There are many options available for birth control, and it can be confusing to sort through the different kinds.  In order for it to be most effective for you, it has to be an option that works well for you.

There’s more to it than just how well it works to prevent pregnancy.  For example, pills can work well and have other beneficial side effects, but if you are someone who can’t remember to take a pill every single day, it’s probably not the best choice.  Likewise, abstinence (not having sexual intercourse) is 100% effective, free, and prevents sexually transmitted infections, but it’s not necessarily a realistic-or lifelong-option!

This discussion is going to be limited to reversible birth control methods, meaning ways to prevent pregnancy that can be stopped at anytime.  So, what’s out there?

Barrier Methods

These are things like condoms, diaphragms, female condoms, and sponges.  The barrier methods work by blocking the movement of semen into the female genital tract.  They have to be used every single time, so they do take some planning—condoms need to be on hand, the diaphragm needsto be fitted and placed into the vagina. The big benefit to them is that using condoms consistently and correctly can decrease your risk of sexually transmitted infections (STIs), including HIV.  You can also use condoms along with other forms of birth control- either as a back-up method, or to protect against STIs.  They are also able to be purchased without a prescription and are inexpensive.  The actual efficacy of male condoms is ~85%, meaning that 85 couples out of 100 using them will not get pregnant in a year (or 100 – 85 = 15 pregnancies per year).  In theory, condoms used correctly and consistently- every single time- will be 98% effective (only 2 pregnancies)…but no one really lives in a perfect world! 

The Pill, the Patch, and the Ring

These methods all work by giving you a dose of two hormones, estrogen and progestin.    The combination of these hormones blocks the signals that would normally trigger ovulation, or the monthly release of an egg.  There are many different kinds of pills, which need to be taken every day.  For women who may not want to take a pill - or have a difficult time remembering to take it-  there are other ways to take the hormones.  The patch is a sticker that is placed on the skin for a week at a time, and the ring is a flexible, plastic ring that is placed in the vagina for 3 or 4 weeks at a time, and can be left in place during sex. The actual efficacy rate of pills, patches, and rings is 92%, meaning that 92 women out of 100 women using them will not get pregnant.  But that’s 8 out of 100 that may get pregnant in a year. 

Taken every day, perfectly with no missed or late pills, patches, or rings, these methods may be 99% effective.

All of these methods have the same side effects; most commonly, these are breakthrough bleeding or spotting, nausea, and breast tenderness.  Because of the estrogen in these methods, these methods can increase the risk of developing blood clots in the legs or lungs.  Women who have had a history of blood clots or strokes and women who smoke over the age of 35 should not take these methods.  But it’s not all bad news:  the pill, the patch, and the ring can improve acne, cramping, heavy periods, unwanted hair growth, and reduce the risk of uterine and ovarian cancers.  If desired, they can also regulate whether and when periods occur; it’s possible to have a period once a month or once a year. 

The Mini-Pill

These pills contain only one hormone, a progestin.  They are much smaller doses that those in regular pills, which also contain estrogen.  They work by thickening cervical mucus and preventing the sperm from reaching the egg.  After taking a mini-pill, the effects wear off after ~22-24 hours- and they don’t always prevent the release of an egg, so it’s very important to take the mini-pill at the same time everyday for it to be effective in preventing pregnancy.  Because of the decreased effectiveness compared to regular pills, it’s often recommended for women who cannot take regular pills, such as breastfeeding women or women who are at high risk of complications from regular pills.

The Emergency Birth Control Pill

These pills, which contain progestins (like the mini-pill, but higher doses), can be used to prevent pregnancy when another method may have failed.  They work by preventing ovulation, or the release of an egg.  If you are already pregnant, they will not cause a miscarriage or abortion.  They are most effective at preventing pregnancy when taken as early as possible after sex, but they can be taken up to 5 days later.  They may decrease the risk of pregnancy as much as 89%.  Because of the cost and the way that they work, they are most useful for unexpected or emergency situations and shouldn’t be used as the main method of birth control. 

The Shot (Depo-Provera)

This method is a hormone shot containing a progestin hormone.  It works through a combination of actions: it prevents ovulation and thickens the cervical mucus.  It is very effective- 97%, meaning 3 out of 100 women may get pregnant using it during the first year, and it can be a very private method to use- once you have taken the shot, no one else would know it.  The main side effects are irregular bleeding or spotting, and most women who use Depo-Provera for 1 year will stop having menses at all. Sometimes after stopping the shot, it can take some time before periods return to normal.  The shot can also cause some bone thinning, but this is reversed when women stop using the shot and does not seem to increase the risk of bone fractures.

The Implant

This method is similar to Depo-Provera, but instead of a big dose every three months, the small plastic rod releases a smaller amount of a progestin hormone continuously.  The rod is placed into a woman’s arm in the office, and it can stay in place up to 3 years, making it a long-acting method birth control.  It is also very effective- also <1% of women will become pregnant during the first year of use.  It can also cause irregular bleeding or spotting as a side effect, similar to Depo-Provera, but these effects wear off very quickly when the implant is removed. 

Intra-Uterine Contraception

This form of birth control is used by placing a contraceptive device into the uterus.  There are two different types of intrauterine contraception that are most common in the US (see below).  Both kinds are very effective, with <1% of women becoming pregnant during the first year.  Both are also very safe to use, although there is a small risk of infection, especially at the time of placement- and can be used by most women, even women who are teenagers, have never been pregnant, or cannot take estrogens. 

The Mirena IUS (for intra-uterine system) is a T-shaped piece of plastic that releases a progestin hormone into the uterine lining, and it prevents pregnancy by thickening cervical mucus and making the uterine lining so thin that a pregnancy cannot develop there.  It can also decrease the amount of bleeding and cramping with periods. The Mirena can stay in place for 5 years.  The Paragard IUD (intra-uterine device) is also a T-shaped piece of plastic, but instead of a hormone, it has copper on it that causes a reaction that kills sperm; it may also prevent pregnancies from implanting into the uterus.  It may cause heavier periods.  The Paragard can stay in place up to 10 years. 

Both of these methods can be stopped at any time by making an appointment to have the devices removed, and the effects wear off very quickly.

As you can see, there are many methods out there.  If you’re interested in any of these forms of birth control, or if you have any questions, you should make an appointment to talk with your doctor.  

by:  Gretchen Reinhart, M.D.

The Medical University of South Carolina (MUSC) in downtown Charleston is widely recognized as having some of the top physicians in the country.  What people don’t know is that some of our premier specialists also see patients in convenient locations throughout the tri-county area. 

Starting Tuesday July 6, women living West of the Ashley won't have to travel far to access the medical expertise and care offered by MUSC obstetricians and gynecologists. MUSC Specialty Care West Ashley:  Women's Health is specifically devoted to the unique health care needs and issues facing women and girls. 

We invite you to explore the NEW website, then make an appointment and see the difference at Women's Health.  The providers and staff are here to serve you, and strive to make all visits outstanding experiences.

When Dr. Jennifer Young finished her fellowship training in Gynecologic Oncology, she traveled to rural Tanzania to participate in a cooperative research project with her former colleagues in the Department of Obstetrics and Gynecology at the University of Virginia.  While in Tanzania, Dr. Young continued her research on cervical cancer screening.  What she observed was that cancer of the cervix tends to be diagnosed in its later stages when it’s less treatable.

Cervical cancer is responsible for a large proportion of female deaths worldwide due to poor screening, and disproportionately afflicts women in developing countries. In Tanzania, cervical cancer ranks as the first most frequent cancer among women between 15 and 44 years of age.  Screening and timely treatment saves lives.  

On Monday May 31, Dr. Young will return to Tanzania, along with doctors from the University of Virginia and her colleague in Reproductive Infectious Diseases, Dr. Gweneth Lazenby.  These doctors will work together to help determine an acceptable method for cervical cancer screening for low-resource women in rural Tanzania.  To aid in this aim, the doctors will collect information on the prevalence and types of human Papillomavirus (HPV) causing cervical dysplasia and cancer in these women. 

“Women are dying of cervical cancer every day in Africa.  If we can be part of bringing new technology to Tanzania that helps diagnosis cervical cancer early, it will be a huge step forward. We are still years away from large scale vaccination against cervical cancer in rural Tanzania and thus need to be able to offer these women something today while (hopefully sometime in the not too distant future) vaccinating their children to prevent cervical cancer in the future,” said Young.

In this post we provide an overview of the pelvic floor muscles and outline simple exercises from Pilates and yoga that can strengthen your pelvic floor. Strong pelvic floor muscles have many health benefits, one of the most beneficial results being the prevention of urinary incontinence.  Also, during pregnancy a strong pelvic floor makes delivery easier and reduces time to regaining elasticity in these muscles.  In addition, sexual function can benefit from pelvic floor strength throughout a woman’s life, including the enhancement of orgasm.

Pelvic Floor Muscles
The pelvic floor is shaped like a bowl.  The skeletal muscles that make up the pelvic diaphragm are supported by the pubic bones.  The muscles are suspended from these bones by tendons like a parachute, giving the pelvic floor its dome shape.   The muscles wrap around the urethra (the opening to the bladder), the vagina, and the rectum.  Voluntary contraction and relaxation of the pelvic muscles controls urination and defecation.  Some forms of incontinence can occur because of the inability to control these muscles to prevent loss of urine or stool.  By strengthening the pelvic muscles through directed exercise, women can exert more control over voiding.  During intercourse, an orgasm results from clitoral stimulation that causes involuntary rhythmic contractions of the pelvic floor.  The areas that contract during orgasm include the outer third of the vagina, perineum, and anal sphincter, also referred to as the orgasmic platform.  Strengthening these muscles can lead to more intense orgasm. 

Kegel
Gynecologist Dr. Arnold Kegel popularized the concept of pelvic floor exercise in order to decrease postpartum urinary incontinence. However, in Kegel’s experience, almost 1/3 of all women were unable to voluntarily contract this muscle with instruction only.  Commonly, women contract their abdominal or external perineal muscles rather than the internal pelvic floor.  In order to insure that the exercise is being done properly, a finger can be inserted into the vagina and the woman contracts the ring of muscles inside the vagina that surrounds the finger.  The pelvic muscles can also be engaged when stopping a bowel movement or stopping urination midstream.

A Home Kegel Excercise
1.         While urinating, start and stop the flow of urine until the bladder is empty.
2.         Lie on your back and bend your knees keeping both feet flat on the floor. Visualize your pelvic muscles and squeeze tension there.  Like riding up an elevator, start in “the basement” with no tension, then add tension slowly until reaching the “5th floor,” where you achieve the most tension possible. Then slowly release tension as you return to “the basement.”

How Pilates Helps
In Pilates, we refer to the pelvic floor as “the basement” of our abdominal wrap. Pilate’s exercises strengthen the pelvic floor, because these muscles are engaged at the beginning of every exercise.  To start, we cue the pelvic muscles, and then exhale the navel to the spine in order to pull the core up and in, down and together. When performing the exercises, keep all other muscles relaxed and don’t grip the buttocks.

How Yoga Helps
Mulabhanda is the yogic concept that engages the pelvic floor. Mula in Sanskrit means root, and bandha means lock. The action is similar to the Pilates focus as well as a Kegel exercise. In many yoga poses, mulabhanda is activated by drawing the pelvic floor muscles between the anus and genitals in and up, contracting the perineal muscles. Mulabhanda builds internal heat and balances the parasympathetic and sympathetic nervous systems. When unlocked, prana (life force, energy) flows.

A Combined Yoga and Pilates Practice
Practice this 20-minute workout several times weekly to help build strength in your pelvic floor

1.         Begin in Sukhasana (easy pose) and engage mulabandha on an exhale. Contract and release 5-10 times.
2.         Open the feet to the width of the mat and sit into Malasana (squat), engaging and releasing mulabhanda 3-5 times. Your hands can be in Anjali Mudra (prayer pose) at the heart.
3.         Straighten legs (moving your feet as wide as your hips), lower head for Uttanasana (standing forward fold). Rotate the inner thighs back and apart then engage mulahandha.
4.         Alternate between squat and forward fold 5 times, exhaling when releasing into Uttanasana. Reengage and release mulabhandha with each Uttanasana and Malasana.
5.         Lie on back with knees either bent at table top or extended out, engage the pelvic floor, exhale navel to spine and curl head, neck and shoulders up to the shoulder blades while maintaining a neutral pelvis (not pressing lower back into mat). While pumping straight long arms up and down 8 inches inhale for 5 counts and exhale for 5 counts. 10 times. Sink navel deeper and squeeze pelvic floor and inner thighs.
6.         Lie flat on the floor with your arms extended to the ceiling and shoulders plugged into their sockets. Squeeze heels, inner thighs, engage pelvic floor, connect navel to spine. Inhale, curl up, and look at toes, arms extended over legs.  Exhale and continue to roll up articulating one vertebra at a time while engaging pelvic floor and pulling belly back, spine is "c" shape curve rounded, pause, inhale, re-engage connections and exhale entire time rolling down, imprinting one vertebra at a time.
7.         Lie on your back for Setu Bandhasana (bridge pose), engage mulabhanda when raising pelvis. Release the gluteus maximus muscles and focus on the pelvic floor muscles. Release the pelvis to the floor and stretch out your legs straight ahead into Paschimottansana (seated forward fold), engaging mulabhanda. Hold the lock for 3-5 breaths.
8.         Lie on your back in Savasana (corpse pose), engaging and releasing mulahanda and relaxing on the last release for 2-3 minutes.

Take a Class
You might want to join one of the many yoga and Pilates classes in the Charleston area and take advantage of the teacher’s expertise.  During class, pay particular attention to how you can engage the pelvic floor in each exercise. Both Gail and Terry (co-authors of this article) teach at the MUSC Wellness Center.

by:  Gweneth Lazenby MD, Terry Hamilton RN, and Gail Corvette