: how you're taking them. The biggest issue that I hear
16:19
Speaker 1: raised about birth control pills other than the kind of
16:22
Speaker 1: if you don't take them at the right time, they
16:24
Speaker 1: don't work. But the biggest issue that people raise is,
16:27
Speaker 1: you know, is this a cancer risk and where are
16:30
Speaker 1: we on that.
16:32
Speaker 2: So there's not a.
16:33
Speaker 3: Lot of evidence that they increase the risk of cancer,
16:37
Speaker 3: And we're particularly concerned about breast cancer in this situation.
16:43
Speaker 3: Unless you have a strong family history of pre or
16:48
Speaker 3: peri mentopausal breast cancer. If you have a strong family
16:52
Speaker 3: history of pre or perimantal puzzle breast cancer, those are
16:55
Speaker 3: often estrogen receptor positive breast cancers, meaning the cancer cell
17:00
Speaker 3: actually respond to estrogen. In that situation, you would want
17:04
Speaker 3: to avoid birth control pills. But for the rest of us,
17:07
Speaker 3: there really isn't an increased cancer risk. And in fact,
17:11
Speaker 3: there is some evidence, and this is newer and developing,
17:15
Speaker 3: that because they prevent ovulation, there may be some benefit
17:19
Speaker 3: from an ovarian cancer risk perspective.
17:22
Speaker 1: Is this a common option you see your patients using?
17:25
Speaker 2: It is?
17:25
Speaker 3: And I think there's some people for whom it's a
17:28
Speaker 3: fantastic option. Some women find that birth control pills are
17:32
Speaker 3: really helpful for treating severe symptoms of PMS. This can
17:36
Speaker 3: also sometimes be called PMDD or pre menstrual dysphoric disorder,
17:42
Speaker 3: where they can have significant changes in mood and really
17:48
Speaker 3: things that really impact their functioning around their period, and
17:51
Speaker 3: birth control pills can be a great treatment for that.
17:54
Speaker 2: If you're someone who has really heavy.
17:56
Speaker 3: Periods or symptoms like endome triosis, those women often do
18:02
Speaker 3: very well with birth control pills.
18:04
Speaker 2: And even women who are having who are in the late.
18:07
Speaker 3: Reproductive phase, they're having frequent periods, lots of headaches, lots.
18:10
Speaker 2: Of symptoms, night sweats.
18:14
Speaker 3: Taking a birth control pill continuously can be a great
18:17
Speaker 3: option in that situation as well.
18:19
Speaker 1: Because it has the estrogen that sort of supports that
18:22
Speaker 1: hormonal balance.
18:23
Speaker 3: Because you basically get a stable dose of estrogen and
18:27
Speaker 3: progesterone all month long without the rises and falls of
18:31
Speaker 3: a natural menstrual cycle, and that stability can really help
18:36
Speaker 3: people feel a lot better.
18:38
Speaker 1: Interesting. Okay, next up, IUDs that's what I have. So spoiler,
18:43
Speaker 1: I have marina. So is that the that's the progesterone
18:47
Speaker 1: eluding version of this?
18:48
Speaker 3: Yes, a marina is a progesterone or a progestine. Progestins
18:52
Speaker 3: are like progesterone, it's a progestine eluding IUD. It's the
18:57
Speaker 3: one of the ones with a little bit of a
18:59
Speaker 3: higher dose of progest and that actually means it lasts longer,
19:01
Speaker 3: so up to seven years with a marina. Those are
19:06
Speaker 3: fantastic because they last so long. So if you are,
19:11
Speaker 3: you know, thirty eight or thirty nine when you have
19:14
Speaker 3: your last pregnancy, you have two morenas, and you're probably
19:18
Speaker 3: at menopause and you've thought about it quite minimally in
19:21
Speaker 3: the interim, which is great, so.
19:24
Speaker 1: I don't get a period on this. How common is that.
19:28
Speaker 2: It's quite common with a marina.
19:30
Speaker 3: It's less common with some of the lower dose IUDs,
19:33
Speaker 3: like the Kylina is a lower dose option. Some women
19:37
Speaker 3: have breakthrough bleeding, some women have periods, but many women
19:40
Speaker 3: will not have a period at all when they have
19:42
Speaker 3: a marina. And that is another fantastic benefit, especially for
19:46
Speaker 3: women in their forties when periods can often get heavier.
19:49
Speaker 1: So Okay, on the one hand, yes, it is a
19:52
Speaker 1: fantastic benefit. But on the other hand, how will I
19:56
Speaker 1: know when I'm in perimenopause for real? For real, because
20:01
Speaker 1: I've just got this great thing that means I never
20:04
Speaker 1: have my period. I could be having it anytime. I
20:07
Speaker 1: probably maybe i'm having it. I don't know my cycle.
20:10
Speaker 1: I know nothing.
20:11
Speaker 3: That's absolutely correct, because the thing to remember about Marina
20:14
Speaker 3: and other progestine eluding IUDs is that they they only.
20:20
Speaker 2: Affect the lining of your uterus.
20:22
Speaker 3: So in theory, the progestine is such a small dose
20:26
Speaker 3: that it's not significantly circulating in your bloodstream.
20:29
Speaker 2: It's just keeping the lining of your uterus really thin.
20:34
Speaker 3: So the rest of your body, your pituitary gland, and
20:37
Speaker 3: your ovaries have no idea this is going on, and
20:40
Speaker 3: they're continuing to cycle normally. So you're ovulating whenever you
20:46
Speaker 3: would be ovulating if you didn't have an IUD, and
20:49
Speaker 3: your hormones are.
20:50
Speaker 2: Rising and falling.
20:52
Speaker 3: As a result, many women will have symptoms of perimenopause
20:57
Speaker 3: like hot flashes, night sweat, and I think you know
21:02
Speaker 3: that can be an indicator. The other thing you can
21:05
Speaker 3: do is you can if you're near the typical age
21:09
Speaker 3: of menopause. I don't know that this makes sense throughout
21:12
Speaker 3: your forties, but you know, if you're around the typical
21:15
Speaker 3: age of menopause, you're nearing the end of your the
21:19
Speaker 3: life cycle of your marina. You can actually check the
21:23
Speaker 3: hormones from your pituitary gland that drive ovulation follicular stimulating
21:28
Speaker 3: hormone or FSH, and if that level is high, then
21:33
Speaker 3: that means that you're likely in or very near menopause,
21:39
Speaker 3: and then you can take out your IUD see what happens.
21:42
Speaker 3: But there's also no downside to leaving your IUD in
21:46
Speaker 3: the full length of its life cycle, and in fact,
21:50
Speaker 3: you can use the IUD as progestin as part of
21:53
Speaker 3: a hormone replacement therapy regimen.
21:57
Speaker 1: So in terms of downsides, are there down sides? Risks,
22:00
Speaker 1: things that you'd be concerned about with an ID or
22:03
Speaker 1: people you'd say this isn't a good option for them.
22:06
Speaker 3: So progestin eluding IUDs tend to be quite safe. The
22:10
Speaker 3: dose of progestine is small enough that they're considered safe
22:14
Speaker 3: for women even at high risk for hormonal cancers like
22:20
Speaker 3: breast cancer. There's a higher risk of a topic pregnancy
22:26
Speaker 3: with progestine eluding IUDs, so a pregnancy outside of the uterus,
22:31
Speaker 3: but that's still quite rare and it's not something that
22:36
Speaker 3: would keep me up at night. Copper IUDs function as
22:41
Speaker 3: a sperm aside, so they work in a completely different way.
22:44
Speaker 3: They basically kill the sperm when the sperm gets into
22:47
Speaker 3: the uterus, so that the egg can't get fertilized. Copper
22:50
Speaker 3: IUDs last a long time and they're hormone free, but
22:54
Speaker 3: they for some women can cause heavier and periods and
22:58
Speaker 3: more painful periods.
22:59
Speaker 2: So if you're periods.
23:00
Speaker 3: Were already heavy or painful, that might not be the
23:04
Speaker 3: best choice. And believe it or not, some people have
23:08
Speaker 3: a copper allergy and that would not be a great
23:11
Speaker 3: choice either.
23:12
Speaker 2: But really they tend to be really well tolerated.
23:16
Speaker 3: They're very effective and people love their auds.
23:20
Speaker 1: People do point out that it's quite can be quite
23:23
Speaker 1: painful to have them inserted.
23:26
Speaker 3: They can it can be painful to have them inserted.
23:28
Speaker 3: I think that the women who experience the most pain
23:32
Speaker 3: tend to be women who have never been pregnant. The
23:36
Speaker 3: process of giving birth changes the sheepe and opening of
23:41
Speaker 3: your cervix, and so afterwards, you know, inserting something through
23:47
Speaker 3: the opening of the cervix is not.
23:51
Speaker 2: It's difficult.
23:52
Speaker 1: It's all stretched out anyway. Yeah, no, but I also
23:54
Speaker 1: I actually think there's another piece of that, which is
23:56
Speaker 1: what I thought you were going to say, which is
23:58
Speaker 1: that that part of what I think is tricky about
24:01
Speaker 1: pain is if you don't know what to expect, it's worse.
24:04
Speaker 1: And it's when I had an aud after I had
24:06
Speaker 1: a baby. They were just like, it's like a really
24:08
Speaker 1: bad uterine contraction. And then I was like, oh, okay,
24:11
Speaker 1: like I know what to expect. Oh that's what it is. Okay,
24:13
Speaker 1: Like I live through, you know, twenty seven hours of those,
24:16
Speaker 1: so it's totally fine.
24:18
Speaker 2: No, there's definitely an aspect of that as well.
24:21
Speaker 3: You can always take like six to eight hundred milligrams
24:24
Speaker 3: if ibe your profen right before you go to your visit,
24:27
Speaker 3: and that definitely helps.
24:29
Speaker 1: Okay, So IUD, we'll like set it and forget it, right,
24:33
Speaker 1: set it and forget it. Let's talk about the sort
24:36
Speaker 1: of more surgical permanent per mash because what's true about
24:39
Speaker 1: both birth control pills and IUD is if I changed
24:42
Speaker 1: my mind, I could pull the goalie or stop taking
24:45
Speaker 1: the pill, and you know, we could we could try again.
24:48
Speaker 1: And you know that for some people that option is
24:51
Speaker 1: really important. For others it's definitely not important. But it
24:54
Speaker 1: is something that strongly differentiates the sort of like temporary
24:59
Speaker 1: from more permanent. So a tubule ligation or a tuble removal,
25:05
Speaker 1: give me a sense of how that works. When would
25:07
Speaker 1: you do it? How much? Just how big a deal
25:09
Speaker 1: is it's a surgical procedure. How big a deal is this? Sure?
25:13
Speaker 2: So it is a surgical procedure.
25:16
Speaker 3: Many women will have a tubule ligation or the long
25:21
Speaker 3: scary word I used before salping gektamy, which just means
25:24
Speaker 3: tuble removal.
25:25
Speaker 2: Many women will have those done as part of a
25:28
Speaker 2: sea section.
25:29
Speaker 3: So they know they're having their last baby, they know
25:32
Speaker 3: they're having a C section, and they decide that they'll
25:34
Speaker 3: do a tuble ligation or salping gectomy is part of
25:38
Speaker 3: that process, in which case you're not actually having the
25:42
Speaker 3: added risk.
25:43
Speaker 2: Of an additional surgery.
25:45
Speaker 3: If you're not having those procedures as part of a
25:50
Speaker 3: C section, then it can be done laparoscopically minimal downtime,
25:54
Speaker 3: but it's still abdominal surgery, and so you know it's
25:59
Speaker 3: not nothing. But like I said, a lot of women
26:02
Speaker 3: have them done as part of a C section.
26:06
Speaker 1: The success rate I assume is like once you have
26:09
Speaker 1: had this that's it. We're done with this.
26:12
Speaker 2: Yeah.
26:13
Speaker 3: So, in the case of a tubal ligation, they're literally
26:16
Speaker 3: cutting the fallopian tubes and closing both ends. So if
26:21
Speaker 3: you picture like if you cut through a hose, you
26:23
Speaker 3: would then sew off both ends.
26:26
Speaker 2: Of the hose.
26:27
Speaker 3: You're very unlikely at that point to get pregnant. The
26:30
Speaker 3: success is over ninety nine percent. In the case of
26:34
Speaker 3: a salping gaktomy, what you're doing is you're literally removing
26:39
Speaker 3: the tube from where it inserts into the uterus, and
26:42
Speaker 3: so the tube itself is completely removed, so the conduit
26:47
Speaker 3: for the egg to get into the uterus is gone.
26:51
Speaker 2: There's a big.
26:52
Speaker 3: Benefit to that procedure as opposed to a tube ligation.
26:56
Speaker 3: There's a lot of data in the medical literal cure
27:00
Speaker 3: now showing that even in average risk women, the reduction
27:06
Speaker 3: of ovarian cancer after a bilateral salping gectomy is about
27:11
Speaker 3: eighty percent. So you are much less likely to develop
27:16
Speaker 3: ovarian cancer if you have a salping gectamy. Why Well,
27:19
Speaker 3: it turns out that ovarian cancer probably shouldn't be called
27:23
Speaker 3: ovarian cancer. It should probably be called fillopian tube cancer.
27:27
Speaker 3: Most of what we call ovarian cancer really arises from
27:32
Speaker 3: the tissue of the filiopian tubes, and so if you
27:34
Speaker 3: remove that tissue, then you remove the opportunity for it
27:38
Speaker 3: to become cancerous.
27:39
Speaker 1: Can I ask an incredibly stupid question, which possibly in
27:43
Speaker 1: this podcast will be edited out always, But then when
27:47
Speaker 1: I ovulate, do the eggs just build up in some
27:51
Speaker 1: part and just like sit there like a little pile
27:54
Speaker 1: of eggs. I'm sorry, No, it just feels like they
28:01
Speaker 1: would just keep hitting the end and then have nowhere
28:03
Speaker 1: to go.
28:05
Speaker 3: So I think it's important to think about a couple
28:07
Speaker 3: of things, a couple of anatomical things.
28:11
Speaker 2: So one is the fillopian tubes are not actually attached
28:14
Speaker 2: to the ovaries.
28:15
Speaker 3: There's an open end that looks kind of like one
28:18
Speaker 3: of those wavy guys at car dealerships with like the waving.
28:22
Speaker 2: Fingers like a balloon guy.
28:23
Speaker 3: Okay, yes, so those wavy fingers guide the egg into
28:29
Speaker 3: the filopian tube. But the filopian tube is just open
28:32
Speaker 3: into the pelvis, and the and the eggs are just
28:35
Speaker 3: ovulating into the pelvis. So it's possible that your eggsit
28:41
Speaker 3: not getting into the tube anyway.
28:42
Speaker 2: And in fact, they've shown studies where.
28:44
Speaker 3: Women have had one tube removed, maybe because they'd like
28:47
Speaker 3: an ectopic pregnancy, and they ovulate from the egg on
28:53
Speaker 3: the side where the tube was removed and still get pregnant,
28:57
Speaker 3: which means that that egg made its way all the
28:59
Speaker 3: way around to the other fallopian tube to get into
29:02
Speaker 3: the uterus. So eggs figure out where they need to go.
29:07
Speaker 3: If they don't get ovulated and end up in the
29:11
Speaker 3: uterus and then passed out or turn into a pregnancy,
29:14
Speaker 3: they just kind of break down and the body resorbs them.
29:17
Speaker 3: The body's very good at recycling material.
29:20
Speaker 1: Okay, I'm glad I asked. I learned a lot. I
29:22
Speaker 1: didn't know that thing about it. I know any of
29:24
Speaker 1: that basically, Okay, let's get to the last thing. So
29:27
Speaker 1: everything else up until this point, and for most couples,
29:31
Speaker 1: I mean, if we put aside condoms, every birth control
29:35
Speaker 1: decision has fundamentally been responsibility of the female partner in
29:39
Speaker 1: a female and male coupled And now we have the
29:43
Speaker 1: opportunity for him to take some leadership and have a vasectomy.
29:48
Speaker 1: So can you first describe a bit what happens in
29:51
Speaker 1: a vasectomy?
29:53
Speaker 3: Absolutely, so, a vasectomy is an office procedure. It doesn't
29:57
Speaker 3: need to be done in an operating room, it's done
30:00
Speaker 3: in a special exam room in the doctor's office using
30:04
Speaker 3: local anesthesia, and it's done by a urologist. The urologist
30:09
Speaker 3: basically makes a very small incision on the underside of
30:13
Speaker 3: the scrotum and identifies a specific tubule called the vast deference.
30:19
Speaker 3: The vast deference carries sperm from the testicle to the semen.
30:24
Speaker 3: And basically what they do is, it's really amazing that
30:27
Speaker 3: they do this because it's so teeny. They basically isolate
30:30
Speaker 3: the vast deference, cut it in half, kind of like
30:33
Speaker 3: we are talking about with a tuba ligation, only on
30:35
Speaker 3: a much smaller scale. So basically what they're doing is
30:38
Speaker 3: cutting and sewing off the ends of the tube that
30:41
Speaker 3: carry the sperm from the testes into the semen. And
30:45
Speaker 3: so what happens after a couple of months, and that's important,
30:49
Speaker 3: After a couple of months, there will know a lamiger
30:52
Speaker 3: be sperm in the semen. The semen otherwise will be
30:55
Speaker 3: completely unchanged and most people can't tell any difference, but
31:01
Speaker 3: there just won't be sperm in it.
31:02
Speaker 1: You say, after a couple of months, why is that?
31:06
Speaker 3: Because men make sperm constantly and those sperm spend time
31:12
Speaker 3: over the course of a couple of months in various
31:14
Speaker 3: parts of the testes the best deference, and then waiting
31:20
Speaker 3: to go into the semen, and you have to deplete
31:23
Speaker 3: the store of sperm on the semen side of your
31:27
Speaker 3: cut before the sperm will no longer be present in
31:31
Speaker 3: the semen by having a lot of sex.
31:34
Speaker 2: No, you do not need to have a lot of sex.
31:36
Speaker 3: It just happens with time, Okay, So it's usually about
31:39
Speaker 3: two months.
31:40
Speaker 1: Okay. So actually I have gotten this question frequently from people,
31:42
Speaker 1: like my partner says that the doctor told them we
31:44
Speaker 1: have to have sex every day in order to like
31:47
Speaker 1: diminish the sperm more quickly. But I guess that's not.
31:50
Speaker 2: That's that sounds like a pipe dream.
31:52
Speaker 1: Sounds like a pipe dream. It's like something okay, all right,
31:55
Speaker 1: so you wait some time and then my sort of
31:57
Speaker 1: Typically I think people would have a test at the
31:59
Speaker 1: end of a couple like there would be some way
32:00
Speaker 1: to evaluate this term.
32:01
Speaker 3: Yeah, I would highly recommend having the semen analysis after
32:05
Speaker 3: two months to confirm that there are no sperm in
32:08
Speaker 3: the semen before I relied on a vasectomy for contraception.
32:12
Speaker 1: What is the recovery like from a vsectomy.
32:17
Speaker 3: I can speak best from my some my secondhand personal experience.
32:22
Speaker 3: So vasectomy is my husband and I is preferred choice
32:27
Speaker 3: for contraception. We have an eight year old and older
32:31
Speaker 3: children and we are not having any more children. He
32:35
Speaker 3: went to dinner that night, so he had a vasectomy
32:37
Speaker 3: at I think I don't know, ten in the morning.
32:40
Speaker 2: I picked him up at one o'clock. At seven o'clock, we.
32:44
Speaker 3: Were in the car from our house in the suburbs,
32:46
Speaker 3: driving in New York City to go out to dinner.
32:48
Speaker 2: And the following day, Saturday, he was.
32:50
Speaker 3: Standing on the sidelines of the field coaching my son's
32:55
Speaker 3: soccer game.
32:56
Speaker 2: So minimal.
32:59
Speaker 1: So the one question I get quite a lot from
33:02
Speaker 1: people about this, including from some people who asked me
33:06
Speaker 1: to ask you asking for a friend, is the question
33:11
Speaker 1: of long term pain. So I have at least one
33:14
Speaker 1: person who told me I had a vasseectomy and I
33:16
Speaker 1: had some long term pain, and his view was that
33:19
Speaker 1: that happens to a lot of people. It was based
33:22
Speaker 1: on I mean, as far as you can tell, that
33:23
Speaker 1: was not based on anything in particular.
33:24
Speaker 3: But I would say that that is a very rare occurrence.
33:29
Speaker 3: The pain is typically very minimal and short lived.
33:33
Speaker 1: Okay. Another question about vissectomies. Are they reversible?
33:39
Speaker 2: So they can be?
33:41
Speaker 3: There are a couple of different techniques. Some techniques are
33:45
Speaker 3: more or less successful. Some techniques show a reversibility of
33:50
Speaker 3: only thirty or forty percent, and some techniques have been
33:53
Speaker 3: in the hands of some surgeons upwards of ninety percent effective.
33:59
Speaker 3: If you're not one hundred percent sure you're done with kids,
34:03
Speaker 3: one option for men undergoing vasectomy is to bank sperm.
34:10
Speaker 3: So most urologists will offer you the opportunity to bank
34:14
Speaker 3: some sperm before you do of vasectomy on the off
34:18
Speaker 3: chance that you would ever want to achieve pregnancy again.
34:21
Speaker 2: Okay, So tubal ligation is also.
34:23
Speaker 3: Technically reversible, And obviously I don't think anyone would recommend
34:29
Speaker 3: a vasectomy or a tubul ligation or a salping gectamy
34:35
Speaker 3: if someone wasn't pretty darn sure they were done having kids.
34:39
Speaker 1: Do you have a sense of how common if we
34:41
Speaker 1: sort of think about these these sort of four long
34:44
Speaker 1: term birth control categories, kind of what you see either
34:48
Speaker 1: in your practice or in the data about who how
34:50
Speaker 1: many people are using different options?
34:53
Speaker 3: I would say most women are largely still using IUDs
35:01
Speaker 3: and birth control pills. I think a lot of times
35:04
Speaker 3: it's because they're using them not so much as contraception
35:07
Speaker 3: but to treat other things, and the fact that their
35:10
Speaker 3: contraception is kind of a bonus. I think more and
35:14
Speaker 3: more couples are considering vasectomy and using vasectomy, and I'm
35:19
Speaker 3: excited to see that more and more people are see
35:23
Speaker 3: this as a possibility.
35:25
Speaker 2: And I do think that there's a fair amount of sort.
35:28
Speaker 3: Of myth busting that's going on and allowing.
35:31
Speaker 2: That to happen.
35:33
Speaker 3: I also think that men are sort of realizing that
35:36
Speaker 3: women have taken on a lot of responsibility for contraception
35:41
Speaker 3: and there are no reversible forms of male contraception other
35:46
Speaker 3: than condoms, and so you know, I mean I spent
35:51
Speaker 3: fifteen years managing the contraception for my husband and I
35:55
Speaker 3: as a couple, and we had another thirteen or more
36:00
Speaker 3: years to go, so it seemed fair.
36:03
Speaker 1: Seemed fair. Yeah, I mean it's a very interesting question why,
36:07
Speaker 1: you know, In some ways, it's it's completely unsurprising to
36:10
Speaker 1: me that this is that people feel uncomfortable about this,
36:15
Speaker 1: and you understand their scissors near your penis like the
36:17
Speaker 1: things that you could imagine being uncomfortable about. But it
36:21
Speaker 1: would be great if this was something that was more widely,
36:25
Speaker 1: more widely discussed, at least as a as a possibility.
36:29
Speaker 3: Yeah, I mean scissors near your penis or you know,
36:33
Speaker 3: a bowling ball coming out of your vagina.
36:35
Speaker 1: I don't know. I mean I totally just like, you know, Look,
36:38
Speaker 1: everybody's doing something for the team. Okay, everybody's given it
36:41
Speaker 1: the office. Okay. So what I like about this conversation
36:47
Speaker 1: I think when I think about it, like, basically, this
36:50
Speaker 1: is a conversation I want to have. And I think
36:52
Speaker 1: this is part of why I'm so excited in many
36:53
Speaker 1: ways about about your newsletter is I feel like I
36:56
Speaker 1: am coming into this and there are a lot of
36:58
Speaker 1: people coming into this with me, and there are just
37:03
Speaker 1: a billion questions that I feel like I did when
37:07
Speaker 1: I started in pregnancy. I was like, oh my god,
37:09
Speaker 1: I didn't know this was going to happen, and here's
37:10
Speaker 1: a new decision I have to make, and so so
37:13
Speaker 1: this is just one of them. But but I'm really
37:16
Speaker 1: happy you're here to help navigate it.
37:24
Speaker 2: I'm so excited to be here.
37:25
Speaker 3: I really love talking about these subjects and I really
37:29
Speaker 3: want to make people feel that they can ask any questions.
37:33
Speaker 3: There's nothing off limits. We can talk about all of this,
37:36
Speaker 3: and I'm right there with you. I'm going through this
37:38
Speaker 3: stage of life myself, and so we'll all navigate it together.
37:43
Speaker 1: And it's so weird, like why can't we sleep? That'll
37:45
Speaker 1: be for the next episode, But like what is it
37:47
Speaker 1: with the hot the hot sleeping and the just like
37:49
Speaker 1: the waking up at two am and I'm being able
37:50
Speaker 1: to go back to sleep. That's that's my That was
37:53
Speaker 1: like last week for me.
37:55
Speaker 2: We'll definitely talk about it anyway. Okay, thank you, Jillian,
37:59
Speaker 2: my pleasure, thanks for having me.
38:17
Speaker 1: Parent Data is produced by Tamar Avishai with support from
38:20
Speaker 1: the parent Data team and pix. If you have thoughts
38:23
Speaker 1: on this episode, please join the conversation on my Instagram
38:26
Speaker 1: at prof Emily Oster. And if you want to support
38:30
Speaker 1: the show, become a subscriber to the parent Data newsletter
38:33
Speaker 1: at parentdata dot org, where I write weekly posts on
38:36
Speaker 1: everything to do with parents and data to help you
38:39
Speaker 1: make better, more informed parenting decisions. There are a lot
38:43
Speaker 1: of ways you can help people find out about us.
38:46
Speaker 1: Leave a rating or review on Apple podcasts, text your
38:49
Speaker 1: friend about something you learned from this episode. Debate your
38:52
Speaker 1: mother in law about the merits of something parents do
38:55
Speaker 1: now that is totally different from what she did. Post
38:58
Speaker 1: a story to your Instagram bunking a panic headline of
39:01
Speaker 1: your own. Just remember to mention the podcast too, Write
39:04
Speaker 1: Penelope right mam. We'll see you next time.