Welcome to The V, our weeklong series devoted to all things sex and reproductive health. This is a safe space free from "taboos," because there's no reason anyone should feel awkward talking about their bodies—ever. That said, we'll be clearing up any misinformation on the subject, starting with this huge misnomer: The "V" in this case doesn't refer to the vagina, but the vulva, which is the anatomically correct term for external female genitalia (including the opening of the vagina). Stay tuned all week for need-to-know guides on birth control, tips for taking your orgasm to the next level, real-life stories about endometriosis, and everything in between.
As someone who's never been on birth control, I find the topic fairly confusing. To be quite honest, the subject isn't exactly cut and dry for those taking the pill either. There are issues of limited access, finite education, and a whole lot of mixed messaging when it comes to women's sexual and reproductive health—this you know.
So to clear things up in case you're looking to start taking birth control, want to switch based on negative symptoms, or are just hoping to learn a bit about your options, I reached out to experts in the field for answers.
"There are many non-contraceptive benefits to using combined oral contraceptive pills including reduction of acne, facial hair growth, menstrual cramping, PMS and PMDD, as well as regulation of irregular periods," says Anate Brauer, MD, a reproductive endocrinologist. "While all combined contraceptive pills that contain both estrogen and progesterone work in a similar way with similar results, there are different preparations with nuances that may lead them to be more efficient at treating some symptoms. There are also different ways to take standard preparations of pills.
"Available preparations of combined contraceptive pills include monophasic (delivering a stable dose of hormone throughout the cycle) versus multiphasic (delivering various doses throughout a cycle to 'mimick' physiologic hormone fluctuations). OCPs are further classified by length of active pills—21-day versus 24- or 28-day versus extended-cycle or continuous, as well as types of estrogens and progesterone in the pills."
So different pill preparations may be more appropriate for your personal symptoms. "If you are not taking any birth control pills at all, your doctor can prescribe Gestagen pills if you want to get a bleeding-free period (i.e., during a planned holiday)," notes Gunvor Ekman Ordeberg, MD, Ph.D., the medical advisor for DeoDoc Intimate Skincare and ob-gyn. "A hormonal IUD may result in no bleeding at all. Additionally, about 20% of women who take mini pills do not bleed as well." The bottom line is that there many different options for birth control. It is important to talk to your doctor to decide which type of birth control method is right for you. Below find some helpful facts to inform your decision (along with your personal doctor's advice).
"Androgens such as testosterone may contribute to acne by increasing production of sebum in the skin," explains Brauer. "Estrogen and progesterone found in all OCPS can reduce androgen activity through both direct inhibition, as well as increasing sex hormone-binding globulin, which binds up free testosterone in the bloodstream. Some OCPs have specific progestins such as drospirenone, cyproterone acetate, chlormadinone acetate, and dienogest, which have additional antiandrogenic activity. For example, Yaz has drospirenone, an antiandrogenic progestin and is therefore marketed for the promotion of clear skin."
"To treat acne," adds Ordeberg, "I recommend taking a birth control pill—Diane is quite effective. If it does not help and acne persists, strongly suggest consulting your dermatologist for the best next step."
For Mood Swings
"Changes in mood may follow changes in hormone levels throughout your cycle," notes Brauer. "Monophasic pills that provide a stable exposure to hormones throughout a cycle may alleviate these mood swings. Women who have severe PMS and PMDD may do better on extended-cycle or continuous pills by avoiding hormonal fluctuations, however, this has not been evaluated in randomized clinical trials."
"Low-hormonal birth control methods can be used to help treat mood swings," suggests Ordeberg. "A hormonal IUD giving off the lowest levels of hormone or birth control mini pills (also giving a low hormone dosage) are great options. In extreme cases, anti-depressive drugs can be recommended by your doctor if results are not gained by the above."
For Menstrual Pain
"Most OCPs, regardless of preparation, will help with menstrual pain," says Brauer. "For women with severe cramping due to endometriosis, however, continuous pills are recommended. The theory here revolves around continuously suppressing hormones, thereby thinning out the lining of the uterus (endometrium) to prevent the creation of new endometriosis as well as suppressing hormonal stimulation of existing endometriosis implants."
"During menstruation, an inflammatory reaction occurs when the inner lining of the uterus is broken down," says Ordeberg. "Therefore, NSAIDs (nonsteroidal anti-inflammatory drugs, aka Ibuprofen) can be bought over the counter and treat menstrual cramps. It is important to take them as soon as you start getting symptoms."
For Regulating Your Period
"The purpose of having a period is to shed the lining of the uterus each month," says Brauer. "Women who do not ovulate regularly, and therefore do not shed their uterine linings, are potentially at risk for uterine cancer in the future due to continuous stimulation of growth of the lining without exposure of progesterone to shed it. Women who do not get a period can either go on a preparation of the pill (either standard, extended, or continuous) or take progesterone supplements every three months in order to shed their lining."
"If you are already taking birth control pills," Ordeberg adds, "you can postpone your menstruation by skipping your sugar pills (inactive pills) and immediately start a new pack of active pills right away. Ask your doctor if you are unsure of how to proceed."
[Ed. note: Please speak with a doctor before trying any new birth control methods or making major adjustments.]