Reproductive autonomy is a truly fabulous thing! Who would have thought.
Sara and Supraja detail all the ways not to get pregnant if you don't want to here.
Contraception (PART 1): the long acting reversible type.
Everything you want to know about IUDs (Paragaurd, Mirena, Liletta, Kyleena, Skyla), the impant (Nexplanon) and injection (Depo-Provera).
Listen up.
Reproductive autonomy is a truly fabulous thing! Who would have thought.
Sara and Supraja detail all the ways not to get pregnant if you don't want to here.
Contraception (PART 1): the long acting reversible type.
Everything you want to know about IUDs (Paragaurd, Mirena, Liletta, Kyleena, Skyla), the impant (Nexplanon) and injection (Depo-Provera).
Listen up.
Hi, I'm Sara
Supraja:and I'm Supraja, and this is Gyn& Tonic.
Sara:Welcome back to Intimate Convos with your besties.
Supraja:Hi Sara.
Sara:Hello.
Supraja:Hello. Thank you for the margarita.
Sara:I'm always so scared you're gonna spill it on my laptop.
Supraja:I'm always so scared. I'm gonna spill it on your everything. Are you kidding me? I like, can barely focus during this conversation cause I'm like, don't drop anything. Don't spill, don't. I'm like,
Sara:I'm you. Keep your hands over there.
Supraja:Is it only the laptop that you would defriend me for or anything else I should be aware of?
Sara:Uh, the couch I would need to replace, but.
Supraja:But our friendship would remain
, Sara:probably.
Supraja:We have to take a short break for
Sara:now.
Supraja:Okay. How are you?
Sara:I'm good.. Sipping this Margarita.
Supraja:I saw that you were watching some fun things on. Netflix via your Instagram where you document all the things you do every hour of the day
. Sara:I know people are always like, my Instagram is private for a reason cuz , I like post so much it's such like a therapy for me.
Supraja:Yeah. Your stories are really funny. Although I, I think it's funny, but I'm also like, Sara, you don't look like every male celebrity with long hair. Sara will like constantly post these photos of herself with like some random like Johnny Depp. And be like, twins. So they're like, what is that? What's that about?
Sara:Well, I did one that was like John Travolta from Saturday Night Live. What else did I do? Keanu Reeves.
Supraja:Yeah, like why
Sara:Lieutenant Dan? When my hair was short and humid
Supraja:I think that you look fabulous and. I think it's just fun.
Sara:I just, I just like, like to use Instagram as a way to like, you know, poke fun of myself and it's cute. Just so, yeah.
Supraja:It is like a weird thing to use social media to promote yourself or like your thoughts. I have a trouble, I have trouble with it cause I really love it, but then it's like, How much do I wanna lean into this of like trying to project a certain image of myself this weekend for example, I just posted a million shots of me in a bikini,, I don't know, it's a weird thing.
Sara:I love it though. Cause I feel like I connect with people and I love it when my friends tell me. I like always know what's going on in your life. I know. I feel like I don't have to catch up with you. And I like went on a few dates with this one guy who also mini ghosted me. I'm just kidding. He didn't a ghost, well, I don't know, whatever. That's another story. But we got into this heated conversation one time about Instagram and he was so anti it and the Kim Kardashians and stuff, and I was like,
Supraja:Oh, I remember you telling me about that.
Sara:Yeah. And I was so upset. Well, I wasn't, I didn't get upset. I obviously challenged him.
Supraja:You cried?
Sara:No, I didn't cry. No, I got heated. I was like, but I just remained calm. Oh, heated. Oh, I could tell he was getting annoyed too, but I was like, but I just think Instagram's such a, for the most part, can be a really cool way to connect with people. Even when I started skiing for the first time, it was so fun to have people reach out to me and I started skiing and hanging out with people I never hang out with. Yeah. And, or people will post about books or shows that I'm watching or I'm going on a trip and people will give me food. I just, I just like love it because I can connect with people and people know what's going on in my life.
Supraja:I know, I think we forget how new all of the social media stuff is, because I do, I see some of the points of , We're getting obsessed with validation or everybody's putting out just the best versions of themselves. Yeah. It's not even a real version. Like we all have a hundred different filters on blah, blah, blah, and it really warps your sense of reality. But I think the other side is true too, where it is this amazing platform for connection. I agree. I am still connected to so many people. I wouldn't be. Yeah. And that I genuinely want to be through it. And I also think never before have people felt so accessible in like all different parts of the world that you're exposed to all different types of people. So we'll get to a place hopefully where there's, it's more healthy and we lean into the positive things and kind of reflect on the things that might be warping with our brains.
Sara:I definitely post selfies, but I also post really fugly selfies too. Like I look disgusting today, like part two. I don't know, I just try to keep it balanced. Yeah. I don't know. It's like my blog, my diary, you know, I really enjoy it.
Supraja:Okay, we're supposed to talk about contraception part one. Today
Sara:I e. Birth control.
Supraja:Birth control. So we're gonna do two parts. The first part today is gonna be longer term contraception.
Sara:But reversible.
Supraja:But reversible. And maybe sometime in the future we'll do irreversible contraception, but that'll be a whole separate sitch
. Sara:Mm-hmm.
Supraja:long term contraception, that's reversible. Sara, what do you think of when we. Talk about that
Sara:IUDs and the implant that goes into your arm, Uhhuh, those are the first two that I always talk about with patients because they're the most effective but reversible. But I will talk about everything with patients.
Supraja:Same.
Sara:Like, let's talk about fertility beads. Just kidding. But we are gonna talk about it.
Supraja:Really. I can't wait to talk about it. I don't know anything about it. So listen to Sara when that comes up. So I agree. I think about IUDs, which are devices that go in the uterus and stay there for a number of years. Implants, like you said, the one that we use called an Nexplanon. And then I think Depo, which is the shot every three months, is kind of like an intermediary where it's sort of long acting contraception, but it's every three months so we can talk about a little bit about that too. And I found my life was changed when I got an IUD for so many reasons, like my prior habits. Highly, highly irresponsible.
Sara:Really? Oh, I'm such a maniac. I know. You would be good.
Supraja:No, I would like take a handful of birth control pills every time
Sara:I did that. One time I missed my pill. I was on the birth control pill for 10 years.
Supraja:Uhhuh.
Sara:I did really good on it, but that's cause I'm most psycho. No, because one time I looked at one of my friend's packets and it, it looked like it's a blister pack and there was literally , it looked like. Whatever those , um, like a whack-a-mole where like there were so many like irreg, like yeah. Where some pills were taken somewhere. Now I was like, what is happening here? Are you trying to get pregnant?
Supraja:My god. I would do that. I wasn't that crazy. I didn't just do like a random, week,
Sara:what's happening,
Supraja:but I, my is mine. Were just unused. And then every three months or so, I would take a handful. I was, but I did know. Then I was like, this isn't sustainable. I need an IUD and then I got one.
Sara:Well, the one time I did do that, I just, and I took two pills. One time I threw up and I've learned my lesson. I got just so nauseous from taking two pills at one.
Supraja:Oh.
Sara:But yes, so the IUD is nice. Well, in the sense that it is, you know, put it in place and then it is quite effective. It is not user dependent anymore.
Supraja:Yeah. And I'd say like that's the biggest sell, and that's what makes it so much more effective than a lot of the things that we do control, like the pill, for example, because it doesn't have the element of user error. Uh, okay. So there are multiple types of IUDs. Yeah.
Sara:So I always start by bundling 'em into two groups, hormonal, non-hormonal. Mm-hmm. Um, and so I'll talk about each one separately, but when we think about non-hormonal IUDs, we think about the copper IUD, also known as the paraguard IUD. And again, an IUD is just a T-shaped plastic device that either has. Copper wires or uh, ejecting a little bit of hormone every day.
Supraja:Mm-hmm
. Sara:Um, and then the way the copper ones work, it has a local effect that is essentially toxic to sperm, so they cannot survive.
Supraja:Mm-hmm.
, Sara:and it doesn't depend on hormones. You continue to have your regular cycles. So yeah, you'll still get a period every month. Yeah. It will potentially influence your period, but you still bleed every month.
Supraja:Yeah, and I'd say compared to other types of IUDs, the pros are last longer, so you can keep it in for 10 to 12 years. And that for people who have like an absolute contraindication to any type of hormone, it's a very effective type of birth control. The cons I'd say is like people will actually have a heavier period because of the copper IUD. But when you're prepared to know that your period, it might be worse. Like most people think it's a tolerable change. It's like tends to be people who didn't know that could happen, that are upset by it and want it removed. And that's usually the worst in the first year. So after the first year, it settles out a little bit. So then there's the hormonal IUDs a couple brands that make the doses, but we use the Mirena or Liletta, which is the one that has slightly more hormone in it. About 52 milligrams. A very similar T-shaped device can last for about eight years. And there's the Lina, which is 19.5 milligrams, lasts for about five years. And then the Skyla, the smallest one. It's 13.5 milligrams, , and lasts for about three years. So go ahead.
Sara:And when we say smaller, it's!Smaller by. Two millimeters in one length, four millimeters in the other direction. Yeah. So it's not like it's like half the size or something. It is a little bit smaller and can be helpful in certain patients, but it's not like it necessarily makes it easier to put in or more comfortable. Yeah, it's just a teeny bit smaller.
Supraja:Like originally was marketed for people who hadn't had babies before. The idea being. They might benefit from a smaller device, but then like we found that people's experiences are pretty much equal. Mm-hmm. So it doesn't really matter, um, the, the ways they work. Sara, so kind of similar, right?
Sara:So this IUD has one hormone in it, and it, the hormone is called progestin. It's the same hormone your body naturally produces every month. But essentially the way it works in a birth control method is it,, thins the lining of your uterus. So that, you know, every month the lining gets thicker to prepare for a pregnancy so that when an egg implants, after meeting sperm, that has this nice bed where it can support a pregnancy. But what the IUD is doing is it's essentially preventing that from happening. So the lining is actually quite thin and it makes it not a great place for an egg to implant. It also increases the amount of mucus in your cervix, and this is in your cervix. Nobody can tell what their cervical mucus is. I'm not talking about like vaginal discharge. You're not nec, not feeling like more discharge or anything. It's just cervical mucus way up at the end of the vagina. And then in some women it can keep them from ovulating
Supraja:mm-hmm. So when you ovulate, that sort of mitigates whether or not you have. Period every month. Um, along with some of the other things like the thinning of the lining and things, but that's why some people towards the end of their IUD lifespan will be like, oh, my period is back, because it's not doing as good a job of blocking the ovulation, but it's still very, very effective. The efficacy is actually the same for all eight of those years because it works through so many different mechanisms
Sara:and I tell people like, your symptoms might change year to year while you're on the IUD one year. You may have no bleeding the next year. You might have. Random spotting every few months. The third year, you might actually get regular spotting every month, like a cycle, and you might actually get periods back. Mm-hmm. And it can change from IUD, like I remember the first time I had my first Mirena IUD. No bleeding for the first few years, then second IUD bleeding every month. Like, it just varies. Yeah. And I tell people that like, it's not gonna always be consistent.
Supraja:Same.. People are always terrified of the insertion and then terrified of like potential complications. So, so how did you, we both have one right? Yeah, I'm like, I'm pretty sure you still do. Although for a while I feel like you were using every type of birth control. It's cause you're like, I have an IUD, I'm taking the pill. I'm like, it's I used seven condoms.
Sara:It's cause I started getting bleeding with my second IUD and initially it was very light. I didn't need to use anything. And then it started, I needed to use a tampon for the first time in seven years. I was like, what is this? What is this? I was like, I have to purchase a tampon. And I was like, horrified. Yeah. And so I put myself on the birth control pill. To suppress my period completely for a little while.
Supraja:Yeah. Which is a good point actually. Like I feel like the biggest benefit of my IUD has been that my periods are way better. Cuz I used to have like horrendous periods. Like I would wake up in the middle of the night like crying cuz it hurt so bad. Yeah. Yeah., it just was really painful
. Sara:Well, that's why I started birth control in the first place when I was 17, cuz I would be in like fetal position.
Supraja:Yeah. Which is not normal . Like people will try to tell you that having a so debilitating period is just like what it means to have a uterus. Not true. If your period like makes you call outta work, makes you cry, makes you like throw up, like not normal, may a lot of people have periods that are not normal, but still means you should talk to someone about it.
Sara:Yeah. So I was a med student. I was a fourth year med student.
Supraja:When you got yours?
Sara:When I got mine and I had already, I remember going to Planned Parenthood when I was 17 to get STI tested, and it was free,
Supraja:did your mom know?
Sara:No. Why do you think I went to Planned Parenthood? I gotta go through my insurance.. But I'm all about Planned Parenthood, so I went to get an IUD placed and so I was like, So nervous. Cause I knew kind of what to anticipate and I knew the steps. And so I made the PA at Planned Parent. I was like, tell me every step. Tell me when you're putting out the tac love. Actually it really wasn't that bad. Um, it really wasn't that bad. I think it is uncomfortable. It felt like a burning, cramping sensation for about, yeah. One minute and then it was over and I was like, I literally remember going home and I was like, I have an IUD. Aww. I was like so proud of myself. I was like, I was like, I'm so cool. I have an IUD. Yeah. The second time when I got an exchange, I really knew what was coming. And that was more uncomfortable. Um, and I remember myself like crawling up the table, the nurse practitioner I work with who's phenomenal is, you know, so good with me, but it's just, it, it is uncomfortable. Yeah. But it's so quick. It's like literally two minutes of.
Supraja:Although, I will say my, I had a very difficult IUD placement. Oh. Because they like couldn't get it in. Oh. They were like dilating, dilating, dilating. My friend was doing it. Of course, but her whole face just like turned white because she couldn't get it. Yeah. And then, yeah, it was, it was not fun. It was like painful. I would not say uncomfortable. I would be like, That hurt. Yeah. But it was wor, I love my IUD it took me a while to get used to it too. Like I had irregular bleeding, I had cramping probably for a month. I mean, it gradually got better and within a few months I felt normal. But it took a while. But I just really thought it was worth it. Like it was so much less anxiety. I don't have a period, so I, I am in so much less pain. I'm so much more. Just able to live my life.
Sara:I think it's a huge spectrum. Like I have patients who literally don't make a peep and they literally don't feel anything, and then others who you know, are like horrified by the discomfort. Yeah, most people fall in the middle and yeah, it's just uncomfortable for two, three minutes where you're actually putting it in.
Supraja:That's a good point more and more people ask me about pain control options. things that people will do are just taking ibuprofen, which I do tell people to take ibuprofen.
Sara:Yeah, I did that too.
, Supraja:Toradol, which is like an intense version of ibuprofen basically, you can do a paracervical block, which is where we inject numbing medicine into your cervix directly, which doesn't actually numb you, but it reduces the pain , and then you could potentially do it when you're asleep in the operating room. I kind of think I have mixed feelings, like it's all so fast that I sometimes think just the paracervical block makes the whole thing way longer, right? So I'm like, you're almost getting, you're gonna feel discomfort for longer if we try to do all these methods. I. Um, I guess the other thing I didn't mention is sometimes we'll place a cytotec beforehand with the idea that that opens the cervix and maybe makes it easier to place, which might also reduce discomfort. Again, none of these things have been proven to reduce discomfort, but I think different people have different experiences with it. And I do think in general, like the amount of discomfort that people with uteruses, are just expected to tolerate is kind of wild. That I am a little skeptical. Like, I'm like a skeptical of the, of the recommendation being like no one needs anything. I'm like, I've had a bunch of people without this are who decided that, you know? Cuz for some people it really does make a difference and some people do say like, I had a horrible experience and then I got medication with my second one and it was way better. So I think knowing like how exams have gone for you before, Knowing what amount of pain you're willing to tolerate is really important, and if you really know, like I want an IUD and I just could not tolerate that, like ask if you can do it in the OR. Or in a center where you're asleep.
Sara:I think it's also hard to study pain. Mm-hmm. It's just so subjective. Mm-hmm. And I agree. I would not want somebody to give me a paracervical block cuz it's gonna add five more minutes to this procedure. I don't wanna deal with that. I just want you to go as fast as possible. But that might not be somebody else's goal. Somebody else's goal might be, I don't care how much time we take, I'd want you to do anything that could theoretically help make this more comfortable. Sure, that's fine. Yeah. Um, but yeah, definitely wasn't the worst thing in the world. Worth every. Minute of discomfort. Um, cuz I literally have never worried about getting pregnant until my never, because I've just been so crazy about birth control. Yeah. I think the only time was before I started using birth control and I was only relying on condoms. That's when I was nervous about getting pregnant.
Supraja:Well that's a good point of, people do hear horror stories of like, oh someone got pregnant anyway. Someone had an ectopic . It does happen, but it's super rare. So the efficacy of an IUD is like over 99%. We think better than tying your tubes even so, like literally nothing is a hundred percent unless you never have sperm in there. But it's as good as it could possibly be. Yeah.
Sara:Yeah. It's very effective because the, it's not, again, relying on potential user error. Once it's there, it's there. But there are some side effects that have been associated with it., the most common ones are irregular bleeding. Which essentially means s. Bleeding outside of your scheduled period during a time you were not expecting. So you're like spotting two weeks after your period. Some people will even spot for two or three weeks while having the IUD. Sometimes this will happen after a Y. It just can happen whenever. But usually when you first put it in, it does get better for most people, but it's understanding that it may take three to six months to get better, or you might need another medication to help. Make this transition smoother before it does.
. Supraja:Okay. And then have you heard of this Mirena crash?
Sara:No. I literally just heard about it today for the first time.
Supraja:People keep asking me, Sara, about the Mirena crash cuz again, like there's some lawsuit about it where like you take your Mirena and people wanna sue for the experience they have. So I was trying to do a little digging cause I'm like, what is this? Everybody keeps being like, am I gonna have the Mirena? Crash. Like what happens? Because there's all this information about out there, about like how you might have, basically saying that when you remove the Mirena, you might have experiences like mood swings fatigue, bloating, weight gain, acne, headaches. Like basically you might feel like crap when the IUD comes out. And I was like, well that's kind of strange. Like why? Because it really is a mostly. Local thing and we don't, there's not a reason to really feel that way that you, you could. Measure. But, so what I was able to find is that it's very anecdotal, it's just like people's experiences coming off of it. Um, which does mean that some people might experience a version of that, but probably most people are not going to. And the reason that theoretical reason is just that your body gets used to your hormones doing one thing and there's a change cuz you're removing this hormonal device. So your body just js as adapting to having a different type of hormonal cycle. And some people are very sensitive to those hormonal changes. So that could be the case, but it's usually pretty mild and usually like resolves itself because you just get used to what your hormones are doing and there's less things changing. So I don't know. I mean, I think like if you're someone where having a month or two of mood swings would be really dire for you, maybe it's not worth it. But I would also say that like. Getting pregnant, is that times a million? Or like being postpartum is that times a million. So you kind of have to weigh your pros and cons of like what options make sense to you and how to create the life that you want.
Sara:Yeah. I feel like any, any medication has kind of this like withdrawal effect where you're suddenly going back to what you were before the medication and you know, I've been on birth control for 17 years, whether it's been a birth control pill or an IUD. I'm sure I'm gonna feel very weird when I come off of it, but it was definitely worth 17 years of not having an unplanned pregnancy. And I think again, it just comes down to having a conversation with your provider like I. You know, I've heard of this, you know, what, what do you think about it? It is possible, but what, what is more important to you in making this decision? The risk of getting pregnant or the risk of this side effect. And that's really up to you. Only you can make that decision.
Supraja:Yeah, exactly. What risk are you comfortable with? You know, it's like just figuring out what's worth it to you and what isn't. Okay. That's IUDs. So Nexplanons are similar to IUDs in that they're long acting, but they go in the arm. So you can avoid pain of having an intrauterine procedure.
Sara:I've had an implant.
Supraja:You have?
Sara:Yeah. Oh, I had no idea in med school before I got my IUD.
Supraja:Oh. Well tell us, what was your experience?
Sara:Well, first of all, an implant is essentially a plastic device. It's literally almost this. Size and shape of a matchstick, but made of plastic. And it releases.
Supraja:So if you wanna look fire,
Sara:yeah, put that in your bicep. Actually don't put it in your bicep. It's actually should be below below that groove. Um, but essentially it's a plastic device that has also a progestin, the same hormone as the IUD, but a different formula. And it works essentially very similarly. So it's releasing a small amount of hormone every day, and it lasts for about five years. Um, and your doctor can put it in, in the office. Will numb your skin and then insert it with the device.
Supraja:Um, and it kind of works the same way as the IUD and that it like increases cervical mucus decreases your, how your tubes work, inhibits you from ovulating, releasing an egg every month. It is systemic in how it works. So people who have like associate with symptoms of like the birth control pill, et cetera, it might be kind of similar to that. Um, it's progesterone only, so especially as you're getting used to it, you might have things like, Bloating, breast tenderness. I'd say the most common thing initially is that irregular bleeding. People have unscheduled bleeding. Sometimes it's heavy, unscheduled bleeding. That's like the most common reason people get it removed early. Some people don't have that. Some people just stop having a period right away, so that's possible too.
Sara:Those are the lucky people.
Supraja:Those are. What was your period like?
Sara:I spotted every day. It wasn't heavy, but I spotted every day for like. 17 days and, but actually the killer for me was the cystic acne I got. You got cystic acne. Yeah, it was, I never had acne, especially cuz I had been on the pill for 10 years. Yeah. It was all over my face, my chest, my back. I was like, I can't, this is not worth it to me. Yeah. And so I took it out after two months.
Supraja:Okay. We're really promoting this one hard, huh?
Sara:Well, I, well, I guess what, you know, it's so funny because I have a family member who did poorly on the Mirena, IUD. Uhhuh. Um, and, you know, we're genetically related, but I did great on the Mirena. It's just like, you can't, yeah. It's just like, you can't predict it. You can't predict it. And I have patients who do great on the implant, and it is, and it is the most effective of all the methods. Yeah. Including, Um, having your tubes removed, this is a great form of birth control. It just is. Doesn't work for everybody. And sometimes you only find out in the moment.
Supraja:Yeah, that's the nice thing about these things. They're reversible, you know, you just take it out. So, and then your acne went away. Look at your clear skin. Smile again
Sara:cause I was on the pill for a little bit.
Supraja:The pill is particularly good with acne because of the estrogen component and we'll talk about that in our next episode.
Sara:Somebody messaged me on Instagram. I was like ranting on my vlog and thought I was like, these neighbors who don't recycle. I was getting super heated and cuz they put styrofoam in the recycling thing. Unacceptable. But she was like that girl, I'm so sorry you chose violence today, but your skin looks fabulous. Your skin looks really good,
Supraja:but it's been really shiny cause of the birth control pill. Anyways, I digress. See Sara's on like seven methods of birth control. Not necessary for one, but she's like, I'm on the pill. The mirena Actually, I did have an implant. I just got removed.
Sara:Trial and error sometimes you gotta figure out what works for you.
Supraja:Um, okay. But what I was gonna say about those side effects is, Usually six months to a year they go away and for some people much, much shorter than that. And if they're really bothersome to you, like reach out to your provider cuz oftentimes there's something you can do in addition to decrease those symptoms or it's really not getting better. You can get it taken out cuz there's lots and lots of other options. Okay, the last one, the shot. Have you had the shot, Sara?
Sara:No, I haven't had the shot. I think it's such a good method for certain people though. It's just again, You don't know beforehand who this is gonna be a great method for. Yeah. But for some people it works fabulous.
Supraja:So it's called Depo-Provera. Do you think all these companies will give us money for saying their names?
Sara:I mean, they could do that or pay off my student loans.
Supraja:Provera we're, yeah, we have loans. Depo Provera.
Sara:There are a lot of loans. A lot of loans. I need these loans paid.
Supraja:If any of you grateful, grateful listeners wanna get our loans paid via Depo write to them. Okay? Just get, I don't even know the part company that makes Depo. Do you know? We're really bad at asking for sponsors. We have zero.
Sara:It's Mylan. It's Mylan. M y l I'm just kidding. I'm not kidding actually.
, Supraja:so Depro Provera, it's a shot. You get it every three months. It's progesterone only, very similar to the Nexplanon and that it's systemic progesterone. Um, but you have to get it every three months and it works kind of in these very now predictable ways based on everything else we've said. Like prevents you from releasing an egg every month. It decreases your tubal motility, like getting the egg to the uterus. It increases your cervical mucus, so it's harder for the sperm to get in. And it's pretty effective.
Sara:Yes., the pregnancy rate in the first year was less than 6%. Remember the IUD and implant? It's less than 1%, but I think with the depo injection, the difference is you are counting on the patient to come in. At that schedule 12 week visit. So there is, there could be some user error 12.
Supraja:So if you like miss that interval or like forget it can be a little bit challenging. Mm-hmm. Um, in terms of the side effects, this is actually the only one that has been shown with weight gain. And I'd say like people can gain up to about five pounds. Yeah. That's what I tell patients.
Sara:Yeah. Granted, people have told me I gained 20, 30 pounds and. The, the studies don't necessarily support that, but everybody's experience is valid. Like that person is never gonna use it with good reason. Yeah.
Supraja:So, yeah. So if you're someone who like really struggles with your weight or for whatever reason, gaining five pounds is just not tolerable to you, that's something to think about.
Sara:That's fair.
, Supraja:and then I feel like everybody always talks about the bone stuff.
Sara:Yes. So essentially it decreases bone mineral density, but once you stop using it, it returns and it does not increase your risk of fracture right while you're on it. So, which is important granted. If you are somebody who is already at risk for getting bone fractures like you are on, you know, chronic use of steroids or something, then maybe this is not the best method for you. But that's not very many people.
, Supraja:exactly. Cuz that's why people care about your bone mineral density. It's like a proxy for your bone strength basically. Um, so yeah, exactly what you said. So I feel like this is a good one for people who don't want a device in their body, but really don't want have to worry about it often., and are really tolerant of hormonal changes. Like they're not super., , sensitive to different hormones. Uh, and, and it also is actually the one that's the most effective at getting you to stop bleeding fully, like to cause what we call amenorrhea, but it just can take a while to get there
Sara:but we, I have patients like who've been on this for 10 years because they have such bad endometriosis or pain with periods. And this just has stopped their period completely. Yeah. And so to them it has been life changing. Mm-hmm. Um, and they're very good about coming in every 12 weeks cuz the thought of having a period and having discomfort is life impairing that it's not even an issue.
Supraja:People are really worried about their fertility being impaired by these sorts of devices, and I do wanna say none of them. Zero of them affect your fertility potential. That being said, depo, it takes the longest for you to start ovulating and having a regular cycle again. So the longest period of time between like stopping and try getting pregnant. Yeah. So, but does not impact your ability to get pregnant.
Sara:Sometimes not often take up to a year and a half people to get regular cycles back. So if you are somebody who's looking for a method to just time deliveries, like I, you know, I just had a baby. I wanna have a baby in two more years.
Supraja:Do you think that'll be us? Cuz we're in our mid thirties?
Sara:No. I'm just gonna get an IUD.
Supraja:And then just have it pulled.
Sara:Yeah, a hundred percent. I Mirena please sponsor me. I'm just kidding.
Supraja:Yeah, I was just gonna, yeah, MIrena, she'll use yours a lot. No, I was just kidding. She will not wait the eight years. She'll just buy another one right away.
Sara:Yeah. Frequent user. I have a punch card. Okay. But I think it isn't, I think it's a great question. I love it when people ask me this. These are my family planning goals. Wonderful question. These are the methods, you know, that I would recommend if you were really trying to conceive within a year or two, like I would actually stay away from this one. Um, But
Supraja:sweet. Yeah. So next time to give you a little preview, we're gonna talk about the pill, emergency contraception, what to do if you have an oopsies barrier, contraception, and then natural methods.
Sara:The rhythm method.
Supraja:The rhythm.
Sara:I hate that word.
Supraja:Rhythm,
Sara:rhythm method. It just sounds, it just sounds so crunchy. Granola,
Supraja:really? Yeah. I think that sounds kind of hot. You know, like people who have good rhythm are probably good in bed
Sara:I don't have good rhythm, but I think I'm, I'm just
Supraja:okay next time. Love you guys.
Sara:ciao.