Let’s Talk About Plan B (and other forms of emergency contraception)

 

the-morning-after

Practicing safe sex is very important for many reasons. One reason we will focus on today is preventing unplanned pregnancies even after having unprotected sex. This is where emergency contraception (“EC”) enters the scene — it helps prevent pregnancy after the deed is done. Some people still call it the “morning after pill” but you have a bit more time than that to get your hands on it. Plan B is usually the first to come to mind we think of EC — but there are other options  and we will be discussing those as well!

When should you use emergency contraception?

If you had unprotected sex, EC can be used to prevent pregnancy. EC is most effective if taken right after unprotected sex occurs but can actually be used up to 5 days after (Side Note: as days go by, the effectiveness goes byebye).

Are there any side effects?

The side effects of Plan B are similar to other hormonal birth control and generally not an issue for most people. In case you do have any side effects, these are normal:

  • Nausea and vomiting
  • Headache
  • Fatigue or dizziness
  • Tender breasts
  • Abdominal pain or cramps

These side effects only last a couple days. Also, your menstrual cycle may become affected (light, heavy, early, or late). Do not worry if this occurs. However, if you have severe abdominal pain or do not get your next period, please visit your primary care physician or gynecologist.

Is Plan B FDA-approved?

Yes! It’s a very safe medication that has no contraindications or safety concerns.

Are there options other than Plan B?

Yes! Let’s dive right into this subject!

There are a few options available to you.  The first is the popular Plan B One-Step pill or one of its many generic forms (Take Action, Aftera, React, MyWay, etc).

The second is the Ella pill, which is less famous because it requires a prescription but works a bit better than Plan B.  You can only pick one of these two pills. Taking both is a recipe for failure since they basically cancel each other out, so please don’t try it.

Your third and most effective option is the copper IUD. If you’re interested in this one, check with your local clinics to see if you can get it quickly enough. It’s a good idea to take one of the pill options while you figure out the IUD.

How do EC pills work?

Little known fact, it can take up to 6 days for the sperm and egg to meet after having unprotected sex. This form of birth control causes the woman’s ovary to delay releasing the egg. Hence, there will be no egg for the sperm to meet! Sorry guys.

Now that we’ve discussed these options, you’re probably wondering how you can get a hold of them…

No matter how old you are or your gender, anyone can buy Plan B or one of its generic versions over-the-counter — that means no prescription needed — at your local pharmacy. However, everyone needs a prescription for Ella. A prescription for Plan B will probably help get your insurance to pay for it though.

You can meet with Dr. Sally at The Pharmacists Clinic and get a prescription for EC or other methods of birth control. Tip: Go in and get it before you need it. That way you can just grab it out of your medicine cabinet if the situation presents itself.

Remember, these are back up and there are more effective methods of birth control that can be used before you jump in between the sheets.


bianca-tranquil-round

About the Author:

Bianca S. Faridian is a third-year pharmacy student at the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences.

Male Birth Control With a Flip of A Switch

The future of contraception may allow men to control their fertility with just a flip of an on-off switch! This switch, called the Bimek SLV, was developed by German researchers. This might just be the most innovative uses of technology when it comes to birth control for men.

How exactly does it work?

It’s a small device about the size of a gummy bear that attaches to each of the two spermatic ducts and functions to regulate the release of sperm cells. In its closed state, the device obstructs the release of sperm during ejaculation. It diverts only the flow of the sperm cells, not the ejaculatory fluid. So men can expect to ejaculate normally. Sperm actually makes up only about 5% of the ejaculatory fluid. The rest is made of other substances such as proteins, enzymes, and water.

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Conversely, the valve can be easily switched open and allow the release of sperm, immediately restoring fertility. The sperm cells that are blocked are ejected out of the spermatic duct through several outlets on the device. Outside of the ducts, special cells known as phagocytes break down sperm. The Bimek SLV is proposed as a life-long, hormone-free method for men to control their fertility.

What would the experience of getting this entail?

First off, a medical examination would be required to make sure that he is a good candidate for the device. An incision is made on the testicles and the devices inserted. The procedure to implant the switch is similar to undergoing a vasectomy. Therefore, the risk of complications or adverse effects after insertion is very low. The procedure itself takes only 30 minutes and is done under local anesthesia. And although it only takes only 1 day to recover, it does take 3 to 6 months before the device becomes completely functional and is able to divert sperm from the ejaculatory fluid.

How much does it cost?

Estimated costs for the surgery and the two Bimek SLV valves is about €5000 Euros or about $5,400 US dollars. Pricey, indeed!

It may be years before this device even lands in the US marketplace because it still needs to undergo clinical trials to make sure it’s safe and effective. If everything runs according to schedule, the device is projected to receive European market approval in 2018.

For more information, see the Bimek SLV website.  Or watch this video:


KevinVuPharmDCandidate

About the Author: Kevin Vu is a recent graduate from the University of California San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences.

Hormonal Birth Control Now Available Directly At Pharmacies in California

Like our neighboring state to the north, pharmacists in California can now prescribe and dispense birth control directly to women.  Now this warrants a happy dance!  Women now have another choice in how they get their birth control.  They can either go see their primary care provider, Ob/Gyn, family planning clinic, or go straight to the pharmacy.  At the pharmacy, women will have their choice of birth control pills, patch, ring, or injection.  All thanks to a state law passed back in 2013.  So why the delay?  It took 2 and 1/2 years to develop and approve the protocol because of the multiple rounds of revisions.

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Is this safe?  What about the pap smear?  A pelvic examination and a pap smear are not necessary to initiate hormonal birth control.  They are important for other health reasons.  Women will need to complete a health history questionnaire and have their blood pressure taken at the pharmacy.  This helps the pharmacist figure out which methods of birth control are safe.  If the pharmacist finds something concerning in your health history or if you want a long-acting birth control device like the implant or IUDs, then you’ll be referred to a provider who can help with that.  Ultimately, the goal is to improve access to medications where there is a public health benefit.  After the visit, the pharmacist will send a note to your primary care physician to fill them in — unless you don’t want the pharmacist to do that of course.

Interested in getting your birth control directly from your pharmacist?  Give them a call first to find out if they are providing this service.  Just because pharmacists CAN provide this service doesn’t mean they WILL.  California pharmacists want to participate but they are worried about time constraints at the pharmacy that prevent them from taking the time to do this.  Over time, more and more pharmacists will provide this service.  When you call the pharmacy, ask when would be a good time to come in for this service.  Pharmacies have “rush hours” and the pharmacist will be able to give you more time if you  come in when it’s slower.  Some pharmacies may even make appointments for this service.  In California, women of any age can access this service from a participating pharmacist.  No age minimums and no ID checks.  This service is completely confidential and no information can be shared with your parents or anyone else!

What’s this going to cost me?  If you go to the pharmacist for your birth control visit and fill your prescription, the prescription costs will be covered by your insurance the same as if it was written by a different provider.  Unfortunately, insurance companies aren’t paying pharmacists for the visit like they pay physicians and the long list of others who can provide birth control, including nurse practitioners, physician assistants, nurse midwives, and even nurses.  So you may have to pay out of pocket for the visit and submit the receipt to your insurance company and hope they reimburse you (if you try this, please let us know if this works or not!).

Is this a good idea?  This is an enormous step forward in increasing access to birth control.  Hopefully women will appreciate having more choices in where to get birth control.  Next steps?  Ideally more states will pass similar laws expanding access with pharmacist prescribing — Tennessee is already moving forward with legislation and many other states are considering it.  There is also growing support for over-the-counter birth control pills.  

Want to consult with Dr. Sally Rafie, PharmD, BCPS about your birth control and get a prescription?  Fill out the contact form and let her know how to reach you.

Ask Dr. Sally: Will Birth Control Get Rid of My Acne?

Blemishes! Breakouts! Acne! Pimples! Zits!

Whatever you want to call them, there’s one thing all those words have in common… we don’t want them! Personally, I didn’t experience acne throughout my teen years. However, once I hit my twenties, (and the rollercoaster of the real world began) life became stressful and my hormones decided to act up. This led to adult acne (No thanks!). When I saw a question about using birth control pills to treat acne asked on our site, I knew I had to answer it due to my personal experience.

Ask Dr Sally Birth Control for Acne

First up: Does birth control get rid of acne?

I’ll give you a quick answer to diminish your anxiety while reading this article. YES! YES, it can get rid of acne!

How does birth control treat acne?

There’s a crystal clear connection between hormones and acne. Acne is stimulated by an excess formation of oil, known as sebum, by the glands in your skin. This eventually has the talent of clogging pores and allowing bacteria to build up. Which hormone causes the production of sebum? Androgens. An example of an androgen would be testosterone. (Side note: Women typically produce lower levels of androgens compared to men.) In women, higher levels of androgen can lead to excess sebum. Therefore, taking a BC that contains estrogen (a hormone) and progesterone (another hormone) can lower the amount of androgens in your body. Voila! Acne can go away now! However, patience is definitely key. This does not happen overnight. It takes about two to three months before the skin clears up.) Why is that? Your body needs time to adapt. Plus, BC helps stop new blemishes but your current ones need to heal on their own.

Before starting birth control, it is important to discuss all options with your health care provider. Other options include antibiotics, sometimes killing the bacteria in your skin pores is all you need (but, resistance can occur!). There are both topical and oral options. You have a vast amount of options when treating your acne!

Which birth control works best?

There are tons of different birth control medications to choose from. Only four of them are FDA-approved to treat acne. These three oral birth control products contain both estrogen and progestin (a synthetic form of the natural progesterone hormone). You DO NOT want to use a BC that only has progestin – those pills can actually make your acne worse. Just because a birth control pill isn’t approved for acne, doesn’t mean it won’t work. But there are some formulations that are better than others. Ask us if you have a specific question.

The FDA approved BC products are:

  • Ortho Tri-Cyclen: This pill is approved to treat moderate acne in females ages 15 and above.
  • Estrostep: This pill is approved to treat moderate acne in females ages 15 and above.
  • Yaz and Beyaz: These pills are approved to treat moderate acne for females ages 14 and above.

Are there side effects to worry about?

There are always side effects when taking any medication. The degree of each side effect varies person to person, but some common side effects of taking birth control are nausea, vomiting, headaches, breast tenderness, mood changes, decreased sex drive, weight gain, and change in menstrual flow. Serious risks are rare and include heart attack, stroke, and blood clots. Some people shouldn’t take any birth control pills if they have a history of heart disease, hypertension, blood clots/blood clotting disorders, or smokers over the age of 35. (Side note: If you’re a smoker, let’s help you in trying to quit!)

Birth control pills should not be used to treat acne by girls who have not had their period yet.

How can I get the maximum benefit of taking birth control pills when trying to get rid of my acne?

  • Ask your doctor for topical medications that you can use while also on BC.
  • Tell your pharmacist or physician about any other medications that you are taking (there can be drug interactions!).

 

BiancaAbout the Author:

Bianca S. Faridian is a third-year pharmacy student at the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences.

Blog picture from Jade via Flickr.

Will Pharmacists Give You Birth Control Without a Prescription? The Survey Says…

For those who may have been following this blog since its inception, you may recall that I was conducting a research project with Dr. Rafie last year. We conducted a survey study to gauge pharmacists’ attitudes towards a recent California law that will allow pharmacists to provide hormonal birth control directly to women without a prescription.

Kevin Vu ACCP MeetingI recently had the opportunity to present my findings at the American College of Clinical Pharmacy (ACCP) Global Conference on Clinical Pharmacy. Held in San Francisco, this conference was a gathering of pharmacists from around the world and provided a platform for those in the field to network, share and exchange ideas, as well as learn the latest developments in the pharmacy world.

So what were some of the findings I presented from our survey of community pharmacists in California?

  1. Only half of the pharmacists were familiar with the new law that allows direct pharmacy access to birth control.
  2. Most pharmacists (about 70%) said they were very likely or somewhat likely to participate in this new service. It’s promising to see all the excitement and interest within the pharmacy community around this new authority! We are hopeful that this will manifest as lots of pharmacists actually providing the service when it becomes available. We don’t want women to have to call or visit multiple pharmacies before they find a pharmacist who can help them.
  3. The main reasons for why pharmacists said they wanted to participate in this service was that patients would benefit from improved access and that this service would foster increased use of birth control. This increased use and consistent use could eventually translate to fewer unplanned pregnancies, which currently stands at half (51%) of all pregnancies that occur in the U.S. every year.
  4. Nearly all (98%) of pharmacists feel comfortable intervening if they notice a patient had a drug interaction with their birth control. This is encouraging given that pharmacists are often seen as the final safety check when it comes to medications, ensuring that patients are getting medications that are safe and effective.

As the service is on the brink of being rolled out, I’m glad to say that some California pharmacists have already begun participating in training programs specifically aimed to help prepare them for participation in this service. With time, the hope is that patients and pharmacists across the country will recognize the value of direct access to birth control, and that other states will follow and adopt a similar authority.


KevinVuPharmDCandidate

About the Author: Kevin Vu is a fourth-year pharmacy student at the University of California San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences.

My Pharmacist and Me: How California Pharmacists Can Help Protect Patient Privacy

As pharmacists prepare to step into the ring of providing sensitive family planning services to their patients, it is important to brush up on patient confidentiality strategies, especially as they pertain to teens.

But wait…isn’t that what HIPAA is for?

Well yes… but wait there’s more! Once the statewide protocol for pharmacy access to hormonal contraception gets approved in California, pharmacists are likely to see teens pursue this option as a confidential, convenient way to get effective birth control. As a pharmacist, you should know that in the State of California, minors are allowed to obtain birth control without parental consent. In fact, you legally cannot discuss any family planning issues with a minor’s parents without the patient’s written permission. While you should encourage teens to keep open communication lines with their parents, you need to respect their decision if they choose to keep their sexual health a private matter. Knowing that they can trust their pharmacist to keep their healthcare private is VERY important to teens and they would benefit from being assured that you will keep their information confidential.

How does the ACA affect patient privacy?

The Affordable Care Act not only expanded insurance coverage for young adults through their parent’s plan up to age 26, it also provided complete coverage for birth control for women. This brings up an important dilemma, patients may now have expanded coverage for birth control, but they may be afraid to access it because of privacy concerns. While you have provider-patient confidentiality laws to adhere to, the insurance companies do not have to keep it confidential. This means that if your patient uses her insurance to cover her birth control, but her parent or spouse is the policy holder, then the insurance company could send billing information that reveals services obtained to that policy holder.

keepitconfidential birth control pregnancy test STD teen insurance pharmacy pharmacist

How can I make sure my insurance company keeps my health information confidential?

In California, a law was passed that allows dependents to fill out a Confidential Communications Request form to prevent insurance companies from sending potentially revealing information to the policy holder. Instead information specified in the form will be sent directly to the patient by either email or an alternate mailing address as requested by the dependent. More information for patients and providers can be found at myhealthmyinfo.org.

How can pharmacists help?

This is an important counseling point for pharmacists to review with patients.  Cost can become a big barrier to access when patients do not feel comfortable using their insurance and have to resort to paying out of pocket.  Since this is a new law, pharmacists can help spread the word and direct patients to the website for more information and the form.  Pharmacists should always be aware of their state laws regarding serving minors and confidentiality.


Courtney HeadshotAbout the Author:  

Courtney Miller is in her second year of pharmacy school at the University of California San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences. 

What California Teens Need to Know About Pharmacy Access to Birth Control

ProviderGuess what California! Having safe sex is about to get a whole lot easier for you in the next few months! We think that increasing access to highly effective forms of birth control is the best way to help prevent unplanned pregnancies and the lawmakers in California agree! A law was passed that is getting ready to rock how you get your birth control in a big way. Starting towards the end of 2015, your local pharmacist can start providing you with more effective forms of birth control in the pharmacy (the pill, the patch, the ring, and the shot)!

This means that you would be able to get your birth control without worrying about making a doctor’s appointment or clinic visit. (Side note: Getting checked out by a doctor regularly is really important! ESPECIALLY, if you are sexually active. It just shouldn’t prevent you from getting effective birth control!) Now if you need birth control you are going to have choices – the doctor’s office, your local family planning clinic, or your local pharmacy!

Who can get birth control at the pharmacy?

First of all, all you ladies out there can use it! Women of all ages — including teens — will be able to use this service. You also don’t need to have insurance or an ID card to get birth control. In California, minors can consent to medical care for the prevention or treatment of pregnancy without parental permission. In fact, legally the pharmacist cannot disclose any information to your parents without your written permission. Of course we know that your parents had sex at least once (hey, you’re here right?) so they probably know a thing or two about sex and birth control. So if you feel comfortable you can always chat with them about any questions you might have and they are welcome to come along to the pharmacy. We know teens like their privacy too; so just know if you don’t want to tell them, we won’t either!

How does pharmacy access to birth control work?

So here’s how it works. It is kind of like when you go get a flu shot from the pharmacist (if you don’t do that you totally should!). You fill out a health screening questionnaire and get your blood pressure taken to make sure that it is safe for the pharmacist to give you birth control and that’s it! The pharmacist will review your questionnaire and talk you about which methods of birth control would be safe for you to use. Then you can discuss how each method works and pick which you like best. The pharmacist will then provide you with birth control supplies just like you would get with a doctor’s prescription and you are good to go.

Keep in mind that not all pharmacies will be providing this service right away. It’s always a good idea to give the pharmacy a quick call to find out if they do before you go in.

How much will this cost me?

There will probably be a small service fee for the screening. This is different than the cost of the medication. If you do have insurance, you will most likely be able to get your prescription filled with no copay. (Thanks Obama!) If you are under your parents insurance, the insurance company might send your parents documents about what you got from the pharmacy. If this is something that you want to keep private, consider filling out a “confidential communication request” for your insurance company. See www.myhealthmyinfo.org for more information and a copy of the form.

What if I don’t live in California?

Basically, this new law is very exciting in the word of birth control. Hopefully once the other states see how much it has helped in California they will follow suit! So if you don’t live in California keep your eyes out changes to come!

What are some trusted sources for more info about birth control methods?

If this gets you excited about birth control, check out these helpful links to help you learn about different methods! These are really cool resources for teens and they break down all the pros and cons of each method. Bedsider includes videos from guys and girls talking about the experiences they’ve had with each method. On their website you can also sign up for text reminders for clinic appointments or to remind you to take your birth control pills, patch, ring, or shot. Planned Parenthood has an interactive quiz to let you know which methods might work best for you. They’ve even got info just for teens.

How can I get my questions answered?

Check out our new resource page just for teens!  If you have any other questions about your sexual health or anything pharmacy related you can submit your question anonymously. Your question will be answered by Dr. Sally Rafie, PharmD, who is a pharmacist and is very passionate about sexual health and how pharmacists can help!


Courtney HeadshotAbout the Author: Courtney Miller just finished her first year of pharmacy school at the University of California San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences. She is from the central valley which has the highest rates of teen pregnancy in California so this topic is very close to her heart!

My Personal Journey from “Choose Life” to “Choose Control”

I am a pharmacy student at UCSD and if you would have told me one year ago that I would be spending my summer advocating for adolescent reproductive health I probably would have laughed.

My Conservative Background

You see, I was born and raised in the central valley in California, in a conservative community, in a conservative Christian home. I was raised to value human life, including the unborn. You could (and should) call me pro-life. However, during the winter quarter of my first year in pharmacy school, Dr. Sally Rafie, PharmD gave us a lecture about emergency contraception that really impacted me. She shared some staggering statistics. You see, in the United States over 50% of pregnancies are unplanned. Of those unplanned pregnancies, 40% are going to end in abortion. That’s about 20% of all pregnancies in the U.S. But it was her next comment that really struck me and got me interested in this topic, “if we are ever going to decrease the number of abortions, we have to decrease the number of unplanned pregnancies.” That was a lightbulb moment for me.

Courtney Light Bulb Birth Control Sally Rafie

Why I Care About Teens and Family Planning

This summer I have the privilege of doing a project with Dr. Rafie on pharmacists’ growing role in reproductive health services for adolescents. Teen pregnancy in the U.S. is at an all-time low of roughly 26 births per 1000 teens. Now this sounds like a pretty good statistic right?  Less than 3% of teens are actually having babies every year (of course even more are getting pregnant)!  Until you consider the fact that is one of the highest teen birth rates among developed countries and places like the Netherlands have only 5 births per 1000 teens. That means 5 times as many teens are having babies here in the United States. In the central valley where I grew up, our rates are well above the national average and some counties (like Tulare) nearly double it. Obviously what and how we are teaching our teens about and the access that they have to birth control services is not working.

Studies have repeatedly shown that increasing knowledge of and access to birth control methods and services does not increase the number of teens having sex or even how often or with how many people they have sex with. The only statistic that it affects is the number of teens having safe sex and the number of teen pregnancies and teen births. Studies have also revealed that abstinence-only education is ineffective in decreasing the number of teen pregnancies. When we as conservative Christians fight to implement abstinence-only educational programs in schools and limit teens’ access to information and birth control methods, we are contributing to the number of teen pregnancies, the number of abortions, and the number of teen parents and children in the foster system. That is not a statistic that I want to be a part of. Additionally, unless parents know for 100% sure that their child will be living a life of celibacy, family planning education will be valuable to them at some age even if they remain abstinent until marriage. It can also be helpful for teens to share information with their friends who could benefit from accurate knowledge about birth control.

What I’m Doing About It

A new law was passed in California that will allow pharmacists to provide hormonal birth control directly to patients in pharmacies regardless of age. My project this summer is focused on teen girls to see if this is a service that they are interested in and how pharmacies can serve them best. This project will be very important in helping pharmacists prepare to meet the needs of adolescents in their communities as this new program is rolled out.

If you have questions about any of the statistics I discussed or you just want to know more about my research please feel free to contact me. As you might have guessed, this is something that I feel very passionate about and I would love to discuss it with you more.


About the Author:  Courtney Miller just finished her first year of pharmacy school at the University of California San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences. She is from the central valley which has the highest rates of teen pregnancy in California so this topic is very close to her heart!

Ask Dr. Sally: What Can I Do For Endometriosis Symptoms Since My Birth Control Refills Ran Out?

I was diagnosed with endometriosis 6 years ago and my symptoms improved by taking Beyaz birth control.  My doctor unexpectedly closed her office last month and I have been unable to refill my prescription.  I’ve been off the birth control pills for 3 weeks and I’m experiencing difficult side effects including dizziness, headaches, cramping, and fatigue.  I am not happy with how extremely my body is reacting to the hormonal change.  I would like to try different ways to treat the symptoms of my endometriosis.  I would LOVE to hear more about my options to manage my current symptoms and long-term pain management.

Endometriosis Birth Control Sally Rafie(photo credit: Growley-Ferret via Flickr)

Up to 10% of reproductive-age women have endometriosis, a condition where the endometrial tissue typically found in the uterus exists outside the uterus.  Endometriosis can have a range of symptoms and you’re clearly experiencing some intolerable ones.  Women may experience pain in many forms…just before and during their periods, with bowel movements, with urination, with sex, or general pelvic or back pain.  As many as 1 in 5 women who have endometriosis will experience infertility.  Since you are not trying to conceive at this time, the treatment will be focused on reducing your pain and other related symptoms.

Using A Pain Reliever

To alleviate some of the pain, over-the-counter anti-inflammatory medicines, such as ibuprofen (Motrin, Advil) or naproxen (Aleve) can be taken.  This helps reduce the inflammation that may be contributing to the pain.  These medicines should be used and not acetaminophen (Tylenol) because that works in a different and in this case, less effective, way.  Talk to your health care provider about appropriate dosing since you may need more than what is typically recommended for these over-the-counter medicines.

Manipulating Hormones

To really get at the root of the problem and regulate the hormones, we have to manipulate the hormones by taking hormones.

Birth Control Pill

The first step is to try a hormonal birth control such as a birth control pill with a combination of estrogen and progestin hormones.  When taking a combination birth control pill, eventually the endometrial tissue stops building up.  Talk to your health care provider about which formulation would be best for you.  Typically, a formulation that is progestin dominant and contains a more androgenic progestin will be most effective.  The pills should be taken continuously, and the inactive placebo pills skipped, to get the maximum benefit of reducing pain.

Beyaz is similar to Yaz, a popular birth control pill, with added folic acid (to prevent neural tube defects in case of pregnancy).  While this formulation is progestin-dominant, it is not an androgenic-progestin.  An alternative to try would be to try Loestrin 1/20 or Microgestin 1/20.

Birth Control Shot

Another form of birth control that can help relieve symptoms of endometriosis is the injectable shot, known as DepoProvera (depot medroxyprogesterone acetate).  This shot is given only once every 3 months.

Birth Control IUD

The Mirena intrauterine device releases a progestin hormone to alleviate the painful symptoms of endometriosis similarly to the birth control shot.  The hormone is released locally in the uterus and therefore has fewer side effects such as weight gain and bone loss.  This is also a highly effective form of birth control that, once inserted, works to prevent pregnancy for five years.

Oral Progestin Hormones

If you are not interested in preventing pregnancy while treating endometriosis or this treatment doesn’t give you enough relief, there are other options.  Pills with higher doses of progestin hormone can be used and work similarly to prevent buildup of endometrial tissue.  Side effects may include weight gain and breakthrough bleeding.

Gonadotropin-Releasing Hormone Agonists

These medicines last much longer than the other hormones.  This is a good option for women who did not respond to birth control pills.  These medicines, known as nafarelin nasal spray (Synarel), leuprolide shot (Lupron Depot), and goserelin shot (Zoladex), work by reducing estrogen levels in the body, creating a state similar to menopause.  This medicine has some uncomfortable side effects (see previous post).  Combination estrogen and progestin hormones or progestin alone can be added on to manage these side effects.

Danazol

This is a derivative of the hormone testosterone and was the first treatment actually approved for endometriosis.  It works by counteracting estrogen and comes along with the effects of testosterone, such as unwanted hair growth, mood changes, acne, and deepening of the voice.

Surgery

Surgery is the closest thing to a permanent fix to this problem.  Although one surgery may not be enough and we always have to weigh the risks of surgery with the benefits.

Problematic tissue can be treated by laparoscopically visualizing the lesion and either removing it or ablating it with a laser.  For more severe endometriosis, there are other procedures to interrupt nerve fibers.

Women who are not planning to become pregnant can consider a hysterectomy to remove their uterus, potentially along with the ovaries.  This basically puts a woman in menopause, so there are other symptoms to manage there.

Natural Options

There are some natural options that may help cope with a minimal or mild form of this condition.  See the list in a recent post on this subject.

I hope this information is helpful and guides the discussion with your healthcare provider.

Got a question? Send it to us.

— Dr. Sally Rafie

This is for informational purposes only and is not a substitute for medical advice, diagnosis or treatment, and is not meant to replace a one-on-one relationship with a healthcare provider.

Look For These 5 Features When Choosing A Pharmacy For Your Birth Control

When it comes to picking a pharmacy for your birth control — whether you are buying something over-the-counter or filling a prescription — we are inundated with choices.  There are probably as many pharmacies in your neighborhood as there are coffee shops.  Everything from your corporate chain pharmacies (think CVS or Walgreens) to grocery store pharmacies (Vons, Ralphs) to big box pharmacies (Costco, Walmart, Target) to independent pharmacies (YourStreet Pharmacy, Sally’s Drugs).  There are a couple of other options too.  We can’t forget about mail order pharmacies and online pharmacies.  So how do we pick one?

There are a couple of features to look for.  These can be applied to other medications beyond birth control too.

#1 – Privacy  

Is there a private area where you can discuss your confidential medication and other health issues with the pharmacist?  We have all overheard awkward conversations between the pharmacy staff and the person in front of us in line.  The dividers on the counter don’t cut it.  It doesn’t have to be this way.  Some pharmacies are making the effort to have a private room or at least a private cubicle to meet with you.  

Target Pharmacy Counter

(Photo credit: Random Retail via Flickr)

Does the pharmacy guarantee your personal health information will not be shared with family members or others without your permission?  There are laws protecting your personal health information but that doesn’t always mean you’re safe.  A lot of people send their loved ones to the pharmacy to pick up their medications or ask a question, so the pharmacy is used to sharing information.  But if you want your records to stay private, ask about their privacy practices.  

#2 – Knowledge

The pharmacy exists for two reasons.  One is to get you the medication supplies you need.  The other is to make sure your medication will be safe and effective for you — essentially serving as a second set of eyes on your doctor’s prescription.  Birth control is not one-size-fits-all.  Pharmacists add an important layer of safety to the risky business of using medications.  You want to be sure your pharmacist is knowledgeable about birth control and everything that goes with it, like the menstrual cycle and sexual health.  

Birth control is amazing.  It prevents unwanted/unplanned pregnancies and does wonders for some mood disorders, making periods lighter and less painful, getting rid of acne, and so much more.  It’s not without its side effects.  As with all other medications, it’s a balancing act of the risks and benefits.  In most cases, the benefits outweigh the risks.  But you want to be sure your pharmacist warns you about the risks –there are some rare yet serious complications.  Many women give up on birth control because of more benign side effects like spotting, hair growth, decreased sex drive, weight gain, etc.  A pharmacist who knows birth control can use this information to recommend a different birth control formulation that will give you less grief and helps you plan if/when you want a baby.

#3 – Service

What services does the pharmacy provide that might add value to you as the patient or client?  Check if they can auto-refill your prescription.  Some pharmacies may be able to call/text/email you when your prescription is ready for pick up or when you’re due for a refill to see if you want them to process it.  Ask if the pharmacy can reach out to you when you are due for vaccines or other preventive health check-ins like STD testing.  

Perhaps you’d like to make an appointment to discuss your birth control or other health/medication issues with your pharmacist.  If this is an available service, does the pharmacy have an online scheduling option?

Is your pharmacy willing to go to bat for you?  This may mean playing phone tag with your doctor to get your prescription just right.  Or spending time convincing your health insurance company that you need this method of birth control or whatever medication and that the insurance company should pay for it (so you don’t have to).  See if your pharmacist has collaborations with other nearby health care providers and refer you as needed for related services like a pap test, pelvic exam, or breast exam (note: these are not needed for birth control, but help screen for cancer).

#4 – Convenience

Is the pharmacy convenient for you?  And I included you because we are each looking for something different.  Would it more convenient if the pharmacy was near school, near work, or near home?  Would you prefer they are open on weekdays or weekends?  Mornings or evenings?  Don’t forget to consider the parking situation.  

In this century, it’s not just about getting to the physical location anymore.  Does your pharmacy send you through an automated phone maze or is it easy to get through to someone who can help?  Can you email or text your pharmacy?  Do they accept refill requests online?

Now think about what the pharmacy can offer you to make it even easier.  Do they offer delivery or shipping services?  A small fee could well be worth the added convenience.  Your time and effort is money…and there’s the cost of gas too.

Does the pharmacy have other items that you can conveniently grab or have delivered/shipped?  Maybe you want to pick up a Mother’s Day card (hint hint, it’s just around the corner).  Or you’d like to pick up a thoughtful gift for your roommate.  Or you just need to stock up on the basics — we all need to brush our teeth  and use deodorant right?

#5 – Trustworthiness

This is somewhat of a catch-all for for the remaining things you should be looking for.  First, is the pharmacy legitimate and licensed?  Your neighborhood pharmacy will be but what about the anonymous people operating the online pharmacies.  Are the pharmacists licensed with their state board of pharmacy?  Does the pharmacy have a license/permit?  Are they getting the medications from a trusted wholesaler or could they be off-market?  The integrity of a medication cannot be trusted if it touches an off-market wholesaler.  You do not want to be fooled by counterfeit medications.  There’s a fantastic book on this topic.

Why isn’t cost on the list?

Medication prices are controlled much higher upstream and the pharmacies may not have much input on the matter.  The drug wholesalers set prices and insurance companies dictate how much the pharmacy gets reimbursed for dispensing prescription medications.  Oftentimes, pharmacies are actually losing money on some of the prescriptions they fill.  When the pharmacy’s costs and reimbursements are controlled by these outside factors, so is the cost to you — the patient.  Your copay will be the same regardless of which pharmacy fills your medication.*  So you can let the other features listed above help you pick the pharmacy that meets your needs.

*Some health insurance plans have lower copays when using their mail order pharmacy.  So a 3-month supply may be given for the price of 2-monthly copays.  Some health insurance plans may have “preferred” pharmacies so using a non-preferred pharmacy could cost a bit extra.

We would love to hear about your experiences with different pharmacies.  Please add comments below!