Conditions and Management

The birth control patch is a convenient, discreet contraceptive method that you stick onto your skin. But how does it prevent pregnancy on a biological level? What’s happening inside your body when you wear this transdermal patch?

Let’s unpack the science behind it.

How the Patch Stops You from Ovulating

The combined estrogen and progestin in the patch suppress key hormones produced by your pituitary gland called gonadotropins. Specifically, they suppress follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

FSH and LH signal your ovaries to mature and release an egg each month—which is the process of ovulation. The patch hormones interfere with FSH and LH to shut down ovulation at its source. Without an egg, the sperm doesn’t have anything to fertilize.

In addition, the steady estrogen makes the mucus in your cervix thicker. This mucus acts as a barrier that keeps sperm from swimming up through your cervix. This prevents the sperm from reaching the uterus and fallopian tubes, where they could find an egg.

The progestin also causes changes to the uterine lining. It prevents the endometrium from thickening enough for an egg to properly implant. This three-pronged action is how the patch effectively prevents pregnancy.

Steady vs. Cyclical Hormone Delivery

The transdermal patch allows the hormones to be directly absorbed through your skin gradually over the week. This leads to more continuous, stable blood levels of estrogen and progestin.

With daily birth control pills, you get a large spike of hormones all at once that then decrease steadily each day before you take the next dose. So, pills cause more peaks and valleys in hormone concentrations.

The steadier hormone delivery of the patch helps minimize side effects related to fluctuating hormone levels. Many women report fewer issues such as breast tenderness, nausea, headaches, or mood swings compared to the pill.

However, the total estrogen exposure ends up being higher with the patch. This sustained absorption means your body is exposed to 60% more estrogen over the course of a cycle compared to pills.

How Potent Are the Patch Hormones?

Pharmaceutical companies determined the ideal dosing by testing which combinations of estrogen and progestin effectively stopped ovulation. Clinical trials showed that average hormone levels of around 0.6-1.2 ng/mL for progestin and 25-75 pg/mL for estrogen reliably prevent ovulation.

Your blood levels of both hormones stay within this target range all week long with the patch. There are no significant ups and downs.

Factors such as heat, humidity, exercise, or contact with water don’t substantially impact the absorption from the patch. Your hormone concentrations remain stable in various conditions.

When the Patch Starts and Stops Working

It takes about two weeks of wearing a fresh patch constantly for your hormone levels to build up to effective ovulatory-suppressing concentrations.

So you’re protected from getting pregnant after having your first patch on for one full week. Backup contraception such as condoms is suggested for the first week just to be safe.

Once you stop using the patch, your estrogen and progestin levels return to your normal baseline within a month. Ovulation resumes, and you’re able to get pregnant again. This reversibility is a major benefit of the patch.

In clinical trials, the birth control patch was proven very effective when used correctly. Less than 1 out of 100 women got pregnant over a year. But with typical use, the failure rate rose to around 9 out of 100.

Proper weekly application is essential. Using backup protection is wise if you ever forget to change your patch on time or if the patch falls off.

Side Effects and Health Considerations

Since you’re getting regular doses of estrogen, the patch can cause some estrogen-related side effects. Many of these go away once your body adjusts within the first three months.

Common symptoms include breast tenderness, nausea, headaches, spotting between periods, and skin irritation where the patch is stuck. Mood changes, fluid retention, decreased sex drive, or weight gain may also occur.

About 20% of women get skin reactions at the application site. This side effect motivates some users to stop the patch altogether. Switching locations each week minimizes skin irritation.

A serious concern is the increased risk of blood clots in the legs or lungs compared to birth control pills. The patch elevates clotting risk about twofold. However, the overall likelihood is still low in healthy women.

Those over age 35 who also smoke should avoid using the patch due to their higher baseline clotting risk. Estrogen further amplifies this risk significantly.

The patch may also not be an option for women with health conditions such as high blood pressure, obesity, diabetes, migraines, or depression. Certain medications can interact and make the patch less effective, too.

Your doctor will consider your medical history and assess whether the benefits outweigh the potential risks for you personally.

Figure Out If the Birth Control Patch Is the Right Choice for You with Raleigh Gynecology & Wellness

The birth control patch provides a unique hormone delivery method that many women find convenient and comfortable. While the risks of blood clots and other side effects should not be ignored, the patch remains an effective, reversible option for pregnancy prevention in healthy women.

If you’re interested in trying the patch or have any concerns about potential side effects for your health, Raleigh Gynecology & Wellness’s experts are here to help you.

Contact us today at (919) 636-6670 or schedule a consultation online, and our team will help you determine if the patch is the right fit for your needs and preferences.

Intrauterine devices (IUDs) have become an increasingly popular birth control option for many women. IUDs are small medical devices in the shape of the letter “T” that are placed in the uterus by a doctor to stop you from getting pregnant.

There are two main categories of IUDs available in the U.S., namely hormonal IUDs and nonhormonal copper IUDs.

However, as is the case with any medical apparatus, IUDs present certain potential complications and risks you need to know about. Understanding the more common IUD complications can help you identify any issues early and know how to handle them.

Expulsion

One of the most common IUD complications is expulsion, which is when the IUD partially or completely falls out of place in the uterus. This occurs in about 2-10% of IUD users, with most expulsions happening within the first three months after insertion.

You may not have obvious symptoms if your IUD is expelling, so it’s important to check your IUD strings regularly. The strings are the thin plastic threads attached to the IUD and that hang down into the vagina through the cervix after the device has been inserted.

If you feel the hard plastic of the IUD itself at the cervical opening or the strings seem longer, this could indicate expulsion.

Expulsion is more probable if you have heavy periods or severe cramping, which can essentially push the IUD out. Not having delivered a baby vaginally also raises the risk. Teens and young women are at a slightly higher risk as their uteruses are smaller.

Partial expulsion is more concerning, as the IUD can become less effective even though it still appears in place.

If you suspect your IUD has moved, see your doctor immediately. They can confirm expulsion through an ultrasound or physical exam. A partially expelled IUD must be removed and replaced if you want ongoing pregnancy prevention.

Infection

There is a slight risk of developing pelvic inflammatory disease (PID) when you first get an IUD inserted. PID is a condition in which your fallopian tubes, uterus, or ovaries get infected. The overall risk is less than1% and primarily occurs within the first 20 days after insertion.

PID risk comes from bacteria being introduced during the insertion process. You have a higher chance of developing PID if you already suffer from a sexually transmitted infection (STI) that hasn’t been treated when the IUD is placed. Using condoms along with the IUD can help reduce PID risk.

Symptoms include severe pelvic pain, fever, unusual vaginal discharge, and pain during sex. PID requires antibiotic treatment. In rare cases, PID can lead to scarring and impaired fertility if left untreated.

After the first month, IUDs do not increase PID risk. Any later infections are likely from STIs acquired through sex rather than the IUD itself. Seeing your provider promptly for testing if you develop PID symptoms is key.

Perforation

Perforation refers to a situation in which the IUD pierces the wall of the uterus. This complication is rare, occurring in about 1 to 2 out of every 1,000 IUD insertions.
If perforation happens, it typically occurs during the insertion.

The provider may then be able to remove the IUD immediately if they notice. Or the IUD may migrate outside the uterus within the first couple of months after insertion. An IUD that perforates can damage other organs and require surgery for removal.

Having a perforation is more likely to occur if you are breastfeeding or if it has been less than six months since you gave birth due to the enlarged uterus. Perforation risk also goes up if you have fibroids that change your uterus’ shape.

Symptoms include severe pelvic pain that lasts more than a few days after insertion and possibly fever or unusual discharge. Let your provider know if you have severe or persistent pelvic pain so they can check for perforation.

Missing or Lost Strings

Many IUD users are advised to periodically check that the thin plastic IUD strings can be felt protruding from the cervical opening. But sometimes, the strings can seem to disappear, which is known as having missing or lost IUD strings.

This happens in around 2-10% of IUD users. It is not necessarily indicative of the IUD falling out. More commonly, the strings get tucked into the cervical canal or curled around the cervix. An ultrasound or x-ray can often locate the IUD.

If strings are not palpable, it’s important to visit your healthcare specialist for an examination. They can determine if your IUD is still in the proper position by using an exam or imaging techniques. If it has moved or partially expelled, it must be removed.

Rarely, missing strings may indicate perforation or expulsion. But in most cases, the IUD is still effective and in the right spot.

Changes in Menstrual Bleeding Patterns

It is common to experience irregular bleeding and spotting, especially in the first 3-6 months after IUD placement. This often improves over time.

Hormonal IUDs such as Mirena, Kyleena or Skyla can lighten periods or lead to no period at all. On the other hand, the nonhormonal ParaGard copper IUD often causes heavier bleeding and worse menstrual cramps.

Talk to your healthcare provider if you have heavy or prolonged bleeding that is concerning, as it may indicate improper placement or a complication such as expulsion. They can also suggest medication options to help regulate or reduce bleeding patterns.

Get Personalized IUD Guidance from Raleigh Gynecology & Wellness

While IUDs are very effective birth control options for many women, being aware of potential complications can help you make the best decision for your needs. Openly discuss any concerning symptoms that may arise after getting an IUD with your doctor.

Don’t hesitate to request a second opinion if needed. The risks of complications are low with proper insertion and follow-up care from an experienced provider.

Raleigh Gynecology & Wellness specializes in IUD insertions and management. Our team stays up-to-date on the latest IUD recommendations to provide the highest quality care.

We’re happy to address any questions or concerns you may have about IUDs and help you determine if it’s the right contraceptive choice for your lifestyle and health needs. Contact us today at (919) 636-6670 or schedule a consultation online to learn more about the benefits and potential risks of IUDs for pregnancy prevention.

The vaginal ring is a popular hormonal birth control method that steadily releases progestin and estrogen into your system. This stops you from ovulating and thickens your cervical mucus to prevent sperm from reaching an egg.

The flexible plastic ring is inserted into the vagina, where it stays for three weeks at a time before being removed for a break of one week. If you use the vaginal ring as prescribed, it is over 99% effective at preventing pregnancy.

But to maintain this high efficacy, you must know how to properly remove the ring after the 3-week period. This straightforward process only takes a minute once you understand the simple steps.

When to Remove the Vaginal Ring

The vaginal ring works on a 28-day cycle. You insert a ring and leave it in for three weeks straight. Then, you remove the ring the same day you inserted it (21 days later). This is followed by a 1-week pause before starting a new ring.

For example, if you insert a new ring on Sunday the 1st, you would remove it on Sunday the 22nd. Your weekly ring-free break lasts from Monday the 22nd through Sunday the 28th.

On Sunday the 29th, you would insert the next ring to start the cycle again. It is essential to take the ring out after exactly 21 days of use. Leaving it in longer than the recommended three weeks makes it less effective at preventing pregnancy.

Step-by-Step Guide to Removing the Ring

Removing the vaginal ring is a quick and simple process. With a bit of practice, it should come right out painlessly. Here is a step-by-step guide:

Before Removal

Wash your hands with water and soap to prevent transferring bacteria into the vagina.

Removing the Ring

• Get comfortable. You can stand with one foot raised on the toilet seat or sit on the toilet.
• Reach up into your vagina with your pointer finger. Feel around the upper vaginal wall until you locate the ring.
• Curl your finger slightly and hook it under the edge of the ring. You should be able to feel the entire ring with your fingertip.
• Gently pull down and forward. The ring should slide smoothly out of the vagina. Don’t apply force if you encounter resistance.
• The removal should not hurt at all. If you experience any pain, stop and go to your gynecologist.

After Removal

• Put the used ring back in the foil sleeve it originally came in. Then throw the pouch away in the garbage – do not flush it.
• If desired, rinse the ring with cool water before throwing it away.
• Your 1-week ring-free break now begins. You may get your period during this time.

Inserting a New Ring

• After exactly seven days, insert a new ring on the same day you removed the previous one.
• Use a backup method, such as condoms, for the first week of the new ring. The hormones take time to become effective.
• Follow the same steps to insert the new ring as you did the first time. Push it gently into the vagina until comfortable.

Troubleshooting Ring Removal

For most women, removing the vaginal ring is uncomplicated. But, issues can occasionally arise. Here is what you should do if you run into problems:

Forgot to Remove on Time

If you leave the ring in for up to 7 days past the 3-week mark (up to 4 weeks total):

• If you planned a ring-free week, remove it as soon as you remember and start your break.
• If you planned continuous use without a break, remove the old ring as soon as you remember and put a new one in right away.

You remain protected against pregnancy in both cases and don’t need backup contraception. But leaving the ring in for more than four weeks in a row makes it much less effective.

Ring Stuck Inside

If you cannot grasp the ring with your finger to pull it out:

• Stay calm and relax your muscles. Anxiety can cause tightening that makes removal harder.
• Try squatting or bearing down as if having a bowel movement. This helps push the ring lower in the vagina so it is easier to reach.
• Wait a few hours and attempt the process again. The ring cannot get lost or go too far up.
• If you still cannot remove it, call your gynecologist for an in-office visit. They can safely remove the ring.

Ring Falls Out

The ring can sometimes partially or fully slip out during sex, while using the bathroom, or with straining. If this happens:

• Rinse the ring in cool water and reinsert it as soon as possible if It’s been out for less than 3 hours.
• If it’s been out for over 3 hours in weeks 1 or 2, reinsert the ring and use backup contraception for seven days.
• If it’s been out for more than 3 hours in week 3, dispose of the ring and use a backup method of birth control. Insert a new ring no later than 7 days after the previous ring was removed or expelled.
• Pay attention to symptoms such as cramping or bleeding, which could signal expulsion. See your doctor if you are concerned.

Master the Vaginal Ring with Assistance from Raleigh Gynecology & Wellness

Properly inserting, using, and removing the vaginal ring is essential for it to work effectively as your contraceptive method. While the process can seem complicated at first, it becomes second nature for most women with some practice.

If you have concerns about using the ring or have problems, don’t hesitate to consult your gynecologist. The Raleigh Gynecology & Wellness team can walk you through all aspects of the vaginal ring, from insertion to removal.

We’ll make sure you feel comfortable with this convenient monthly contraceptive. Contact us today at (919) 636-6670 or schedule a consultation online to discuss whether the vaginal ring is right for you, and we’ll provide the guidance you need every step of the way.

With the array of birth control options at our fingertips today, it’s no wonder many women feel overwhelmed when choosing the best method for their needs. There are many factors to consider, from implants and IUDs to patches and rings. But among hormonal contraceptives, one underrated option stands out for its stellar benefits: the progestin-only pill.

Let’s explore five compelling reasons progestin-only pills deserve a top spot on your list if you want practical, reversible family planning.

Reduced Risk of Blood Clots

Traditional combo birth control pills include estrogen and progestin. Estrogen increases blood clotting factors, which raises the risk of developing dangerous clots compared to not using hormones.

The risk of blood clots is small in otherwise healthy women, but those with certain medical conditions such as inherited blood clotting disorders and smokers over 35 are at higher risk and should avoid estrogen-containing birth control.

Progestin-only pills avoid this risk by excluding estrogen entirely. This reduces the risk of complications such as deep vein thrombosis (DVT) or pulmonary embolism – threats that can become fatal if a clot travels to the lungs.

Clots usually start in the deep veins of the legs before breaking off and moving to the lungs, obstructing blood flow. Chest pains, leg swelling/pain, shortness of breath, and similar issues might indicate a clot.

Those prone to clotting or with a family history have higher risks from the estrogen in combination pills. Progestin-only options let these women access birth control without increasing clot odds.

No More Estrogen-Related Side Effects

The estrogen in combination pills can trigger unpleasant side effects such as breast tenderness, nausea, headaches, and mood swings. By avoiding estrogen altogether, progestin-only contraceptives let women dodge these bothersome symptoms.

Without estrogen peaks and dips every month, progestin-only pills promote hormonal stability day-to-day. This may lead to more even moods, comfortable breasts, and calm digestion for improved well-being.

Preventing estrogen-related discomforts makes progestin-only birth control an excellent choice for healthy women who want to avoid disrupting their lifestyle.

A Safe Harbor for Estrogen-Sensitive Women

Certain conditions warrant avoiding estrogen-containing medications. For instance, women prone to migraines with aura should avoid combination pills with estrogen due to increased stroke risks. Women with uncontrolled hypertension or significant risks for heart disease should also avoid estrogen containing birth control.

In these cases, progestin-only pills offer a safe harbor for women needing contraception. The total lack of estrogen lets women with these sensitivities access effective birth control without compromising their health or exacerbating their condition. For optimal outcomes, progestin-only pills support women who prefer estrogen-free contraception.

Worry-Free Breastfeeding

New moms who choose to breastfeed often worry about selecting postpartum birth control. Estrogen-containing combination pills can interfere with milk production and have potential developmental effects for nursing infants.

Progestin-only options avoid these concerns by excluding estrogen. The progestin hormone used in these pills transfers only minimally through breastmilk, allowing moms to nurse their babies without worry.

For women seeking effective birth control after giving birth that also preserves healthy breastfeeding, progestin-only pills thoughtfully check all the boxes. Mothers can relax knowing their infants receive the ideal balance of nutrients in their milk, even while taking these pills.

Discover Your Personalized Birth Control Options with Help from Raleigh Gynecology & Wellness

With so many birth control options to evaluate, it can be challenging to identify the best fit for your needs and priorities. But as you can see, progestin-only contraceptives offer compelling benefits, making them worth a close look.

By avoiding the risks and unpleasant side effects of estrogen while providing a safe yet effective approach, progestin-only pills are advantageous for many women. Their gentle formulation also enables worry-free breastfeeding and safe contraception for women who cannot use estrogen.

The Raleigh Gynecology & Wellness team has extensive experience guiding women to contraceptive solutions that align best with their needs. Contact us today at (919) 636-6670 or schedule a consultation, where we can explore if progestin-only pills may be right for you.

Several effective hormonal birth control options contain progestin but no estrogen. These progestin-only contraceptives include injections, implants, pills, and certain intrauterine devices (IUDs).

Let’s look at the unique benefits of progestin-only birth control pills, sometimes termed “mini-pills.”

What Are Progestin-Only Pills?

Progestin-only pills are oral contraceptives that contain progestin without estrogen. They come in 28-day packs. These pills are termed “mini-pills” because the amount of progestin in each active pill is lower than in combination birth control pills, which contain estrogen and progestin. The mini-pill contains only the hormone progestin at a relatively low dose.

How Do Mini-Pills Prevent Pregnancy?

Mini-pills prevent pregnancy through three key mechanisms:

• They thicken the mucus in the cervix to block and trap sperm, preventing passage through the cervix into the uterus.
• They provide inconsistent ovulation prevention – around 4 out of 10 mini-pill users will still ovulate sometimes. However, the thick cervical mucus prevents sperm from meeting and fertilizing the eggs.
• They thin the uterine lining, making implantation of an embryo extremely difficult or unlikely.

Taking the mini-pill at precisely the same time daily helps ensure the cervical mucus remains thick. Taking it more than 3 hours late, or missing pills altogether, allows the mucus to thin out. This could permit ovulation and sperm passage into the uterus to occur.

What Are the Benefits of Mini-Pills?

When taken exactly in line with the recommendations, mini-pills prevent pregnancy effectively, with less than 1% of women getting pregnant in the first year of ideal mini-pill use.

Mini-pills do not affect breastfeeding or harm infants in any way. This makes them a good birth control choice for postpartum women, allowing new mothers to prevent pregnancy without interrupting breastfeeding.

Some women experience much lighter menstrual periods or no periods when taking mini-pills. For those who normally have heavy, painful monthly bleeding, this relief can be substantial. Mini-pills may help make periods lighter, shorter, and more manageable. Some women also appreciate eliminating monthly bleeding for convenience.

Mini-pills are safe for those who cannot use contraceptives containing estrogen due to health risks. Some conditions where estrogen poses dangers include:

• History of blood clots: The estrogen in combination pills increases clotting factors in the blood, which can be hazardous for women already prone to blood clots. Progestin has a lower clot risk than estrogen.
• Migraines with aura: Estrogen can exacerbate migraine headaches. In women who have migraines with neurological aura symptoms, taking estrogen may significantly increase stroke risk.
• High blood pressure: Mini pills are considered safe for women with hypertension.
• Liver tumors: Estrogen may cause or worsen the growth of tumors in the liver. Mini-pills are a safe oral contraceptive choice for these women.

Because they lack estrogen, mini-pills do not raise clotting factors or cardiovascular disease risk for users. This makes them a safer contraceptive choice for those who cannot take estrogen for medical reasons.

You can start mini-pills right after pregnancy without delaying the return of your fertility. You can get pregnant quickly after stopping mini-pills, as progestin has no lingering effect on ovulation.

What Are the Potential Side Effects?

Unpredictable spotting or bleeding between periods is the most common side effect women report with mini-pill use. You may experience frequent spotting or irregular bleeding that is difficult to predict. This abnormal bleeding pattern could persist over time.

Other potential side effects include nausea, headaches, and breast tenderness. These are usually minor and often resolve after a few months of mini-pill use.

With mini-pill packs containing four inactive pills, you may get your withdrawal bleeding during those inactive pill days. This allows for more predictable monthly menstruation.

Who Should Avoid Using Mini-Pills?

Certain women with particular medical conditions should avoid using mini-pills:

• Women with active liver disease: Progestin gets metabolized by the liver, so impaired liver function can be problematic.
• Those diagnosed with breast cancer: Progestin may adversely affect the growth of certain types of breast cancer.
• Women with unexplained uterine bleeding: The cause of bleeding should be investigated before progestin use.

You should thoroughly discuss your complete medical history with your doctor before using mini-pills. Women over age 35 who smoke should use caution with mini-pills, as the risks likely outweigh the benefits.

Consult Raleigh Gynecology & Wellness for Progestin-Only Guidance

Progestin-only contraceptives such as mini-pills can provide effective birth control and unique benefits for many women. If you think this progestin-only pill option may suit your needs, schedule a consultation with Raleigh Gynecology & Wellness.

Our team of experts can review your health history, discuss your preferences, and determine if mini-pills or other progestin methods are a good match for you. Contact us today at (919) 636-6670 or schedule an appointment online so we can help you take charge of your reproductive health with confidence.