How it Works

The mini pill is an oral birth control pill that contains progesterone alone and no estrogen. It is sometimes call a “POP” (progesterone only pill). While it does decrease ovulation, its primary method for preventing pregnancy is thickening the cervical mucous to prevent the sperm from entering the uterus, as opposed to the traditional estrogen/progesterone pill which works by preventing ovulation.

The mini pill is metabolized very quickly in your body and only thickens cervical mucous for ~23 hours.  It is important to take the pill at the same time each day. If you are more than an hour late taking the pill, then you need to use back up contraception (i.e. condoms) for the next 48 hours. It is 92% effective for preventing pregnancy. Also it does not have a placebo week, so it must be taken every day.

The Good

The mini pill does not contain estrogen, so it does not have the risk of blood clots and stroke like the traditional pill. It is safe for women who smoke and have heart disease. Additionally, it is commonly used in breast feeding since it does not interfere with milk production.

The Bad

The mini pill does not regulate the menstrual cycle as well as the traditional pill and women who take it often have irregular cycles. Additionally, some find it difficult to take the pill at the same time each day.

The Ugly

Several medications can decrease the efficacy of the mini pill including seizure medicine and the herbal supplement St. Johns wort. Women on the mini pill also have a higher rate of developing painful ovarian cysts.

Have you tried using the mini pill? Did you find it challenging to take it at the same time each day?

How It Works

Nexplanon is a 4 cm plastic rod that is inserted under the skin of your upper inner arm. It contains progesterone that is slowly released over 3 years. Once inserted, it is 99.7% effective for 3 years.

The device is inserted in the office in about 1o minutes. First I clean the arm with sterile soap, then I inject numbing medicine (lidocaine). After that, patients only feel pressure as I insert the device under the skin. Once in place, it does not cause discomfort. A band-aid is left on for 24 hours. If inserted correctly, you can easily feel it under the skin but only see it if you stretch the skin taunt around it.

Its primary mechanism of action is prevention of ovulation, additionally it thickens the cervical mucous to prevent sperm from accessing the uterus.

The Good

Nexplanon is highly effective and requires no effort once inserted. It does not cause weight gain. It can be removed at anytime and ovulation should resume immediately.

The Bad

Nexplanon can cause sporadic bleeding. It is usually not continuous or heavy bleeding, but often women do not know exactly when their period will come.

Though not listed as an  official side effect, I have had several patients request to discontinue the device because it made them moody.

The Ugly

Nexplanon is the ‘granddaughter drug” of the Norplant. The Norplant was made of 5 small rods that were very difficult to remove.

The single rod Nexplanon is MUCH easier to remove. It is removed in the office and usually takes about 15 minutes. Also Merck has been extremely thorough in its training of providers on how to insert the device properly. Despite these precautions, there are case reports of the device being inserted into the muscle which required surgical removal.

How It Works

Depo-Provera (“the shot”) is a progesterone only injection that prevents ovulation. It is given as a shot in the arm every 3 months and is 99.7% effective.

The Good

Depo-Provera requires minimal effort and is highly effective. When you first begin taking it, your bleeding is often sporadic, but over time (~ 3 months) the progesterone thins the lining of the uterus, so that your period becomes lighter or in many cases absent.

It is an excellent treatment for endometriosis.

The Bad 

Depo-Provera can cause weight gain, usually between 5-15lbs. Additionally it can take up to a year for your cycles to return to normal (ovulation) after you stop using it, so if you are planning another child soon, it is not a good option.

Long term use can also lead to vaginal dryness and painful intercourse. Often this can be treated with lubricants or topical estrogen cream. It resolves after discontinuing the medication.

The Ugly

Depo-Provera has been associated with worsening depression, so it is not recommended for women with severe depression.

Long term use has been associated with bone loss and osteoporosis. The effect reverses over time when you discontinue it, but can take years. Women using Depo-Provera for more than 2 years are recommended to get a bone density test, exercise regularly and take calcium.

 {Photo Credit}

How IUDs Work

There are 2 types of Intrauterine Devices available in the US: Paraguard and Mirena. Both are T shaped devices that are inserted into your uterus at the doctor’s office. Each blocks conception by preventing the sperm and egg from meeting, but they accomplish this in two different manners. They are 99.7% effective and completely reversible.

The Paraguard IUD is made of copper. The copper creates a spermicidal environment within the uterus, killing sperm before it can reach the egg. {Remember conception actually happens in the fallopian tube}. It contains no hormones.

The Mirena is made of plastic that is embedded with progesterone. The progesterone acts to thicken the cervical mucous to the point that sperm cannot swim through it, blocking conception.

A common misconception about IUDs is that they work by causing abortion; this is not true. In my research for this series, I came across two very interesting articles that disprove this myth. The first looked at ultra sensitive pregnancy tests in IUD users. In a series of 30 patients, none had positive tests, confirming no damage to implanted embryos.¹ The second study looked at whether IUDs prevented implantation of fertilized embryos. In a group of women getting their tubes tied shortly after ovulation, they flushed their tubes with saline and then looked at their eggs under the microscope. None in the IUD group had fertilized eggs, whereas the majority of the control group had fertilized embryos.² This means that the IUDs prevented fertilization

The Good

IUDs are 99.7% effective and once inserted require no more effort. When you decide its time to conceive, they can be easily removed, and it is safe to attempt conception immediately. The ovaries still ovulate regularly, so the hormones throughout your body are the same.

The Mirena also thins the lining of the uterus, so that your period is lighter or in some cases absent. Mirena is FDA approved for treating heavy menstrual bleeding as well as for contraception. It has also been shown in some studies to help with endometriosis pain.

Neither device causes weight gain.

The Bad

To insert an IUD, I have to push a plastic tube inside your uterus. That HURTS. It only takes about 30 seconds to do it, but most women find those 30 seconds very unpleasant. After insertion, expect menstrual type cramping for several days. Ibuprofen may help a bit with the pain.

The Paraguard tends to make your periods heavier and crampier than normal.

The Mirena can cause irregular bleeding. Usually the bleeding is light and resolves within 3 months, but up to 5% of women will have persistent spotting troublesome enough to discontinue using the device. Only a small percentage of the progesterone in the Mirena is absorbed into your blood stream, but some women do get hormonal side effects, such as acne or abnormal hair growth.

The Ugly

In the process of inserting the IUD, there is a ~1/500 chance that it can be pushed all the way through your uterus (perforation). When this happens, surgery is performed to remove it.

 Have you tried an IUD? What has been your experience? Did I answer your questions regarding the use of IUDs?

1 Wilcox AJ, et al: Urinary human chorionic gonadotropin among intrauterine device users: Detection with a Highly Sensitive and Specific Assay. Fertil Sterility 1987; 47:265-269.

2 Alvarez F, et al: New insights on the mode of action of intrauterine contraceptive devices in women. Fertil Sterility 1988; 49: 768-773.

When we first started this blog, I was overly concerned with people’s perception of it. In an effort to uphold my professional image, I attempted to make all posts palatable to all. I avoided any topic that might be too controversial. In hindsight, that shouldn’t have been that big of an issue because no one who wasn’t related to us was actually reading the blog.  At the beginning of this year, I essentially stopped caring about controversy. I decided that since so few were reading, I may as well write about whatever I wanted.  It started with this post on home birth, a topic that I was passionate about, but had been afraid to tackle. Instead of getting the hate mail I had feared, this topic struck up a respectful, intelligent conversation among our readers. As the year has progressed, we have become more free with our topics, and guess what? People are actually reading it!

This week I am biting the bullet and discussing birth control. Considering that our blog is about pregnancy, perhaps it’s a little odd, but nevertheless contraception has been repeatedly requested as a topic by our readers. This is another controversial area that I have avoided in the past due to fear of backlash, but I think it’s an important one. There is A LOT of misinformation out there concerning contraception, especially from ‘Christian’ organizations.

Over the next week I will present you facts, statistics and my opinion on the various types of contraception. You can then use the information to prayerfully decide your own convictions on this very personal topic.

I will discuss some hot button issues such as whether IUDs cause abortion, whether Yaz really is a ‘bad pill’ and when I believe life begins. You will also learn why Natural Family Planning is my favorite form of birth control.

For those who feel that Christians shouldn’t practice birth control, I fully respect your beliefs and admire your convictions. I hope we can ‘agree to disagree’ and you will join us back on the blog next week when this series is finished. And if you need an OB, check me out, because I love delivering babies and you keep me busy!

As usual, this blog cannot give out individualized medical advice, but if you have a general question about a form of contraception, I would be happy to answer it for you in the comments.

Each day I will post about a specific form of contraception, then at the end of the week I will add all those links back into this post to make them easier to bookmark/Pin.

My sources for this series include several text books and articles. I will do some foot noting, but I am not going to take the time to footnote every reference. If you desire to know where I got a specific bit of information, I am happy to provide that to you.

Who’s ready for some controversy?aception?

TPC Disclaimer: The information in this series in based upon Dr. Rupe’s medical training and additional research into each topic. The posts are meant to be a guide for readers who are considering these forms of contraception. We acknowledge that even amongst a faith-based community there will be readers with differing opinions. We respect the viewpoint of every person in this community. At times Dr. Rupe may share her personal opinion which she formed after much research and prayer on a subject. When delivering a personal opinion, she will note it as such. It is not our intent to influence your beliefs but rather empower you with medical information to help you prayerfully consider your options for birth control.

An OB/GYN’s Guide to Contraception

Part 1: How You Get Pregnant

Part 2: The Pill

Part 3: IUDs

Part 4: Depo Provera

Part 5: Nexplanon

Part 6: The Mini Pill

Part 7: The Morning After Pill

Part 8: Condoms, Diaphragms and Natural Family Planning

Part 9: Tubal, Essure and Vasectomy

{No, we are not closing the blog or taking the book off the shelves. Keep reading and you’ll see exactly what “shop” I’m closing up this year.}

My sweet miracle boy

As I write this, I am sitting in Dr. Rupe’s office waiting for a procedure that will permanently prevent me from becoming pregnant again. It seems oddly monumental to be putting an end to my season of infertility and child bearing. After all of the longing and waiting and struggle, it’s almost ironic to be “closing up shop” as I like to say.

I hope that this post does not create controversy. I’m simply sharing my story, not trying to posture my beliefs on birth control and pregnancy prevention. It’s an extremely personal decision that should be deeply covered in prayer. My husband and I feel very peaceful about our decision. We believe the Lord has completed our biological family (we are open to adoption in the future) and with my history of miscarriage, it feels almost irresponsible for me to get pregnant by surprise. So we are taking the steps we feel led to take in order to close this chapter of our lives and peacefully move forward.

Part of me is excited to move on…to put all of the energy I used to spend on hoping and praying for children into loving and leading them. Yet, there’s a part of my heart that is grieving…the hope, the excitement and the joy of new life. Never again will I feel those tiny baby flutters inside my belly. Never again will I experience the breathtaking miracle of childbirth. As long as it took to travel this road and as hard as the journey was, in hindsight it was a mere blink of the eye.

“So as the sufferings of Christ overflow to us, so through Christ our comfort also overflows.” 2 Corinthians 1:5

My dad and I were talking this morning about how suffering was built into the cross of Christ. It was part of his story and thus it is part of ours. But the purpose of our suffering is to bring deeper intimacy with Jesus. I’ve said it before but I’ll say it again…I often miss the sweetness that came with the sorrow of infertility and loss. It drew me so close to Jesus. As I stand here, at a major crossroad of my adult life I pray that I can take what I’ve learned about suffering and carry it with me through every season ahead of me. In those moments when I feel like a mothering failure…when I think my children will never “get it”…someday if I lose a loved one…or if we hit a financial hardship…may I allow the reality of his presence to carry me through. Whatever it takes to keep me desperately clinging to him, that I will joyfully bear.

Thank you for allowing me to share my journey so openly here. It’s been wonderfully therapeutic to get it all out in the blogosphere and I feel like I’ve been surrounded by a community of women – some on a similar journey and some on an altogether different path – all cheering me on from the sidelines. I pray this blog does the same for all of you no matter where you are. We are in this together and once we are on the other side of child-bearing, we can hopefully walk together in child-rearing {Man, do I need support there! And I thought getting pregnant was hard…}.

My deepest desire for this blog is to use what he has taught me through this journey to love and support all of you. I am committed to hearing from him on all he has for me to share in the future. But that does NOT mean we will stop talking about infertility, miscarriage and trying to conceive. That is part of both my and Dr. Rupe’s hearts and stories and it’s a large part of the reason we wrote the book and started this ministry. I suppose this post is a bit self-indulgent. I just felt I needed to express my innermost thoughts and utmost gratitude to you, my Pregnancy Companion community. Thank you again for walking with me.

Looking forward to where he leads next,

Jessica

With all of my patients, as they enter the third trimester, I discuss what their contraceptive plans are for after the baby is born.

Many smile a beautiful, blissful, glowingly pregnant smile and say, “Oh no. I don’t think we will ever use contraception again.  Hopefully we will get pregnant again right away!”

Fast forward to their postpartum visit. A sleep deprived, exhausted new mom sits before me. Her first topic of conversation: contraception.  While she is madly in love with her new baby, the thought of having another right away is a little overwhelming. She is not physically ready to go down that road again.

Some women are ready right away. I once had a women ask me at delivery when she could try for another baby. My answer, “Well, you at least have to wait for me to get the placenta out!”

The decision on when to try for your next child, obviously depends on many factors. Finances, age, personal goals and beliefs on contraception are just a few. I was recently asked on our FB page what the ideal timing between pregnancies is from a medical stand point. According to studies looking at pregnancy outcomes, it is best to conceive 18 months to 4 years after your last delivery.

I find it interesting that the ‘optimal’ time for conception of the next child is about 18 months since this is when children are truly at their most adorable. Full of toothy grins and giggles as they toddle around.  This stage of ultimate cuteness entices people to have another baby. They then proceed to conceive before their child hits the ‘terrific twos.’ Which while adorable, at least in my house, is a challenging time.

Pregnancies conceived less than 18 months since the last delivery have an increased risk of preterm delivery and low birth weight. Pregnancy takes a lot out of your body, and it takes time for a woman to recover from the stress and for her nutrient supplies to get back to normal. The theory is that the body has not fully recovered at less than 18 months causing the baby’s extra risk of not growing as well (low birth weight). The risk of preterm delivery is further amplified in teens who conceive again quickly, since teens have often used their nutritional supplies on their own growth as well as their baby’s.

VBAC: Women who attempted a trial of labor after a cesarean section have an increased risk of uterine rupture if the pregnancies are less than 18 months apart.

Pregnancies conceived less than 12 months since the last delivery have an increased rate of placental abnormalities, such as placenta previa and placental abruption. Placenta previa is a condition where the placenta covers the opening of the cervix making vaginal delivery unsafe and increasing the risk of hemorrhage. Placental abruption occurs when the placenta begins to detach from the uterus before the baby is delivered.  It can result in hemorrhage and fetal distress.

Pregnancies conceived less than 6 months from delivery have an increased rate of neural tube defects and autism. Neural tube defect is associated with low maternal folate levels, so most likely in pregnancies less than 6 months apart, the mother has not had time to fully replenish those supplies.

Pregnancies conceived greater than 4 years from the last delivery  have an increased rate of preeclampsia, fetal growth restriction and cesarean section. It is unsure why this increased risk is seen other than the possible health changes in the mom over this time.

The actual ‘increased risk’ in each of the cases is statistically significant but overall low for the average woman. Take preterm delivery, the risk increase with conceiving early is 20%. For the average mom with no history of preterm birth, this changes her risk from 1% to 1.2%, which is negligible. However, a woman with a previous preterm delivery sees her risk go from 15% to 18%. These increased risks are most significant for those moms who already have risk factors for these conditions.

For the average healthy mom with no medical problems and a vaginal delivery, the increased risks of these complications with conceiving again soon are extremely low. Women with a cesarean section should wait 18 months for their scar to fully heal, especially if they desire a trial of labor (VBAC). Those with a history of pregnancy complications listed above are advised to wait the suggested interval before conceiving.

Lots of prayer and being on the same page with your spouse should be at the forefront when you are making the decision on when to have another child. But knowing the medical facts is equally important for making sure you are ready – both body and mind – to grow your family.

From a practical standpoint, we’d love to hear from our readers who have multiple children on how the timing worked for you.