Latest / The Antisocial Doctors Podcast / Episode 2: Are Birth Control Pills Really Bad for You?

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Episode 2: Are Birth Control Pills Really Bad for You? · The Antisocial Doctors Podcast

1:27
Sonia Singh MD: You are listening to the Antisocial Doctors Podcast, hosted by me, Sonia Singh, a board certified internal medicine physician with a Master's in nutrition and a special interest in health anxiety
1:38
Rebecca Berens MD: and me, Rebecca Barons, a board certified family medicine physician with a special interest in disordered eating.
1:43
Sonia Singh MD: We're also a millennial women anxious moms and curious humans navigating social media.
1:48
Sonia Singh MD: We've seen firsthand how these platforms can be powerful tools for education and connection, but can also make us unwell.
1:56
Rebecca Berens MD: This podcast is meant to be the antidote to your doom.
1:58
Rebecca Berens MD: Scrolling, a solve for the anxiety, stress, guilt, shame, and confusion.
2:02
Rebecca Berens MD: That comes from social media's messaging around health.
2:05
Rebecca Berens MD: In each episode, we discuss a health related talk trending on social media with curiosity, nuance, evidence, humility, and compassion.
2:12
Sonia Singh MD: This is not your average debunking podcast.
2:14
Sonia Singh MD: We wanna explore not just what is trending on social media, but why, why are so many people drawn to this?
2:20
Sonia Singh MD: What is the nugget of truth here?
2:21
Sonia Singh MD: What are the facts?
2:23
Sonia Singh MD: What can we learn from this as patients and doctors?
2:25
Sonia Singh MD: No shame.
2:26
Sonia Singh MD: No blame, no snark.
2:27
Rebecca Berens MD: We're so glad you're here.
2:40
Sonia Singh MD: Okay.
2:41
Sonia Singh MD: Hi Rebecca.
2:42
Sonia Singh MD: Hi Sonia.
2:44
Sonia Singh MD: So today we're actually rerecording an episode that we already recorded.
2:48
Sonia Singh MD: But we had more ideas on it, so yeah.
2:49
Sonia Singh MD: It's, we had to go back and talk about it again, because there's just too much to cover.
2:52
Rebecca Berens MD: It is a huge topic, and I feel like we're probably eventually gonna do another episode.
2:56
Rebecca Berens MD: Yeah.
2:56
Rebecca Berens MD: Or a few on this topic.
2:57
Rebecca Berens MD: It's
2:57
Sonia Singh MD: probably gonna need a part two and a part three, but we'll try to do it some better justice today.
3:02
Sonia Singh MD: So, tell us the story that inspired this episode topic.
3:06
Rebecca Berens MD: Yeah, so this is a story that I see over and over again.
3:09
Rebecca Berens MD: So this is not just one patient.
3:11
Rebecca Berens MD: But I see this a lot.
3:12
Rebecca Berens MD: So I'll see a patient that comes in that either has or has not been diagnosed with PCOS, but has PCOS.
3:19
Rebecca Berens MD: And, they'll come in and they'll tell me, oh yeah, I've had a regular period since I was a teenager.
3:25
Rebecca Berens MD: I've had these other issues.
3:26
Rebecca Berens MD: They always just prescribe me birth control.
3:28
Rebecca Berens MD: Mm-hmm.
3:29
Rebecca Berens MD: And never really with a full explanation of, what was causing the irregular periods.
3:34
Rebecca Berens MD: Mm-hmm.
3:34
Rebecca Berens MD: What's causing these other symptoms and the implications of that diagnosis beyond just the irregular periods to where it's just oh, just take birth control now your periods irregular problem solved.
3:43
Rebecca Berens MD: And feeling that dissatisfaction with that answer.
3:47
Rebecca Berens MD: And I think you found an excellent tweet that kind of encapsulates the problem that we all see with
3:53
Speaker 3: that.
3:54
Sonia Singh MD: Yeah.
3:54
Sonia Singh MD: So I'm sure a lot of you who are listening to this have had, have seen this tweet at some point, I think maybe two or three years ago.
4:00
Sonia Singh MD: A lot of people I knew were resharing it and posting it.
4:03
Sonia Singh MD: So basically the tweet says, an entire generation of women was prescribed birth control from the age of 14 for acne and irregular periods.
4:11
Sonia Singh MD: And now that same generation is dealing with PCOS, hormonal imbalances, depression and infertility.
4:17
Sonia Singh MD: So that is the claim that birth control pills are slapped on or given to people as a bandaid, and then they cause all these problems down the road.
4:25
Sonia Singh MD: So we're gonna delve into that a little bit.
4:28
Sonia Singh MD: I have some ideas about this, but you tell me why do you think this tweet was so viral and why do you think this whole, antibi birth control movement has been so big in the last few
4:37
Rebecca Berens MD: years?
4:38
Rebecca Berens MD: So there's so many reasons for this, but I think one of the big overarching ones that I know you and I have both seen is women in general feel very dismissed and unheard when they go to the doctor.
4:49
Rebecca Berens MD: Particularly if it's A-A-G-Y-N related concern, but really any concern, I think women are feeling unheard.
4:55
Rebecca Berens MD: And so, especially when they go in and they're having a problem and they're told, oh, just take birth control.
5:01
Rebecca Berens MD: Yeah, the problem's fixed, but then the question is always why am I having this problem?
5:05
Rebecca Berens MD: Yes.
5:05
Rebecca Berens MD: And this is not necessarily a bandaid forever.
5:08
Rebecca Berens MD: And I think, the implication from this tweet is, oh, you gave me birth control and now I have all these problems.
5:14
Rebecca Berens MD: When in actuality it's probably like there was a problem that was causing the symptoms you had to begin with.
5:19
Rebecca Berens MD: And rather than figuring out the cause of that problem and explaining it and understanding what that is and what other ways there may be to manage it mm-hmm.
5:27
Rebecca Berens MD: Or what other, screenings or testing may need to be done, it's just like, here's a bandaid prescription.
5:31
Rebecca Berens MD: Yeah.
5:31
Rebecca Berens MD: Yeah.
5:32
Rebecca Berens MD: Get outta my office is kind of the implication.
5:34
Rebecca Berens MD: Right.
5:35
Rebecca Berens MD: And so then later if a woman is having symptoms, maybe they've stopped birth control'cause they wanna start trying to conceive and they're struggling to conceive.
5:43
Rebecca Berens MD: Mm.
5:43
Rebecca Berens MD: Or they stop the birth control and their symptoms are coming back.
5:45
Rebecca Berens MD: They're like, was this caused by me taking birth control all these years?
5:49
Rebecca Berens MD: Mm-hmm.
5:50
Rebecca Berens MD: And they're not really, they don't really have the answers that they were looking for.
5:53
Rebecca Berens MD: Yeah.
5:54
Sonia Singh MD: Yeah, I can totally see that.
5:55
Sonia Singh MD: Can talk about this a little later too, but this concept of like birth control masking something I think is very popular.
6:02
Sonia Singh MD: Like this idea that oh, I was just taking this and it just masked all these symptoms.
6:05
Sonia Singh MD: And I think it's interesting to think about what's the distinction between taking the birth control and having it masked something versus it actually being an evidence-based treatment for that condition.
6:14
Sonia Singh MD: And I, and I think a lot of people, it boils down to, well, is it treating the root cause, which is you mentioned.
6:20
Sonia Singh MD: And I think, as we're probably gonna discuss for a lot of these conditions, we may not know the root cause, which I think leads to a lot of uncertainty and uneasiness and leads people to seek answers in other places.
6:31
Sonia Singh MD: So
6:32
Rebecca Berens MD: yeah, and I think that implication comes a lot from.
6:36
Rebecca Berens MD: As we know, women's health conditions in particular have been understudied.
6:40
Rebecca Berens MD: Their research is not well funded for these conditions, and then has not as a result then been taught mm-hmm.
6:46
Rebecca Berens MD: In an evidence-based fashion in medical schools in the same way that some other conditions have been, just because there is a larger gap there in the research.
6:53
Rebecca Berens MD: And so sometimes when we're talking about evidence-based treatments, well, to have evidence you have to have the studies to provide you with the evidence.
7:00
Rebecca Berens MD: And historically speaking, women were not included in studies necessarily, or these issues were not considered important enough to be funded.
7:08
Rebecca Berens MD: And so yeah, we are lacking evidence in some areas because we don't have the research to back it up.
7:13
Rebecca Berens MD: And so that can just contributes further to this sort of conspiracy theory idea.
7:16
Rebecca Berens MD: Mm-hmm.
7:17
Rebecca Berens MD: Which is not entirely false, right.
7:19
Rebecca Berens MD: That there really is a lack of evidence in some of these areas.
7:22
Rebecca Berens MD: Yeah.
7:23
Rebecca Berens MD: Yeah.
7:23
Sonia Singh MD: And this is a recurring theme.
7:25
Sonia Singh MD: I think in a lot of the topics we'll discuss, especially women's health topics, is that whole, trend of not enough funding for research, not enough research, not taught in medical school as well, not enough guidelines and data to make clinical decisions on.
7:37
Sonia Singh MD: So even though you go to your doctor and they may actually be telling you what is the best available evidence about a certain thing, the answer may still be, we don't know the exact cause and we don't know a natural way to treat this.
7:47
Sonia Singh MD: And, we don't know exactly why this happened to you and not your sister or whatever.
7:50
Sonia Singh MD: And so I think that's where a lot of times, like you said, like false information and, conspiracy theories and sort of alternative stuff gets flourishes.
7:59
Sonia Singh MD: Yeah.
8:00
Rebecca Berens MD: And then coming into the conspiracy idea too, this is something I think a lot, a lot is Up until recently there was no option for birth control for women, it was not something that we, that we had up until we very recently.
8:11
Rebecca Berens MD: Right.
8:11
Rebecca Berens MD: Yeah.
8:11
Rebecca Berens MD: And recently there have been increasing, attacks on the availability of various reproductive health options for women.
8:19
Rebecca Berens MD: Mm-hmm.
8:19
Rebecca Berens MD: And I think there is sort of, there's some usage in social media of pushing agendas one way or the other.
8:25
Rebecca Berens MD: And I think that also stokes some of the fear-based.
8:28
Rebecca Berens MD: Content that you're seeing mm-hmm.
8:30
Rebecca Berens MD: To kind of, rather than just saying we don't want you to have this.
8:33
Rebecca Berens MD: Mm-hmm.
8:33
Rebecca Berens MD: It's oh, this is not safe for you.
8:35
Rebecca Berens MD: Mm-hmm.
8:35
Rebecca Berens MD: And we're protecting you from this.
8:37
Rebecca Berens MD: And so that's maybe my conspiracy theory.
8:39
Rebecca Berens MD: Yeah.
8:40
Rebecca Berens MD: Mind going that place.
8:41
Rebecca Berens MD: But I do think it contributes some to, to this issue as well.
8:44
Sonia Singh MD: No, I think you're absolutely right.
8:45
Sonia Singh MD: And I did some research on sort of clean living as a concept and clean living movements.
8:50
Sonia Singh MD: And I, I didn't realize this at all, but you know, that's not really a new thing.
8:52
Sonia Singh MD: Those happen actually in cycles, often in society.
8:56
Sonia Singh MD: And often it's, it follows like some other big societal shift, you know?
9:00
Sonia Singh MD: So for instance, maybe you see women's liberation and, reproductive rights being expanded and then there's kind of this reactionary.
9:08
Sonia Singh MD: Backlash to that and having, things move in the other direction and people maybe advocating for natural family planning or, having more babies or, various other, uh, um, things that are basically, a response to that initial movement.
9:21
Sonia Singh MD: So it's, I think it's really interesting to think about these things in that kind of societal, historical context and think about why they're appealing at this moment.
9:29
Sonia Singh MD: And I think this makes a lot of sense in the context that we're in.
9:33
Sonia Singh MD: Okay.
9:33
Sonia Singh MD: So Rebecca, what is the nugget of truth here?
9:36
Sonia Singh MD: What do you think underlies the spirit of the tweet?
9:38
Sonia Singh MD: That is true.
9:39
Rebecca Berens MD: Yeah.
9:40
Rebecca Berens MD: So as we said, Women often do feel rightfully dismissed by the healthcare system.
9:44
Rebecca Berens MD: And often when, like you said, if birth control is maybe the best option that we have evidence-based for a certain condition, and that's what's recommended.
9:52
Rebecca Berens MD: The time constraints that we have in a typical healthcare system visit, you know, typically it's what, like 10 minutes that you get with the doctor don't really allow for a very in-depth discussion.
10:02
Rebecca Berens MD: Mm-hmm.
10:02
Rebecca Berens MD: About, the risks and benefits and potential side effects, and understanding the why of why I'm recommending this, that's maybe not happening.
10:10
Rebecca Berens MD: Mm-hmm.
10:10
Rebecca Berens MD: And so it, it maybe is, the.
10:13
Rebecca Berens MD: Guideline based correct recommendation, but maybe you're not getting a full understanding or the opportunity to be fully informed about all of the Yeah.
10:20
Rebecca Berens MD: Potential risks and benefits.
10:21
Rebecca Berens MD: And so that is certainly true.
10:23
Rebecca Berens MD: And there are some side effects to birth control pills.
10:25
Rebecca Berens MD: Mm-hmm.
10:25
Rebecca Berens MD: Yeah.
10:25
Rebecca Berens MD: It's not as if there are no side effects, any medication is gonna have a potential risk or potential side effect.
10:31
Rebecca Berens MD: And and if that's not being fully explained or, or understood, that could definitely lead to some suspicion later.
10:38
Rebecca Berens MD: Mm-hmm.
10:38
Rebecca Berens MD: When maybe that's discovered or or someone does have a side effect.
10:41
Rebecca Berens MD: Why was this pushed on me?
10:42
Rebecca Berens MD: Why was a, mm-hmm.
10:43
Rebecca Berens MD: Why was I not given another choice?
10:45
Sonia Singh MD: Yeah, even in situations where you make the correct clinical decision, if the patient does not feel on board with it and they don't understand why they're doing it and they haven't been fully informed, that is always gonna feel like the wrong decision.
11:00
Sonia Singh MD: And so, like you said, I think it's really challenging to get to that place in traditional healthcare because there's just so little time to do all of that.
11:09
Sonia Singh MD: So anyway.
11:10
Sonia Singh MD: Yeah.
11:10
Sonia Singh MD: And the other thing you mentioned how there's very real, side effects to birth control.
11:14
Sonia Singh MD: My perception just as somebody passively consuming social media content is the things that I see people worried about, about birth control on social media are usually not the actual risks to the birth control that I counsel patients on and, I, I'm aware of and talk about and I'm actually genuinely concerned about, so anyway, we can dive into that discrepancy a little bit later.
11:35
Sonia Singh MD: So tell us a little, a little bit more about the facts in terms of birth control pills.
11:39
Sonia Singh MD: What are the actual risks?
11:40
Sonia Singh MD: What are they, valid treatment options for tell us more.
11:43
Rebecca Berens MD: Yeah.
11:43
Rebecca Berens MD: Okay.
11:44
Rebecca Berens MD: So for the sake of time in this episode, I'm going to focus just on combination oral contraceptives, which means, the contraceptives that contain both an estrogen and progestin because.
11:56
Rebecca Berens MD: There's so many different types of birth control and they all have different, potential side effect and risk profiles.
12:01
Rebecca Berens MD: And I think what most people are referring to when they refer to birth control is these combination oral contraceptives.
12:06
Rebecca Berens MD: Mm-hmm.
12:07
Rebecca Berens MD: I, as I said, we'll probably have future episodes about some of these other options.
12:09
Rebecca Berens MD: Yeah.
12:09
Rebecca Berens MD: And we can get more into that.
12:10
Rebecca Berens MD: So that's what these risks and side effects are, that focusing on here that I'm gonna be talking about.
12:15
Rebecca Berens MD: So first of all, what are they actually like factually used for and recommended for?
12:19
Rebecca Berens MD: So most commonly they can be used to treat dysmenorrhea or painful periods.
12:24
Rebecca Berens MD: Mm-hmm.
12:24
Rebecca Berens MD: Which is common.
12:24
Rebecca Berens MD: For people who have endometriosis or fibroids, they can be used in that context.
12:28
Rebecca Berens MD: They're also very effective for treatment of acne and hersom or excessive like male, typically male pattern hair growth.
12:35
Rebecca Berens MD: In patients with PCOS.
12:36
Rebecca Berens MD: Yeah.
12:37
Rebecca Berens MD: They can be used to treat hypogonadism or premature ovarian failure, which, these are more rare conditions that some, women are experiencing.
12:45
Rebecca Berens MD: And they also can reduce cancer risk in women who are at risk of endometrial or ovarian cancer.
12:50
Rebecca Berens MD: Mm-hmm.
12:51
Rebecca Berens MD: Who have certain risk factors for those.
12:53
Rebecca Berens MD: They also improve bone health and hot flashes for women in perimenopause who also need effective birth control.
12:58
Rebecca Berens MD: Mm-hmm.
12:59
Rebecca Berens MD: Perimenopause is a topic for another episode, but obviously like perimenopause is hot right now.
13:03
Rebecca Berens MD: Yeah.
13:03
Rebecca Berens MD: And, women in perimenopause can get pregnant.
13:06
Rebecca Berens MD: Yeah.
13:06
Rebecca Berens MD: And so, menopause hormone therapy does not provide effective birth control.
13:10
Rebecca Berens MD: Yeah.
13:10
Rebecca Berens MD: And so if you need effective birth control and management of some perimenopause syndrome, a birth control pill might be a great option for you.
13:17
Rebecca Berens MD: Mm-hmm.
13:17
Rebecca Berens MD: Depending on your other risk factors.
13:19
Rebecca Berens MD: So that's, some real, real uses that, that they can be used for that have evidence-based.
13:24
Rebecca Berens MD: So then I'll just talk about the common side effects that we truly do see.
13:28
Rebecca Berens MD: Most common side effects that are typically milder are nausea, breast tenderness, bloating.
13:32
Rebecca Berens MD: These are typically mild and short-lived.
13:34
Rebecca Berens MD: It's sort of an adjustment period to the pill.
13:37
Rebecca Berens MD: Unscheduled bleeding is another common one, particularly in the first few cycles because, we are taking over your normal hormone cycling right cycle.
13:45
Rebecca Berens MD: Yep.
13:45
Rebecca Berens MD: So there may be some unscheduled bleeding that happens in the process of that adjustment.
13:49
Rebecca Berens MD: And that can also happen later in the course of taking a pill if, say you miss a pill or you're, delayed on taking a dose or whatever, you may get some unscheduled bleeding as a result of that as well.
14:00
Rebecca Berens MD: And then
14:01
Sonia Singh MD: can you talk a little bit about weight gain, because I feel like that's one of the popular, side effects that people come to me concerned about.
14:06
Rebecca Berens MD: Yeah, absolutely.
14:07
Rebecca Berens MD: So weight gain is a really common concern that people have with birth control.
14:10
Rebecca Berens MD: And it's been studied a lot.
14:12
Rebecca Berens MD: Mm-hmm.
14:13
Rebecca Berens MD: And there, there has not borne out in meta-analyses that weight gain is a side effect of birth control on the whole on average.
14:20
Rebecca Berens MD: But of course, with anything individual experience may vary.
14:23
Rebecca Berens MD: And this is really tricky because a lot of times the people that are starting birth control pills are often in a phase of their life where weight gain might be happening.
14:30
Rebecca Berens MD: Anyway.
14:31
Rebecca Berens MD: Mm-hmm.
14:31
Rebecca Berens MD: Naturally.
14:31
Rebecca Berens MD: Mm-hmm.
14:31
Rebecca Berens MD: In adolescence, late adolescence, moving into your early twenties, like part of puberty,
14:37
Sonia Singh MD: starting a new relationship.
14:38
Sonia Singh MD: Yeah.
14:38
Rebecca Berens MD: Like you're gaining weight at that time.
14:40
Rebecca Berens MD: That's a normal thing that's happening.
14:42
Rebecca Berens MD: Yeah.
14:42
Rebecca Berens MD: Um, your body is changing and developing into an adult body.
14:45
Rebecca Berens MD: I think people have this perception that you hate 18 and now you're an adult.
14:48
Rebecca Berens MD: No, you continue to mm-hmm.
14:50
Rebecca Berens MD: Develop into an adult, into your early to mid twenties.
14:52
Rebecca Berens MD: Mm-hmm.
14:53
Rebecca Berens MD: And your body does continue to change Yeah.
14:54
Rebecca Berens MD: In that process.
14:55
Rebecca Berens MD: It's not supposed to be your 18-year-old body forever.
14:58
Rebecca Berens MD: Right.
14:58
Rebecca Berens MD: Um, and so yeah, there's weight gain that happens there and it's really hard to tease out in some cases, is this weight gain because you are growing and changing and going through, you know, development into an adult?
15:10
Rebecca Berens MD: Or is this weight gain because you started college and your habits are different and your routines are different, you eating differently and your Yeah.
15:16
Rebecca Berens MD: Mm-hmm.
15:16
Rebecca Berens MD: Yeah.
15:16
Rebecca Berens MD: Mm-hmm.
15:17
Rebecca Berens MD: Or is this weight gain because you started birth control pill or is it all of these things?
15:20
Rebecca Berens MD: Right.
15:20
Rebecca Berens MD: But like I said, in med analysis, it has not borne out that there is a significant impact of birth control pills on weight gain.
15:27
Rebecca Berens MD: But that said, individual experience is valid.
15:29
Rebecca Berens MD: Yeah.
15:29
Rebecca Berens MD: Some people do experience weight gain.
15:30
Rebecca Berens MD: Yeah.
15:31
Rebecca Berens MD: And if that's been the case for you, that is a true experience that you had.
15:35
Rebecca Berens MD: Yeah.
15:35
Rebecca Berens MD: But that does not mean that we should use an individual experience of an anecdotal case to provide recommendations for an entire population of people.
15:43
Sonia Singh MD: Exactly.
15:43
Sonia Singh MD: So, is there a chance you may gain weight on a birth control pill?
15:47
Sonia Singh MD: Yes.
15:47
Sonia Singh MD: There is a chance you may lose weight on a birth control pill.
15:50
Sonia Singh MD: All we can say is that the best available data tells us that on the whole, it doesn't seem like it's likely to make you.
15:56
Sonia Singh MD: Gain a significant amount of weight.
15:57
Rebecca Berens MD: Exactly.
15:57
Rebecca Berens MD: You may.
15:58
Rebecca Berens MD: Yeah.
15:59
Rebecca Berens MD: Another common one that we talked about that's been recently reevaluated as well is, mood changes.
16:04
Rebecca Berens MD: Mm-hmm.
16:04
Rebecca Berens MD: So, there's been a lot of studies on mood changes affected by birth control pills and some have reported an increase in moodiness or, depressive symptoms.
16:12
Rebecca Berens MD: Some have reported a decrease.
16:14
Rebecca Berens MD: There is some evidence that, someone with a preexisting mood disorder has an increased risk of discontinuation.
16:20
Rebecca Berens MD: Mm-hmm.
16:20
Rebecca Berens MD: And that might affect studies results as well.
16:23
Rebecca Berens MD: Mm-hmm.
16:23
Rebecca Berens MD: Like you're actually more likely to discontinue the pill if you have a preexisting mood disorder.
16:27
Rebecca Berens MD: And is that maybe it was exacerbated by the pill.
16:29
Rebecca Berens MD: Mm-hmm.
16:30
Rebecca Berens MD: But then also, it's an evidenced-based treatment for premenstrual dysphoric disorder.
16:34
Rebecca Berens MD: Right.
16:34
Rebecca Berens MD: And it clearly improves mood symptoms in those patients.
16:37
Rebecca Berens MD: So again, this can be individualized.
16:39
Rebecca Berens MD: There was a, a study that you found, in 2023, it was a population based cohort study for over 250,000 women in the uk.
16:48
Rebecca Berens MD: And that did suggest that in the first two years of using an oral contraceptive, there may be an increased risk of depression, or that using it in adolescence might increase the risk of depression later in life.
16:57
Rebecca Berens MD: But again, this was.
16:58
Rebecca Berens MD: One study and then there's been other studies saying the opposite.
17:01
Rebecca Berens MD: So again, this is one of those situations where there may be individual cases in which it's an issue, but there also may be cases in which it could be beneficial.
17:08
Rebecca Berens MD: Yeah.
17:08
Rebecca Berens MD: And so it's an individualized decision at that point.
17:11
Sonia Singh MD: Yeah.
17:11
Sonia Singh MD: I wanted, I wanted us to mention this study specifically.
17:13
Sonia Singh MD: 'cause it was recent.
17:14
Sonia Singh MD: I feel like it, it probably made a lot of headlines at the time where people were just like, oh yeah, CIO, I knew it.
17:18
Sonia Singh MD: Birth control, makes you depressed.
17:20
Sonia Singh MD: It makes you feel, and it's just one of these cases where, yeah, you can cherry pick a study and then there's, there may be 10 other studies that don't show any effect, you know?
17:27
Sonia Singh MD: Or there's some, like you said, some situations in which it shows beneficial effect on mood.
17:31
Sonia Singh MD: And so, you really have to put things in the greater context and, be kind of wary when you hear those headlines.
17:37
Sonia Singh MD: Okay.
17:37
Sonia Singh MD: Can you talk a little bit about desire and libido, with respect to birth control?
17:41
Rebecca Berens MD: Yeah, so this one's been big recently, I think, on social media.
17:45
Rebecca Berens MD: So, again, most studies, show no change in, sexual function, oral libido.
17:49
Rebecca Berens MD: There have been both an increase in libido or or a decrease in libido reported or some increase in sexual function issues or decrease reported.
17:57
Rebecca Berens MD: But some of the things that I think have been reported a lot recently in social media, there's been a lot of discussion about it affecting your partner selection.
18:03
Rebecca Berens MD: Are you more likely to choose a more or less masculine appearing partner mm-hmm.
18:08
Rebecca Berens MD: If you're taking birth control?
18:09
Rebecca Berens MD: And there was some evidence actually that said yes, but it was a very low sample size.
18:13
Rebecca Berens MD: And then there was a study with a much larger sample size that said, no, it does not affect.
18:17
Rebecca Berens MD: Partner selection.
18:18
Rebecca Berens MD: And then there was, another discussion I've seen recently, a lot on social media and on some podcasts about it affecting your pre preference for major histo compatibility, complex dissimilarity.
18:27
Rebecca Berens MD: And so, mhc, these are, markers of our, immune system function that are sort of genetically determined.
18:32
Rebecca Berens MD: So this is essentially a way of selecting for, someone who's more genetically different than you.
18:38
Sonia Singh MD: Yeah.
18:38
Sonia Singh MD: So it's like evolutionarily beneficial to find someone dissimilar to you.
18:43
Sonia Singh MD: In
18:44
Rebecca Berens MD: order to have a
18:44
Sonia Singh MD: better mix of genes
18:45
Rebecca Berens MD: Exactly.
18:46
Rebecca Berens MD: Less.
18:46
Rebecca Berens MD: And so, there was a very small study, again, it was like 193 women that said yes, it, it affects our preference and makes us choose people more similar to us.
18:54
Rebecca Berens MD: Mm-hmm.
18:54
Rebecca Berens MD: But again, this is a super small study and really.
18:58
Rebecca Berens MD: How relevant is this to our evolutionary context in this day and age?
19:02
Rebecca Berens MD: There's so many things we're doing right now that, are not what evolution would have selected for necessarily.
19:08
Rebecca Berens MD: And so, how much of an impact does this truly have?
19:10
Rebecca Berens MD: Is it really relevant?
19:11
Rebecca Berens MD: Yeah, I mean,
19:12
Sonia Singh MD: from talking to my friends who are still single, it seems like finding and choosing a mate is already really hard.
19:18
Sonia Singh MD: So if you're also introducing into that, well, could my birth control possibly be making me choose like an evolutionary less?
19:25
Sonia Singh MD: Evolutionarily less fit partner.
19:28
Sonia Singh MD: I mean, I don't know that, and it just, it's another example of just kind of reducing something that is so complex, like female desire into being like, oh, it's the birth control.
19:37
Sonia Singh MD: You know, it's like, oh no.
19:38
Sonia Singh MD: It's a lot of other things.
19:39
Sonia Singh MD: But okay.
19:40
Sonia Singh MD: And then another thing that I've heard people talk a lot about is when they'll say oh, I'm thinking about trying to conceive, so I gotta stop my birth control and reset my system for a year.
19:49
Sonia Singh MD: And what, what is the data on returning to be becoming fertile after using?
19:54
Rebecca Berens MD: Yeah, so this is one that I hear a lot actually is that it affects future fertility.
19:58
Rebecca Berens MD: Mm-hmm.
19:59
Rebecca Berens MD: Not just in the short term, but in the long term.
20:01
Rebecca Berens MD: Mm-hmm.
20:01
Rebecca Berens MD: And there's really no evidence of long term changes in fertility after using birth control.
20:05
Rebecca Berens MD: I think a lot of that comes from, again, if someone is prescribed birth control for irregular periods.
20:11
Rebecca Berens MD: There's probably something underlying that affected the irregularity of periods that is maybe also affecting fertility.
20:16
Rebecca Berens MD: Mm-hmm.
20:17
Rebecca Berens MD: Like for example, PCOS.
20:18
Rebecca Berens MD: And so then when you come off the birth control and you've been like, well it was regulating my periods, but it made me infertile.
20:23
Rebecca Berens MD: It probably didn't, you probably had something affecting your fertility Right.
20:27
Rebecca Berens MD: Outright that was causing the irregular periods.
20:29
Rebecca Berens MD: Right.
20:29
Rebecca Berens MD: That, if we wanna say it was masked by the birth control.
20:32
Rebecca Berens MD: Yeah.
20:32
Rebecca Berens MD: The birth, the birth control was treating the irregularity of your periods Right.
20:35
Rebecca Berens MD: But it was not addressing the underlying issue that is contributing to infertility.
20:39
Rebecca Berens MD: But all that to say, there is no evidence of long-term changes in fertility from the usage of birth control.
20:43
Rebecca Berens MD: Mm-hmm.
20:43
Rebecca Berens MD: Now there is gonna be, again, in a couple months adjustment period, so you're not maybe immediately going to go back into a normal fertile cycle mm-hmm.
20:51
Rebecca Berens MD: Immediately after stopping the birth control.
20:53
Rebecca Berens MD: 'cause again, your pituitary gland has to reset its cycling after we've suppressed it.
20:57
Rebecca Berens MD: Right.
20:57
Rebecca Berens MD: And so yes, there is going to be, a short term, slight delay potentially of a couple of cycles.
21:03
Rebecca Berens MD: Mm-hmm.
21:03
Rebecca Berens MD: But again, you've, there's lots of stories of people getting pregnant on birth control who just missed a couple of pills.
21:08
Rebecca Berens MD: Yeah.
21:08
Rebecca Berens MD: Or, or getting pregnant right away when they stop it.
21:10
Rebecca Berens MD: So it's not to say that it's necessarily gonna be a guarantee.
21:13
Rebecca Berens MD: And that's also important'cause I have had people.
21:16
Rebecca Berens MD: Think that they couldn't get pregnant yet.
21:18
Rebecca Berens MD: Mm-hmm.
21:19
Rebecca Berens MD: And stop their birth control early and get pregnant earlier than they were intending.
21:23
Rebecca Berens MD: And so I think it's really important to be accurate about the risk there.
21:26
Rebecca Berens MD: Yeah.
21:26
Rebecca Berens MD: The other thing too is if you use birth control for a prolonged period of time because you are not ready to conceive yet, and then you are later in your life when you do start trying to conceive mm-hmm.
21:36
Rebecca Berens MD: Obviously there is a natural decline in fertility mm-hmm.
21:38
Rebecca Berens MD: With age.
21:39
Rebecca Berens MD: Mm-hmm.
21:39
Rebecca Berens MD: And so depending on the age you are when you discontinue the birth control, that may have an impact on your fertility as well.
21:44
Rebecca Berens MD: Right.
21:45
Rebecca Berens MD: So it's just important to keep in mind again, if, if fertility is something that's important to you it is something that needs to be considered and planned.
21:51
Rebecca Berens MD: Mm-hmm.
21:52
Rebecca Berens MD: And and we can't necessarily just blame it on the birth control.
21:55
Rebecca Berens MD: Right.
21:55
Rebecca Berens MD: If it takes longer.
21:56
Sonia Singh MD: Okay.
21:56
Sonia Singh MD: So now talk a little bit more about the serious side effects of birth control pills.
22:01
Sonia Singh MD: 'cause I think we as physicians know these, we think about them, we've seen them but they don't feel like the ones that people talk about the most on social media.
22:09
Rebecca Berens MD: Yeah.
22:09
Rebecca Berens MD: All the ones we just talked about that are not actually that big of a deal are the ones that are all over social media and these ones are the actual important ones to consider.
22:16
Rebecca Berens MD: I
22:16
Sonia Singh MD: mean, not to minimize, for some people the effect it may have had on their mood or the effect it may had on their weight or, whatever it is, may have been profound.
22:24
Sonia Singh MD: But on the whole, those are not life threatening where this is the ones that we're trying to talk about now are life threatening.
22:30
Rebecca Berens MD: Absolutely, yes.
22:31
Rebecca Berens MD: So, The serious risks of, the combined oral contraceptives are the, combined birth control pills.
22:36
Rebecca Berens MD: So the first one that I think is, the one that we are really conscious of as physicians, to be assessing for risk is the increased risk of ven venous thromboembolism or blood clots.
22:44
Rebecca Berens MD: Mm-hmm.
22:45
Rebecca Berens MD: So these can be blood clots, deep venous thrombosis in the legs, or they can travel to the lung and cause a pulmonary embolism.
22:50
Rebecca Berens MD: So these can be very serious and can be fatal.
22:53
Rebecca Berens MD: Yeah.
22:53
Rebecca Berens MD: So there is a three to five times increased relative risk of, vte, which is ven thromboembolism with combined oral contraceptives.
23:02
Rebecca Berens MD: And that is based both on the dose of the estrogen and the type of progestin used in the pill.
23:06
Rebecca Berens MD: Mm-hmm.
23:07
Rebecca Berens MD: So there is a change, in that risk depending on the type of pro progestin and the dosage which you choose.
23:10
Speaker 3: Mm-hmm.
23:11
Rebecca Berens MD: However, the absolute risk is still low.
23:13
Rebecca Berens MD: So the baseline risk for a non-pregnant woman is one to five out of 10,000 women years.
23:18
Rebecca Berens MD: Mm-hmm.
23:19
Rebecca Berens MD: So then if you increase that by three to five times, that's three to five per 10,000 women years.
23:24
Rebecca Berens MD: Mm-hmm.
23:25
Rebecca Berens MD: It is, or three to 25.
23:26
Rebecca Berens MD: Oh, yes.
23:26
Rebecca Berens MD: Mm-hmm.
23:26
Rebecca Berens MD: Sorry.
23:27
Rebecca Berens MD: Thank you.
23:27
Rebecca Berens MD: Whereas the relative risk is still half as much as the relative risk increase while you're pregnant or postpartum.
23:33
Rebecca Berens MD: Mm-hmm.
23:33
Rebecca Berens MD: So I think this is the other key thing to think about, and that I think is often not discussed when we're talking about the risks of birth control pills.
23:40
Sonia Singh MD: Yeah.
23:41
Rebecca Berens MD: There are true risks to pregnancy.
23:43
Rebecca Berens MD: Mm-hmm.
23:43
Rebecca Berens MD: Pregnancy is a risky situation Yeah.
23:46
Rebecca Berens MD: For a woman.
23:47
Rebecca Berens MD: Yeah.
23:47
Rebecca Berens MD: And so if you're comparing the risk of unintended pregnancy to baseline versus the risk of birth control to baseline, it really diminishes how risky birth control is looking.
23:57
Rebecca Berens MD: Yeah.
23:58
Rebecca Berens MD: Yeah.
23:58
Rebecca Berens MD: And so I just think that's an important thing to consider.
24:00
Rebecca Berens MD: Yeah.
24:00
Rebecca Berens MD: We're talking about risk here, but you have to also consider what is the risk of not taking birth control for that person.
24:05
Sonia Singh MD: 'Cause if you are terrified of having a blood clot and for that reason you avoid the birth control, but you increase your risk of an unintended pregnancy, you're signing up for a much, much, much higher risk, basically.
24:15
Rebecca Berens MD: Yeah.
24:15
Rebecca Berens MD: Much higher risk of blood clot and a lot of other things.
24:18
Rebecca Berens MD: Yeah.
24:18
Rebecca Berens MD: It's one of the most dangerous things that, that can happen to a woman.
24:21
Rebecca Berens MD: Right?
24:21
Rebecca Berens MD: Yes.
24:21
Rebecca Berens MD: And, and it, there's a lifelong impact right.
24:23
Rebecca Berens MD: Of of pregnancy.
24:24
Rebecca Berens MD: So, so this is just important to, to consider.
24:27
Rebecca Berens MD: Now there are underlying risk factors that increase someone's baseline risk of, a blood clot.
24:32
Rebecca Berens MD: And so if you, have a hereditary thrombophilia, like some sort of genetic disorder, clotting disorder which can come from just like a genetic clotting disorder or other autoimmune conditions, there's a variety of things that can increase your risk of blood clots.
24:43
Rebecca Berens MD: Smoking, if you're also taking a, NSAID like ibuprofen on a regular basis or some other nsaid or have a, an illness for, so example COVID.
24:52
Rebecca Berens MD: So COVID Slightly increases your risk of blood clots.
24:55
Rebecca Berens MD: And so the combination of those two things.
24:57
Rebecca Berens MD: The other thing is like in the postoperative period, say you've had an orthopedic surgery mm-hmm.
25:01
Rebecca Berens MD: Where you're bed bound Yeah.
25:03
Rebecca Berens MD: And you're not moving.
25:04
Rebecca Berens MD: Yeah.
25:04
Rebecca Berens MD: And you just had surgery that greatly increases your clotting risk.
25:08
Rebecca Berens MD: And so that combination of two risk factors can increase the risk more significantly.
25:12
Rebecca Berens MD: And so that's something that, a physician is taking into account before prescribing someone a birth control.
25:16
Rebecca Berens MD: Yeah.
25:16
Rebecca Berens MD: And we may consider a different option Yeah.
25:19
Rebecca Berens MD: For birth control in that person.
25:22
Sonia Singh MD: Yeah, and this is another situation in which I think having a physician who can spend time with you and who knows you and knows your history can be so helpful in informing a decision like this.
25:32
Sonia Singh MD: And the other thing that you didn't mention here, I think was, patients with migraine with aura.
25:35
Sonia Singh MD: Mm-hmm.
25:36
Sonia Singh MD: So it, that's incredibly common that I have seen patients who were started on birth control at some time in their life, and later they developed migraines and no one has ever talked to them about.
25:45
Sonia Singh MD: Well, do you have an aura?
25:46
Sonia Singh MD: And are you aware that, patients with migraine, with aura actually have a higher risk of stroke or clotting on birth control?
25:52
Sonia Singh MD: And, it's amazing how often they say no.
25:54
Sonia Singh MD: No one's ever talked to me about that.
25:56
Sonia Singh MD: And I really think it's, again, that's a function of so many different problems in our healthcare system.
26:00
Sonia Singh MD: It's partially a function of time.
26:02
Sonia Singh MD: It's fragmentation, maybe they're getting that from their OB and then the PCP doesn't know that they're on a birth control pill and maybe they went to an urgent care for their migraine.
26:10
Sonia Singh MD: And so no one is kind of looking at the entire picture.
26:12
Sonia Singh MD: But yeah, these are all things that I think, the decisions should be so, individualized and should be made together, with the patient.
26:19
Rebecca Berens MD: Yeah.
26:19
Rebecca Berens MD: And to, to that point, like you said, a common thing that I notice is that people do not report birth control when they are As a medication.
26:26
Rebecca Berens MD: Yeah.
26:26
Rebecca Berens MD: As a medication.
26:27
Rebecca Berens MD: Mm-hmm.
26:27
Rebecca Berens MD: You ask what are the medications you're taking?
26:28
Rebecca Berens MD: Mm-hmm.
26:29
Rebecca Berens MD: It just.
26:30
Rebecca Berens MD: It seems like it's separate in people's mind.
26:32
Rebecca Berens MD: It goes in a different bucket.
26:33
Rebecca Berens MD: That's not a thing, right?
26:34
Rebecca Berens MD: Yeah.
26:34
Rebecca Berens MD: Yeah.
26:35
Rebecca Berens MD: So sometimes you may go, you said to an er, urgent care with a severe migraine and they ask you your list of medications and you just, in your mind it's in a separate place.
26:42
Rebecca Berens MD: You're just like, that's not a medication.
26:44
Rebecca Berens MD: I think'cause
26:44
Sonia Singh MD: people think I'm not taking it to treat a disease, so they don't think of it like it's my blood pressure medicine, or it's my cholesterol medicine.
26:49
Sonia Singh MD: They just think oh yeah, no, that's, oh yeah, I take that, but like I don't have any problem.
26:53
Rebecca Berens MD: Yeah.
26:54
Rebecca Berens MD: And so, that's why it is so important again to make sure you are getting, Giving a thorough history.
26:58
Rebecca Berens MD: Yeah.
26:58
Rebecca Berens MD: But also that people are asking the questions.
27:00
Rebecca Berens MD: 'cause I always specifically separately ask about birth control because I've noticed that habit that people have.
27:05
Rebecca Berens MD: Mm-hmm.
27:06
Rebecca Berens MD: But again, it's just, it's hard to do in a time limited fashion.
27:08
Rebecca Berens MD: And the other thing, as you mentioned with the fragmentation, like increasingly I'm seeing people getting their birth control prescribed asynchronously on the internet.
27:16
Speaker 3: Yeah.
27:16
Speaker 3: Mm-hmm.
27:16
Speaker 3: They like not even talking to anyone.
27:17
Speaker 3: Yeah.
27:17
Rebecca Berens MD: They click a few boxes and, and, I don't know, take a picture of their driver's license, I guess, and send it to someone on the internet and then it shows up at their door.
27:24
Rebecca Berens MD: So yeah.
27:25
Rebecca Berens MD: There's really no discussion of that happening.
27:27
Sonia Singh MD: Yeah, yeah.
27:27
Sonia Singh MD: In those cases, and in those cases, you might say no to some of these things that you just don't even know what they are, you know, no one's actually explained to you what that thing is and you're like, oh, that headache, that that's what that is.
27:37
Sonia Singh MD: Or Oh yeah.
27:38
Sonia Singh MD: Even just knowing what.
27:40
Sonia Singh MD: What different words for clotting.
27:41
Sonia Singh MD: Yeah.
27:42
Sonia Singh MD: Like you may know somebody in your family had a PE or had a clot in their leg or whatever, but the way it may be phrased, you know Yeah.
27:47
Sonia Singh MD: The hereditary
27:47
Rebecca Berens MD: thrombophilia checkbox is not, not triggering in your mind.
27:51
Rebecca Berens MD: Right, right.
27:52
Rebecca Berens MD: So yeah, it's just important to, be aware of, of that.
27:55
Rebecca Berens MD: And, and again, it's just the importance of having that conversation.
27:59
Sonia Singh MD: Yeah.
27:59
Sonia Singh MD: Talk a little bit more about cardiovascular risk.
28:02
Sonia Singh MD: That kind of relates to clotting as well.
28:04
Rebecca Berens MD: Yeah.
28:04
Rebecca Berens MD: So there, there is, this concern around an increased risk for cardiovascular disease and like you mentioned with migraine with aura, for example, increased risk of stroke in those patients.
28:13
Rebecca Berens MD: The other, risk can be with increased risk of myocardial infarction or a heart attack.
28:17
Rebecca Berens MD: Mm-hmm.
28:17
Rebecca Berens MD: So there are, potentially increased risk of cardiovascular disease that actually has substantially reduced with newer birth control pills.
28:24
Rebecca Berens MD: Mm-hmm.
28:25
Rebecca Berens MD: That have lower estrogen doses.
28:27
Rebecca Berens MD: Yeah.
28:27
Rebecca Berens MD: And so, and there is not according to the data that I found any long-term increased risk in heart attack or stroke with a history of use.
28:35
Rebecca Berens MD: It's just while you're actively taking it.
28:36
Rebecca Berens MD: Mm-hmm.
28:37
Rebecca Berens MD: Mm-hmm.
28:37
Rebecca Berens MD: Um, and so again, we can kind of take into account what is your.
28:40
Rebecca Berens MD: Active risk at this moment, assessing you as a patient as a whole.
28:44
Rebecca Berens MD: Yeah.
28:44
Rebecca Berens MD: And then continually reassess that while you're taking the pill and, and decide at some point is the risk increasing based on your other risk factors as to where this may not may no longer make sense.
28:55
Rebecca Berens MD: Mm-hmm.
28:55
Rebecca Berens MD: And so, and again, as with the venous thrombo or blood clot, the absolute risk of heart attack and stroke is lower with the birth control pills compared to pregnancy or the postpartum period.
29:07
Rebecca Berens MD: So, again, important to,.
29:09
Rebecca Berens MD: Mitigate that risk there point the risk of not doing it.
29:10
Rebecca Berens MD: Yeah.
29:10
Rebecca Berens MD: Yeah.
29:10
Rebecca Berens MD: There is also, some data that shows there may be a slight increase in triglycerides and an effect on insulin resistance.
29:17
Rebecca Berens MD: With combined oral contraceptives.
29:19
Rebecca Berens MD: Again, while you're taking them there, this is usually not in a clinically significant way.
29:24
Rebecca Berens MD: But again, you have to weigh the risk and benefits for an individual patient.
29:27
Rebecca Berens MD: And this may play into why some people maybe are experiencing weight gain with birth control pills while others aren't.
29:32
Rebecca Berens MD: If there is an effect on your insulin sensitivity mm-hmm.
29:35
Rebecca Berens MD: Maybe you're more apt to gain some weight and that isn't necessarily gonna happen to everyone.
29:39
Rebecca Berens MD: 'cause there's a lot of genetic predisposition that goes into that.
29:41
Rebecca Berens MD: Right.
29:42
Rebecca Berens MD: And so again, it's a very individualized thing where we monitor for that individual patient Yeah.
29:47
Rebecca Berens MD: Assess their total risk and continually reassess, not just hit auto refill on the internet every three months.
29:52
Rebecca Berens MD: Right, right.
29:54
Sonia Singh MD: Okay.
29:54
Sonia Singh MD: What about, cancer?
29:55
Sonia Singh MD: You briefly mentioned that birth control can actually lower certain cancer risks for certain patients.
30:00
Sonia Singh MD: So talk a little bit more about cancer risks.
30:01
Rebecca Berens MD: Yeah, so, there is no evidence that oral contraceptives or combined oral contraceptives increase overall risk of cancer.
30:08
Rebecca Berens MD: And there's been, long-term studies on this that have showed that and as you said, and as we talked about earlier, there is actually evidence of protection from specific cancers including ovarian, endometrial, and colorectal cancers.
30:20
Rebecca Berens MD: With use of combined oral contraceptives, there is a temporary increase.
30:25
Rebecca Berens MD: Risk in breast and cervical cancer associated with current or recent use of combined oral contraceptives.
30:31
Rebecca Berens MD: But this disappears within two to five years of stopping the pill.
30:34
Rebecca Berens MD: And therefore it's outweighed by the other interesting protective effects.
30:37
Rebecca Berens MD: And I think the other thing to think about with this is, so one, is it causative of breast cancer or is it, there's, they're interacting with the health system at the time.
30:46
Rebecca Berens MD: Well, and also like with the, with breast cancer, if you have an estrogen or progestin progesterone sensitive breast cancer mm-hmm.
30:53
Rebecca Berens MD: And then you're taking additional hormone, it may be more apt to grow.
30:56
Rebecca Berens MD: Yeah.
30:56
Rebecca Berens MD: Which again is why it's important to have your annual checkup.
30:59
Rebecca Berens MD: Right.
30:59
Rebecca Berens MD: Be familiar with any changes in your body, those sorts of things.
31:02
Rebecca Berens MD: Yeah.
31:02
Rebecca Berens MD: And then and then also in the time of life when we are on birth control presumably you're on birth control because you are having unprotected sex.
31:09
Rebecca Berens MD: And so that is going to increase your cervical cancer risk.
31:11
Rebecca Berens MD: Right.
31:12
Rebecca Berens MD: Because that is how we contract cervical cancer is with exposure to the HPV virus.
31:16
Rebecca Berens MD: Yeah.
31:16
Rebecca Berens MD: With unprotected sex.
31:17
Rebecca Berens MD: Right.
31:17
Rebecca Berens MD: And so, there's other factors there.
31:20
Rebecca Berens MD: Yeah.
31:20
Rebecca Berens MD: That might be contributing to that.
31:22
Rebecca Berens MD: But long term overall, there is no increased risk of cancer with birth control pills.
31:28
Sonia Singh MD: Okay.
31:28
Sonia Singh MD: That's reassuring.
31:29
Sonia Singh MD: And then, I think you already mentioned some of these, there are certain conditions in which birth control pills are actually considered too risky, basically, and so they're contraindicated.
31:37
Sonia Singh MD: You mentioned some of them already, but yeah, I'll just kind of run through them just
31:40
Rebecca Berens MD: to again, like these are things that we should be taking into account.
31:43
Rebecca Berens MD: So we talked about the inherited thrombophilias or, blood clot disorders, autoimmune disease that increases, blood clotting risk, preexisting cardiovascular disease, like you had a prior heart attack or you have known blockages or something like that.
31:54
Rebecca Berens MD: Mm-hmm.
31:55
Rebecca Berens MD: The other ones that we didn't really talk about, hepatic adenoma.
31:58
Rebecca Berens MD: So if you have a, this is a, a type of growth in the liver that's typically benign but can grow with.
32:02
Rebecca Berens MD: Oral contraceptive use, as we said, migraine with aura, or if you're, older than the age of 35, that does increase stroke risk.
32:09
Rebecca Berens MD: Yeah.
32:09
Rebecca Berens MD: So there needs to be, concern there.
32:10
Rebecca Berens MD: And then this is an important one, post bariatric surgery or, If you're using a GLP one, there is actually a concern about absorption of the birth control pill, which might impact its effectiveness.
32:22
Rebecca Berens MD: And so it may not be the best option for birth control in that patient.
32:25
Rebecca Berens MD: And I think that's something that is also not well known by the general public and is important again, to discuss with your doctor.
32:31
Rebecca Berens MD: I've, I've definitely had the experience of having a patient.
32:35
Rebecca Berens MD: Take a GLP one compounded from some place that I was not aware of and they did not tell me about.
32:40
Rebecca Berens MD: And that's very relevant for your physician to know.
32:42
Rebecca Berens MD: 'cause it, it's really not the best option.
32:44
Rebecca Berens MD: There may be an absorption issue that could make it less effective for you.
32:47
Sonia Singh MD: Yeah.
32:47
Sonia Singh MD: Honestly, you taught me that.
32:49
Sonia Singh MD: I didn't realize that that was a thing.
32:51
Sonia Singh MD: And I don't feel like the GLP one companies are making a big enough effort to put those warnings on these products because, like you said, I sadly, I think there's a lot of shame too around using these products.
33:02
Sonia Singh MD: So a lot of patients get them through like med spas and weight loss clinics and they don't even disclose to their ob gyn or their doctor that they're using the drugs.
33:09
Sonia Singh MD: And they are, not considered or they're not known to be safe in pregnancy.
33:12
Sonia Singh MD: And so, this could potentially be very bad if you end up with an unintended pregnancy and you've been taking these medications.
33:18
Sonia Singh MD: So
33:18
Rebecca Berens MD: yeah, it's, it's really important to, and again, Another thing where people might not consider it a medication.
33:22
Rebecca Berens MD: Yeah.
33:23
Rebecca Berens MD: Because it's not being prescribed.
33:24
Rebecca Berens MD: Maybe they're getting it from a med spa or they bought it online from a compounding place.
33:27
Rebecca Berens MD: It's not a pill that they're taking.
33:28
Rebecca Berens MD: Yeah.
33:29
Rebecca Berens MD: And so, I think it's, it's just important to be aware.
33:31
Rebecca Berens MD: And then the last one, if you're over 35 and smoking, that is a much increased risk of clotting and cardiovascular disease.
33:37
Rebecca Berens MD: And so that's just an important thing to be, always reassessing risk.
33:41
Rebecca Berens MD: Yeah.
33:42
Rebecca Berens MD: Again, no auto refilling on the internet if we can avoid it.
33:45
Sonia Singh MD: Well, and you know, in the same way that certain things about your history can make you, have an elevated risk beyond what we know from the studies, things in your history can also make you have a lower risk than what we see in the studies.
33:54
Sonia Singh MD: So if you have already been pregnant before, you have tested your body with a very high dose of estrogen.
33:58
Sonia Singh MD: And so if you have been through some of these kind of pro clotting prothrombotic states already, and you have not had an issue with clotting, then that's reassuring that that may be a lower risk for you.
34:08
Sonia Singh MD: So anyway, this is also individualized and, requires a lot of, Patient, doctor, history taking and understanding and discussion.
34:16
Sonia Singh MD: So, I, a couple of years ago fell down this rabbit hole of reading about post birth control syndrome.
34:21
Sonia Singh MD: I know there's an influencer out there who has made a career on this and has an entire book about it.
34:25
Sonia Singh MD: And I had a couple of patients ask me oh, do, do you think I have post birth control syndrome?
34:29
Sonia Singh MD: So what is that and is it a thing?
34:31
Sonia Singh MD: Does it exist?
34:32
Rebecca Berens MD: Yeah.
34:32
Rebecca Berens MD: So there's no credible evidence for a post birth control syndrome.
34:37
Rebecca Berens MD: But there were some studies dating back to the 1970s and I looked these up and I actually couldn't find anything recent text of the studies because they were so old.
34:45
Rebecca Berens MD: Um, and I couldn't find a whole lot recently about it.
34:47
Rebecca Berens MD: But, but there are maybe some decreased micronutrient levels with use of oral birth control pills which I imagine is probably somewhat similar to like in pregnancy.
34:57
Rebecca Berens MD: Mm-hmm.
34:57
Rebecca Berens MD: Obviously pregnancy is a very different situation in terms of the amount of increased nutritional need.
35:01
Rebecca Berens MD: Yeah.
35:01
Rebecca Berens MD: But maybe there's some correlation there.
35:03
Rebecca Berens MD: 'cause it's a lot of the same vitamins, that, that we see that, that can become more easily depleted in pregnancy.
35:08
Rebecca Berens MD: Interesting.
35:09
Rebecca Berens MD: And it was mostly subclinical levels, but it could be more significant if you are someone who already has a poor nutritional status at baseline.
35:16
Rebecca Berens MD: Like maybe you've been chronically dieting or you have some sort of malabsorption issue issue, have celiac or some other GI issue.
35:22
Rebecca Berens MD: Yeah.
35:22
Rebecca Berens MD: And there's a particular concern around this with folic acid.
35:25
Rebecca Berens MD: If you become ly shortly after.
35:28
Rebecca Berens MD: Taking a birth control pill.
35:29
Rebecca Berens MD: Mm-hmm.
35:29
Rebecca Berens MD: Because obviously pregnancy requires a higher folic acid intake.
35:33
Rebecca Berens MD: Yeah.
35:33
Rebecca Berens MD: And, in the early stages of pregnancy, before you realize you're pregnant is the most critical time period.
35:38
Rebecca Berens MD: Mm-hmm.
35:38
Rebecca Berens MD: And so if you're somewhat sub clinically deficient and you're not taking in a whole lot and then you get pregnant, maybe there's some risk.
35:44
Rebecca Berens MD: But I think the point here is if you are someone of reproductive age who could become pregnant, you should be taking a prenatal vitamin with adequate folic acid.
35:52
Rebecca Berens MD: Yeah.
35:52
Rebecca Berens MD: And I think that's something that, Is important to take into account.
35:55
Rebecca Berens MD: And then I just think it's, it's more, again, adequate nutrition is really important and there's in an age where we're so obsessed with dieting and thinness and restriction, maybe we're contributing to some of these deficiencies.
36:07
Rebecca Berens MD: Mm-hmm.
36:08
Rebecca Berens MD: And I think it's just important as always to be vigilant about our nutrition status.
36:12
Sonia Singh MD: Well, it's interesting though that the one study that you did find, was talking about subclinical changes in these things.
36:18
Sonia Singh MD: So when people talk about this post birth control syndrome, they're really talking about symptoms and what I've read about it to me sounds like what we discussed earlier is maybe just manifestations of whatever the underlying condition was that the person was put on birth control for, and now they've taken it away and those symptoms have returned.
36:36
Rebecca Berens MD: Yeah.
36:37
Rebecca Berens MD: And I think that, the symptoms that you would have from like actually clinical deficiencies of these vitamins.
36:44
Rebecca Berens MD: Like it's, for example, folic acid, vitamins B two, B six, B12, vitamin C and E, magnesium, selenium, zinc.
36:50
Rebecca Berens MD: That's not necessarily causing the same symptoms that people are attributing to their birth control.
36:54
Rebecca Berens MD: Right?
36:54
Rebecca Berens MD: Right.
36:54
Rebecca Berens MD: But there's all these vague symptoms that people experience.
36:57
Rebecca Berens MD: Mm-hmm.
36:57
Rebecca Berens MD: Like fatigue.
36:58
Rebecca Berens MD: Mm-hmm.
36:58
Rebecca Berens MD: Fatigue is such a non-specific syndrome.
37:00
Rebecca Berens MD: Yeah.
37:00
Rebecca Berens MD: You can be fatigued for any number of reasons and could it be a nutritional deficiency?
37:04
Rebecca Berens MD: Yeah, sure.
37:04
Rebecca Berens MD: Yeah.
37:04
Rebecca Berens MD: But it could also be just living in 2025 is, is exhausting.
37:08
Rebecca Berens MD: Right.
37:08
Rebecca Berens MD: And so there's a lot of things that could be contributing to that.
37:11
Rebecca Berens MD: And I think the other thing is there's a lot of interest.
37:13
Rebecca Berens MD: In the functional medicine space about well there's, the clinical levels and then there's the optimal levels, right?
37:19
Rebecca Berens MD: And then there's the intracellular levels, right.
37:21
Rebecca Berens MD: And, you know, and some of these things it's so hard to actually know How much of that it has any true evidence behind it that's actually Yeah.
37:28
Rebecca Berens MD: Clinically relevant to a patient.
37:30
Rebecca Berens MD: Right.
37:30
Rebecca Berens MD: And and some of it is yeah, okay, I took the supplement and now I feel better.
37:34
Rebecca Berens MD: Well, is it because you took the supplement or was it a placebo effect?
37:36
Rebecca Berens MD: Or there's so many other factors that could contribute, especially when you're talking about these really non-specific symptoms.
37:41
Rebecca Berens MD: But I think that the key thing is a syndrome of long-term health effects of birth control pills.
37:47
Rebecca Berens MD: Yeah.
37:47
Rebecca Berens MD: Does not exist in any credibly evident way.
37:50
Rebecca Berens MD: Yeah.
37:50
Rebecca Berens MD: I think when we talk about a purse birth control syndrome, and you see that on social media very often.
37:56
Rebecca Berens MD: There is a clear conflict of interest of the person talking about it in that they're probably selling you something.
38:02
Rebecca Berens MD: Right.
38:02
Rebecca Berens MD: Right.
38:03
Rebecca Berens MD: That cures your post birth control syndrome.
38:04
Rebecca Berens MD: Right.
38:05
Rebecca Berens MD: Like a supplement or a course or a diet plan or something.
38:08
Rebecca Berens MD: Right.
38:08
Rebecca Berens MD: And so we always have to take what we're seeing with a grain of salt and if someone is selling you something Yeah.
38:13
Rebecca Berens MD: To treat the condition they're telling you that you have, that your doctor doesn't think is a thing.
38:17
Rebecca Berens MD: Yeah.
38:17
Rebecca Berens MD: It might just need to have some more evidence behind it before you consider, Yeah.
38:22
Rebecca Berens MD: Shelling out your money for that.
38:23
Sonia Singh MD: Yeah.
38:23
Sonia Singh MD: I mean, it's kind of a classic marketing tactic that I think you see over and over is you create fear or anxiety around something or you, you tell a person about a need that they didn't know they had and then you offer them the solution.
38:33
Sonia Singh MD: And I think that's what we see a lot in this.
38:35
Sonia Singh MD: Yeah.
38:35
Sonia Singh MD: In this space.
38:36
Sonia Singh MD: I can tell you that every time I stop birth control, I get terrible acne and I have to shave my legs more often and my period also becomes irreg.
38:45
Sonia Singh MD: And so I could easily, interpret that as oh, this is like some.
38:50
Sonia Singh MD: Wash out of birth control syndrome, but I, I know based on my own medical training, that that's actually probably what my underlying baseline state is.
38:59
Sonia Singh MD: And that really was, what it was like as a teenager.
39:02
Sonia Singh MD: And the birth control for me is a treatment for that.
39:05
Sonia Singh MD: Yeah.
39:06
Sonia Singh MD: And so, there's nothing wrong with, I think people get a little bit stuck on this idea of if you need to stay on it for it to treat that thing, then it's not really treating it, it's just masking it.
39:15
Sonia Singh MD: You have to keep taking it forever.
39:16
Sonia Singh MD: If you wanna keep having that effect.
39:18
Sonia Singh MD: And to me it's like, I mean, yeah, but I wear glasses and I do, I do lots of things that I have to continue to do.
39:24
Sonia Singh MD: I make healthy choices.
39:25
Sonia Singh MD: Like all of these things you choose to do because they serve a purpose and they are effective for serving that purpose.
39:32
Sonia Singh MD: So, that's how I view birth control.
39:33
Sonia Singh MD: But I think it's a very easy to interpret it.
39:36
Sonia Singh MD: In this other way that's it's done something to me and now I'm like this.
39:40
Rebecca Berens MD: Yeah.
39:40
Rebecca Berens MD: You know?
39:40
Rebecca Berens MD: Yeah.
39:40
Rebecca Berens MD: And especially when there's a condition that there is maybe no clear cause treatment for.
39:46
Rebecca Berens MD: Mm-hmm.
39:46
Rebecca Berens MD: Right.
39:46
Rebecca Berens MD: For example, PC os, it's such a complicated condition.
39:49
Rebecca Berens MD: Yeah.
39:49
Rebecca Berens MD: And it's very unlikely that we're gonna find a miraculous cure.
39:52
Rebecca Berens MD: Yeah.
39:52
Rebecca Berens MD: That doesn't involve taking something long term or making specific changes long term.
39:57
Rebecca Berens MD: Right, right.
39:58
Rebecca Berens MD: It's, it's an underlying condition that people have and so it's very, it's very unfair to those patients to say well, you shouldn't be just taking something, you should be treating the root cause.
40:06
Rebecca Berens MD: Like how?
40:07
Rebecca Berens MD: Yeah.
40:07
Rebecca Berens MD: Yeah.
40:07
Rebecca Berens MD: How do you expect them to do that?
40:09
Rebecca Berens MD: We have not advanced that far, scientifically.
40:11
Rebecca Berens MD: I don't know if we ever really will.
40:13
Rebecca Berens MD: Yeah.
40:13
Rebecca Berens MD: Without something that's maybe a long term treatment.
40:16
Sonia Singh MD: Yeah.
40:16
Sonia Singh MD: Yeah.
40:16
Sonia Singh MD: And I have like personal empathy for that, population that deals with PCOS.
40:20
Sonia Singh MD: I was told that I might have PCOS when I was maybe 17 or 18 years old.
40:24
Sonia Singh MD: And I remember going home and punching it into Alta Vista or whatever the search engine was on my, gargantuan desktop.
40:31
Sonia Singh MD: And I remember reading about it and seeing, people struggled with infertility.
40:36
Sonia Singh MD: I remember I looked at a picture of polycystic ovaries, which were just looked very disturbing.
40:40
Sonia Singh MD: Alien, and I was just like, oh my God, my insides look like that.
40:43
Sonia Singh MD: I had this whole kinda mental spiral about it.
40:45
Sonia Singh MD: And now, all these years later, truth, I don't meet criteria for PCOS.
40:48
Sonia Singh MD: I actually don't, probably it was just some ethnic variation and I'm probably somewhere on the spectrum of normal.
40:53
Sonia Singh MD: But I think throwing those words around to people and not explaining them and, and then also even when somebody does explain them, the fact that there's so much uncertainty around them, we don't know.
41:03
Sonia Singh MD: I, I can deeply empathize with that feeling of uncertainty and uneasiness and well, what am I supposed to do about this?
41:09
Sonia Singh MD: You know?
41:10
Sonia Singh MD: So yeah, I think it's it's completely understandable why people are looking for answers and why it feels as though, they're just being given a bandaid.
41:18
Rebecca Berens MD: Yeah.
41:19
Rebecca Berens MD: And then I think the other thing that we talked about that, we haven't really explored yet is, I think patients get frustrated again with the.
41:26
Rebecca Berens MD: The lack of options that they're given.
41:28
Rebecca Berens MD: Yeah.
41:28
Rebecca Berens MD: They're just told this is your option, this is it.
41:29
Rebecca Berens MD: Yeah.
41:29
Rebecca Berens MD: And without being explained, in depth the risks, the benefits, the alternatives.
41:34
Rebecca Berens MD: Mm-hmm.
41:34
Rebecca Berens MD: I think that's the clear thing with informed consent.
41:36
Rebecca Berens MD: Yes.
41:36
Rebecca Berens MD: You have to know risks, you have to know benefits, you have to know alternatives.
41:39
Rebecca Berens MD: Mm-hmm.
41:40
Rebecca Berens MD: And I think alternatives to birth control pills or birth control in general is sort of frowned upon or, or looked down on by doctors.
41:48
Rebecca Berens MD: Mm-hmm.
41:48
Rebecca Berens MD: And I think patients that for maybe a religious or cultural reason, do not want to use a form of birth control.
41:54
Rebecca Berens MD: They're being provided with, these are your options.
41:56
Rebecca Berens MD: If you don't take it, you're non-compliant.
41:58
Rebecca Berens MD: Yeah.
41:58
Rebecca Berens MD: Or, you're crazy or whatever.
42:00
Rebecca Berens MD: They're just, they just feel like I have nothing to offer you.
42:04
Rebecca Berens MD: Mm-hmm.
42:04
Rebecca Berens MD: Um, and one thing that I was really grateful for when I was in my residency training, I trained at Georgetown and so it's a Catholic university and so there actually is a lot of research on, fertility awareness based methods mm-hmm.
42:17
Rebecca Berens MD: Of Family planning that do not involve.
42:20
Rebecca Berens MD: Artificial birth control.
42:21
Rebecca Berens MD: Mm-hmm.
42:22
Rebecca Berens MD: And I think if you go to the doctor and you tell them oh, I don't wanna use birth control, I don't believe in that.
42:26
Rebecca Berens MD: They're just like good luck.
42:27
Rebecca Berens MD: Rather than, hey, here are some ways you can maybe, choose to space your family or choose to manage your fertility.
42:35
Rebecca Berens MD: Yeah.
42:35
Rebecca Berens MD: That doesn't involve taking something.
42:36
Rebecca Berens MD: So I did wanna talk a little bit about the fact that yes, there are truly evidence-based mm-hmm.
42:40
Rebecca Berens MD: Fertility awareness-based methods of contraception or.
42:43
Rebecca Berens MD: Family planning available.
42:44
Rebecca Berens MD: And just talk about the effectiveness of those.
42:46
Rebecca Berens MD: 'cause I think they're very much downplayed by physicians.
42:48
Rebecca Berens MD: So for example, there's a variety of methods and we'll include in the show notes, a little handout summary of the, the evidence-based methods that are out there.
42:56
Rebecca Berens MD: I think people think of the rhythm method from like a million years ago.
42:59
Rebecca Berens MD: That, that's literally what I learned.
43:00
Rebecca Berens MD: Yeah, that's
43:01
Sonia Singh MD: what I think.
43:01
Sonia Singh MD: I, that's what I learned.
43:02
Sonia Singh MD: And I remember the chart in the book, the textbook that would show the effectiveness rates and I just remember the rhythm method being not good.
43:08
Sonia Singh MD: Yeah.
43:08
Sonia Singh MD: And then I think after that point, I just, in my mind it was like, oh, I can't counsel a patient to do that.
43:13
Sonia Singh MD: It's so much less effective than the other things.
43:15
Sonia Singh MD: And honestly, I also don't think I could trust myself to adequately teach them in a way that would make me feel confident that they understood and were gonna be able to, implement, a fertility, awareness based method on their own.
43:27
Rebecca Berens MD: Yeah, absolutely.
43:28
Rebecca Berens MD: And, and you shouldn't have to, right?
43:29
Rebecca Berens MD: That shouldn't be your job.
43:31
Rebecca Berens MD: Mm-hmm.
43:32
Rebecca Berens MD: To teach them the method.
43:33
Rebecca Berens MD: But it is important to be able to say Hey.
43:35
Rebecca Berens MD: This is the evidence for the methods that are available.
43:37
Rebecca Berens MD: Yeah.
43:38
Rebecca Berens MD: These are the names of the methods and resources that you could look at and some resources to direct you to someone who can teach you.
43:43
Rebecca Berens MD: Mm-hmm.
43:43
Rebecca Berens MD: Rather than just saying well, good luck.
43:45
Rebecca Berens MD: And who would, who would that be?
43:46
Rebecca Berens MD: I don't know the answer.
43:46
Rebecca Berens MD: Yeah.
43:47
Rebecca Berens MD: So, so I'll tell you, there's a variety of methods and, most of the Catholic churches near you will know all the teachers locally because it's part of marriage prep.
43:54
Rebecca Berens MD: I can tell you that.
43:55
Rebecca Berens MD: You have to learn fertility awareness based, oh, this is like a
43:57
Sonia Singh MD: totally new world to me.
43:58
Sonia Singh MD: Okay.
43:58
Sonia Singh MD: I'm so, so I
43:59
Rebecca Berens MD: am, I am Catholic by marriage, and so this is part of Catholic marriage prep is you have to learn about fertility, awareness based methods of family planning.
44:06
Rebecca Berens MD: You do not have to necessarily sign off any very formal thing.
44:11
Rebecca Berens MD: It's, it is very parish specific, but, but I mean, there is at least education about it that's required.
44:14
Rebecca Berens MD: And so, the handout that will include in the show notes does list the names of all of the various methods.
44:19
Rebecca Berens MD: But I'll just tell you like with perfect use, their effectiveness rates are between 95 to 99.5%.
44:25
Rebecca Berens MD: That's pretty good.
44:26
Rebecca Berens MD: Okay.
44:26
Rebecca Berens MD: So just for, for reference, Condom effect effectiveness rates with perfect use is 98% and the combined birth control pill with perfect use is over 99%.
44:36
Rebecca Berens MD: Now the key thing there is perfect use.
44:38
Rebecca Berens MD: Right.
44:38
Rebecca Berens MD: No one is perfect, right?
44:39
Rebecca Berens MD: Yes.
44:39
Rebecca Berens MD: We know.
44:40
Rebecca Berens MD: So when we're looking at effectiveness rates of birth control yeah.
44:44
Rebecca Berens MD: We look at typical use.
44:45
Rebecca Berens MD: Yeah.
44:45
Rebecca Berens MD: Not perfect use.
44:46
Rebecca Berens MD: 'cause no one is perfect and we have to assume that we're gonna make a mistake.
44:48
Rebecca Berens MD: And it's particularly easy to not perfectly use a fertility wear awareness based method.
44:54
Rebecca Berens MD: Yeah.
44:54
Rebecca Berens MD: Because it is an active choice every single day.
44:57
Rebecca Berens MD: Mm-hmm.
44:57
Rebecca Berens MD: To not only track the things you need to track mm-hmm.
45:00
Rebecca Berens MD: To be able to, predict where you are in your cycle and whether you're fertile that day, but also to choose to have or not have sex that day.
45:08
Rebecca Berens MD: Mm-hmm.
45:08
Rebecca Berens MD: And, you can see how that could go awry.
45:10
Rebecca Berens MD: Right.
45:10
Rebecca Berens MD: And so with, typical use, the rates, depending on the method is anywhere from 83 to 98%.
45:16
Rebecca Berens MD: Okay.
45:16
Rebecca Berens MD: So still pretty good condoms.
45:18
Rebecca Berens MD: Typical use rate is 87%.
45:20
Rebecca Berens MD: Okay.
45:20
Rebecca Berens MD: And typical use for birth control pills is 93%.
45:23
Rebecca Berens MD: Yeah.
45:23
Rebecca Berens MD: And so, again, there is there are these methods that have like decently good typical use rates.
45:30
Rebecca Berens MD: Mm-hmm.
45:30
Rebecca Berens MD: Not perfect, but decently good.
45:32
Rebecca Berens MD: And of course it depends a lot on the, the individual using them and their motivation and their, adherence to the method where they're gonna be on that, on that typical use.
45:40
Rebecca Berens MD: But, what I will say is something I learned when I was learning about the studies of these methods is it is difficult in the studies to capture the people whose intentions changed.
45:50
Rebecca Berens MD: So for example, if you one month where maybe.
45:53
Rebecca Berens MD: Trying to avoid pregnancy, and then the next month decided oh, well maybe we could, it's okay.
45:57
Rebecca Berens MD: I'm not worried.
45:58
Rebecca Berens MD: That's hard to capture.
45:59
Rebecca Berens MD: Yeah.
45:59
Rebecca Berens MD: Because again, it's a daily choice.
46:01
Rebecca Berens MD: And so, I, I bring this up just to say I think it's important as physicians for us to not be dismissive of people who chooses methods or just say I have nothing to offer you.
46:08
Rebecca Berens MD: Right.
46:08
Rebecca Berens MD: You don't have to go all the way as to teaching them, but you could at least not be dismissive or mean about it.
46:13
Rebecca Berens MD: Yeah.
46:14
Rebecca Berens MD: And then just provide'em like, Hey, you know what?
46:16
Rebecca Berens MD: I don't know any of these methods.
46:18
Rebecca Berens MD: I'm not very familiar with them, but here's a handout I can give you Yeah.
46:21
Rebecca Berens MD: To learn more about them.
46:22
Rebecca Berens MD: Yeah.
46:23
Rebecca Berens MD: And so I think it's, reasonably, It's a reasonable expectation for a physician to at least have that level of familiarity when they're talking about birth control options.
46:30
Sonia Singh MD: No, and I think, like you said presenting the alternatives is part of informed choice, and I think what a lot of people feel is that they're getting thrown a pharmaceutical for everything.
46:41
Sonia Singh MD: And so I think it would go a long way in terms of just.
46:44
Sonia Singh MD: Patient trust, and regaining people's faith in doctors, to feel as though the only option presented was not a pharmaceutical.
46:52
Sonia Singh MD: And even if are clear about, well, the effectiveness is gonna vary depending on, how closely you're following the, the protocol.
46:59
Sonia Singh MD: As long as you've explained that to them and presented it as an option, even if people don't take it, I, I really think that there's therapeutic value in just having that part of the conversation.
47:07
Sonia Singh MD: And I, I will fully admit, I just, I didn't have much knowledge about these.
47:11
Sonia Singh MD: I never was, educated beyond the rhythm method, which was a, small box in the textbook that was like a don't do this.
47:17
Sonia Singh MD: You know?
47:17
Rebecca Berens MD: Yeah.
47:17
Rebecca Berens MD: And I mean it's, if you're not taught, like, how can you know?
47:20
Rebecca Berens MD: Yeah.
47:20
Rebecca Berens MD: And I think, I think it's a fair expectation for patients to have of us to like.
47:24
Rebecca Berens MD: Be curious and look into these other things and Yeah.
47:27
Rebecca Berens MD: And even if you don't offer them term,'cause you don't know, just not being judgment about it, about it if they
47:31
Sonia Singh MD: stay Yeah.
47:32
Sonia Singh MD: Judgment and, the decision that's right.
47:34
Sonia Singh MD: For a woman who's in a stable, long-term relationship and could or could not have a ch you know, doesn't want one right now, but would be okay with it in heaven.
47:42
Sonia Singh MD: That's a very different situation than a 16-year-old who is trying to prevent pregnancy, you know?
47:46
Sonia Singh MD: Right.
47:46
Rebecca Berens MD: Or someone who's experienced a severely high risk pregnancy mm-hmm.
47:51
Rebecca Berens MD: And has an actual, real life threatening risk if they become pregnant again.
47:55
Rebecca Berens MD: Yeah.
47:55
Rebecca Berens MD: That is, they need to have the autonomy different to make the right choice for them, and they're gonna maybe make a different choice.
48:01
Rebecca Berens MD: Yeah.
48:01
Rebecca Berens MD: But they need to have the autonomy of all options being presented.
48:04
Sonia Singh MD: I wanna touch a little bit too on putting the claim in a little bit more of a cultural and political context.
48:10
Sonia Singh MD: Because when I first read that tweet that we shared at the opening, the first feeling that I had was just this is kind of painting birth control generally as something that's just been thoughtlessly or maliciously given to women to just shut them up and control them.
48:26
Sonia Singh MD: And now it's having all of these,, negative impacts and.
48:30
Sonia Singh MD: To me that just totally ignores, the actual historical and political context and what birth control has meant for women's rights and reproductive rights generally.
48:40
Sonia Singh MD: I mean, I think the fact that we think of it that way sometimes is just evidence of how our generation has never had to experience a world in which this wasn't an option.
48:50
Sonia Singh MD: You know, to think that just a few generations ago, women didn't have any control over when their period came or not.
48:56
Sonia Singh MD: The fact that we can control our menstrual cycles, let alone, fertility or anything is that's a big advancement, you know?
49:02
Sonia Singh MD: And then beyond that to be able to control when you do and do not conceive or whether or not you do without any input or, participation from your partner.
49:11
Sonia Singh MD: Is huge, and so I think to I'm sure there are women who remember it becoming an option who would probably be like, man, you guys don't realize like what it was like to not have this, you know?
49:22
Rebecca Berens MD: Yeah.
49:23
Sonia Singh MD: So anyway, I was curious about your thoughts too on just sort of the putting this can kind of like the political context.
49:28
Rebecca Berens MD: Yeah, absolutely.
49:28
Rebecca Berens MD: I mean, and that, we kinda alluded to that beginning, I think there is a concerted effort on the part of some people on social media with a certain agenda to.
49:39
Rebecca Berens MD: Sway people against the use of mm-hmm.
49:41
Rebecca Berens MD: Artificial forms of birth control.
49:43
Rebecca Berens MD: And, there's this whole like trad wife movement Yeah.
49:46
Rebecca Berens MD: On social media and like idealizing this mm-hmm.
49:49
Rebecca Berens MD: Life.
49:49
Rebecca Berens MD: And, and I think, like you said, historically, women fought very hard to have the choice not to do that.
49:56
Rebecca Berens MD: And if that is your choice Yeah.
49:57
Rebecca Berens MD: That is wonderful.
49:58
Rebecca Berens MD: But the choice is the important part of it.
50:00
Rebecca Berens MD: And I think like when there is not a choice in removing that choice from people, it is just, it's, it could be really devastating from the progress that's been made for women mm-hmm.
50:09
Rebecca Berens MD: In the last several generations.
50:11
Rebecca Berens MD: And birth control is a big part of that choice.
50:13
Rebecca Berens MD: Right.
50:13
Rebecca Berens MD: Because, especially even with the fertility awareness based methods, when you are teaching a person, it is not just the woman.
50:20
Rebecca Berens MD: The partner has to be a part of that conversation.
50:23
Rebecca Berens MD: Yes.
50:23
Rebecca Berens MD: And actively, they're actively also participating in that choice.
50:26
Speaker 3: And,
50:26
Rebecca Berens MD: We know that domestic violence is rampant.
50:29
Rebecca Berens MD: Yeah.
50:29
Rebecca Berens MD: You know, rape in marriage is a thing that happens routinely.
50:33
Rebecca Berens MD: And so if you are a woman in a situation like that, you have to, the only way out for that person is to have some choice and some control over the situation.
50:43
Rebecca Berens MD: Mm-hmm.
50:43
Rebecca Berens MD: And so, I think it's just really important to keep that in mind.
50:45
Rebecca Berens MD: And, and you said, I think that's sort of ignored when we focus so much on these, these negatives.
50:50
Rebecca Berens MD: It's well yes, there are some side effects and it's, it should be an individualized decision.
50:54
Rebecca Berens MD: Mm-hmm.
50:55
Rebecca Berens MD: And we should be talking to people about all of their options.
50:57
Rebecca Berens MD: But also we have to consider that we wanna keep this option available for people who need it.
51:01
Rebecca Berens MD: Right.
51:02
Rebecca Berens MD: And I feel like that's being targeted right now.
51:04
Sonia Singh MD: Yeah.
51:04
Sonia Singh MD: I mean, my feeling is just that the overall movement on social media has created a lot of fear and sometimes even guilt.
51:11
Sonia Singh MD: I have patients who will say, oh my God, I was on birth control for 15 years.
51:14
Sonia Singh MD: I just didn't know how bad it was.
51:15
Sonia Singh MD: You know?
51:16
Sonia Singh MD: And it takes a while to undo that for them and be like, it's okay.
51:20
Sonia Singh MD: You are fine.
51:21
Sonia Singh MD: Whatever is wrong right now is probably not because of the birth control.
51:24
Sonia Singh MD: But I think there's so many women walking around that feel that way, that feel like they have done something harmful, to themselves by being on this because of what they're seeing.
51:32
Sonia Singh MD: So, yeah.
51:33
Sonia Singh MD: Anyway, there's another piece of context that I think was important to mention.
51:35
Sonia Singh MD: So, all right.
51:36
Sonia Singh MD: So what are the take homes here?
51:37
Sonia Singh MD: What do you, what do you think, you take from this kind of, as a doctor in terms of what we can learn?
51:42
Rebecca Berens MD: So I think from, as we talked about with, with doctors, we need to acknowledge the gaps Yeah.
51:47
Rebecca Berens MD: And the sexism that's inherent in medical research of Yeah.
51:50
Rebecca Berens MD: How we, why we have those gaps.
51:51
Rebecca Berens MD: And we need to advocate for funding so we can address those gaps because we want to address them in an evidence-based way.
51:56
Rebecca Berens MD: Yeah.
51:57
Rebecca Berens MD: And we wanna make sure that we are not just leaving this to the influencers of the internet to take over.
52:03
Rebecca Berens MD: Right.
52:03
Rebecca Berens MD: And it is very important for us to be very thoughtful in how we're communicating with patients.
52:10
Rebecca Berens MD: Yeah.
52:10
Rebecca Berens MD: And again, the, the tenants have informed consent.
52:13
Rebecca Berens MD: Risks, benefits, alternatives.
52:15
Rebecca Berens MD: Yeah.
52:15
Rebecca Berens MD: We need to have all of those when we're talking.
52:17
Rebecca Berens MD: And it needs to be a shared decision.
52:19
Rebecca Berens MD: And if a patient makes a decision, that's not the decision that you would make.
52:23
Rebecca Berens MD: Yeah.
52:23
Rebecca Berens MD: As long as you have clearly communicated all of the options to them that is their and it's not fair to be judgmental to them about that.
52:30
Rebecca Berens MD: And we wanna make sure that we are sharing all the options.
52:33
Rebecca Berens MD: And actually, I put a note here that we didn't mention, but a vasectomy is also an option.
52:37
Rebecca Berens MD: Yeah.
52:37
Rebecca Berens MD: So I think we also sometimes are so focused on what can the woman do?
52:42
Rebecca Berens MD: Yes.
52:42
Rebecca Berens MD: Yes.
52:43
Rebecca Berens MD: For birth control, vasectomies are great birth control options.
52:45
Rebecca Berens MD: So we wanna make sure that we're taking into account, but we also to recognize that we know there isn't always time.
52:50
Rebecca Berens MD: Yeah.
52:51
Rebecca Berens MD: For doctors in the traditional, we know well volume-based healthcare system.
52:54
Rebecca Berens MD: Mm-hmm.
52:55
Rebecca Berens MD: You and I are very lucky in our practices.
52:56
Rebecca Berens MD: Yeah.
52:56
Rebecca Berens MD: We have lots of time, but that, that's not really the reality for other doctors.
52:59
Rebecca Berens MD: And so, doing what you can to summarize that, whether it's a handout, whether it's something just to make the patient understand that, I really do wanna give you all the information.
53:08
Rebecca Berens MD: This is how much time we have today.
53:10
Rebecca Berens MD: Yeah.
53:10
Rebecca Berens MD: This, it doesn't have to be a decision today.
53:12
Rebecca Berens MD: We can come back to this, but here's some resources for you to, to read.
53:15
Sonia Singh MD: Yeah.
53:16
Rebecca Berens MD: Yeah.
53:16
Rebecca Berens MD: And
53:17
Sonia Singh MD: I think just taking into account as a physician, that when a patient comes to you with a bunch of information that they found on social media, just taking a beat and, reflecting on the fact that this is a buildup of decades of, all the things we've talked about, like feeling unheard and misunderstood and underrepresented and having their concerns not fully addressed, that is leading to this.
53:40
Sonia Singh MD: And, to just take a moment before immediately dismissing that or becoming judgmental and for a moment try to picture things from their perspective and, give them.
53:50
Sonia Singh MD: The explanations and, the evidence-based information in a empathetic, compassionate, non-judgmental kind of way.
53:58
Sonia Singh MD: Yeah.
53:58
Rebecca Berens MD: And I do just wanna acknowledge, like I know how burnout inducing it is Yeah.
54:02
Rebecca Berens MD: For the physicians in the system to deal with this.
54:04
Rebecca Berens MD: 'cause when I left, like the traditional system practice was in 2020.
54:08
Sonia Singh MD: Yeah.
54:09
Rebecca Berens MD: I cannot even imagine
54:10
Sonia Singh MD: Yeah.
54:11
Rebecca Berens MD: How things have escalated in the last five years.
54:14
Rebecca Berens MD: But When they come and they're coming in with this sort of immediate it's me versus you.
54:19
Rebecca Berens MD: Right.
54:19
Rebecca Berens MD: It's this
54:20
Sonia Singh MD: there's already a distrust.
54:21
Sonia Singh MD: Yeah.
54:21
Sonia Singh MD: There's distrust, you know, and
54:22
Rebecca Berens MD: it's it's so hard to overcome that and hold yourself together, visit after visit, after visit, after visit.
54:28
Rebecca Berens MD: But I think for us to rebuild that trust, that is so important.
54:30
Rebecca Berens MD: And so again, leaning on any resources that you can to say here's a list of all of the resources.
54:35
Rebecca Berens MD: And you're welcome to come back and we can talk about them in more depth, but just having something to give to so that they feel that you actually truly have considered all the options for them.
54:42
Rebecca Berens MD: Yeah.
54:43
Rebecca Berens MD: And that's something you can put together and then use it over and over again.
54:46
Rebecca Berens MD: Well,
54:46
Sonia Singh MD: hopefully this podcast can be one of those resources, we're doing this because we have the time and bandwidth and I think like 99% of physicians do not have the time and bandwidth to do this level of discussion.
54:56
Sonia Singh MD: And we just talked for who knows how long, an hour or something on this topic and, you get, the average of 11 minutes or something with your healthcare provider.
55:05
Sonia Singh MD: So, I can understand why so many doctors.
55:08
Sonia Singh MD: Fall short here, because it feels like a losing game, and especially when, they hear your voice for those 11 minutes and then, their social media feed is telling them all day, every day, something completely different.
55:18
Sonia Singh MD: It's, it feels like you're never gonna win.
55:20
Sonia Singh MD: Yeah.
55:20
Sonia Singh MD: So, hopefully we can be a resource in that respect.
55:23
Sonia Singh MD: Okay.
55:23
Sonia Singh MD: And then as patients, what do you think people should take home from this?
55:27
Rebecca Berens MD: Yeah, so I hope that this kind of review has given people some one context Yeah.
55:32
Rebecca Berens MD: For this discussion.
55:33
Rebecca Berens MD: And then also some more balanced information Yeah.
55:36
Rebecca Berens MD: Than what you're seeing.
55:37
Rebecca Berens MD: On social media.
55:38
Rebecca Berens MD: Yeah.
55:38
Rebecca Berens MD: Yes, there are true real risks and side effects to birth control pills, but there's also a lot of benefits and in the right patient they can be a great option.
55:46
Rebecca Berens MD: Yeah.
55:46
Rebecca Berens MD: And so it's, it really should be a shared decision and hopefully this is, more information for you to be able to help make an informed decision for yourself.
55:54
Rebecca Berens MD: And we'll include some resources in the show notes too for where patients can go to learn about.
55:58
Rebecca Berens MD: All of the various birth control options and compare them and then, we'll probably do some more, more birth control content in the future.
56:04
Rebecca Berens MD: 'cause it's a big topic.
56:05
Rebecca Berens MD: Okay.
56:06
Rebecca Berens MD: And then how do you talk to your patients about birth control?
56:09
Rebecca Berens MD: Yeah, so first I think with me, I'm seeing a lot of patients with PCOS, it's a super common thing that I see.
56:13
Rebecca Berens MD: And so when someone comes in, well, first of all, I'm always asking a menstrual history.
56:17
Rebecca Berens MD: For any patient that menstruates, how old were you when it started?
56:20
Rebecca Berens MD: What was it like when it started?
56:21
Rebecca Berens MD: What is it like now?
56:22
Rebecca Berens MD: Yeah.
56:22
Rebecca Berens MD: What birth control have you used in the past?
56:24
Rebecca Berens MD: And then what concerns do you have about it?
56:25
Rebecca Berens MD: Often they're coming in mm-hmm.
56:27
Rebecca Berens MD: With a menstrual concern.
56:28
Rebecca Berens MD: And so it's just hearing what is your cycle like, how long has it lasting?
56:31
Rebecca Berens MD: What's the bleeding like?
56:32
Rebecca Berens MD: What's pain like, getting a full understanding of the symptoms that they're experiencing and doing an evaluation.
56:40
Rebecca Berens MD: Of where that could be coming from, rather than just saying okay, let's treat it right and then we'll figure it out later.
56:46
Rebecca Berens MD: It's more of a discussion of we are gonna figure out what caused this, but in the interim mm-hmm.
56:50
Rebecca Berens MD: Here are some options that could help you manage the bleeding.
56:52
Rebecca Berens MD: Yeah.
56:52
Rebecca Berens MD: Because I'm sure you've seen this as well, there's so many patients who become severely anemic from heavy menstrual bleeding.
56:57
Rebecca Berens MD: Mm-hmm.
56:57
Rebecca Berens MD: There are patients who are, just completely unable to do the social activities that they would like to do.
57:04
Rebecca Berens MD: Yeah.
57:04
Rebecca Berens MD: Because of the pain, the bleeding is either it's so either so painful or it's so irregular and unpredictable.
57:09
Rebecca Berens MD: Yeah.
57:09
Rebecca Berens MD: They're like, I don't wanna swim, I don't wanna go to the beach.
57:12
Rebecca Berens MD: You know?
57:12
Rebecca Berens MD: Right.
57:12
Rebecca Berens MD: And so, we can manage their symptoms now
57:15
Speaker 3: but
57:15
Rebecca Berens MD: we can also figure out what's causing it.
57:17
Rebecca Berens MD: Mm-hmm.
57:18
Rebecca Berens MD: And help get as best of an understanding as we can.
57:20
Rebecca Berens MD: And so I think that it's that It's both.
57:22
Rebecca Berens MD: It's not just treating, it's also evaluating.
57:24
Rebecca Berens MD: Yeah.
57:24
Sonia Singh MD: Yeah.
57:26
Sonia Singh MD: Okay.
57:27
Sonia Singh MD: So that brings us to the end of the episode.
57:29
Sonia Singh MD: We're gonna put some resources and references in the show notes, also some Instagram, social media handles that you can follow for evidence-based information to balance out maybe some of the other things you're seeing.
57:39
Sonia Singh MD: And that brings us to the end of the episode.
57:42
Sonia Singh MD: All right, thanks.
57:43
Sonia Singh MD: Thanks.
57:45
Sonia Singh MD: Hey guys, last but not least, we have a very important disclaimer.
57:50
Sonia Singh MD: This podcast is intended for educational and entertainment purposes only.
57:54
Sonia Singh MD: The content shared on this podcast, including but not limited to opinions, research discussions, case examples, and commentary, is not medical advice and should not be considered a substitute for professional medical evaluation, diagnosis, or treatment.
58:08
Sonia Singh MD: Listening to this podcast does not establish a physician-patient relationship between you and the hosts.
58:14
Sonia Singh MD: We are doctors, but not your doctors.
58:16
Sonia Singh MD: Any medical topics discussed are presented for general informational purposes and may not apply to your individual circumstances.
58:23
Sonia Singh MD: Always seek the advice of your own qualified healthcare professional regarding any questions you have about your health.
58:29
Sonia Singh MD: Medical conditions or treatment options, never disregard or delay medical advice because of something you've heard on this podcast.
58:36
Sonia Singh MD: While the hosts are licensed physicians, the views and opinions expressed are our own and do not represent those of our employers, institutions, organizations, or professional societies with which we are affiliated, although we do our best to stay up to date.
58:49
Sonia Singh MD: Please note that this podcast includes discussion of emerging research, evolving medical concepts, and differing professional opinions.
58:56
Sonia Singh MD: Medicine is not static and information may change over time.
59:00
Sonia Singh MD: We, the hosts make no guarantees about the accuracy, completeness, or applicability of this content, and we disclaim any liability for actions taken or not taken based on the information provided in this podcast by listening to the Antisocial Doctors Podcast, you have agreed to these terms.
59:16
Sonia Singh MD: Thanks again for joining us.