I’m Dr. Mara Gordon, a primary care physician, assistant prof. of family medicine at Cooper Medical School of Rowan University, and an NPR contributor. I have a special interest in reproductive health and a passion for helping my patients find a m...

Do you know anything about the research done on male birth control? Do you think it would be possible to have this in the near future?

Thanks!

What a super interesting topic! There's a lot of active research on contraception for people with penises, and we wanted to include all of it in the Life Kit podcast episode but just didn't have time! There are some ongoing clinical trials of male birth control options. And of course, there's vasectomy. Hopefully we'll see more options in the coming years.

Hello, would you please give an overview of advantages / disadvantages to continue birth control into your 40's?

Basically a time when controlling fertility is not such an issue but menopause hasn't arrived yet?

Many thanks.

Hi there! I encourage my patients in their 40s to at least consider pregnancy prevention — unintended pregnancies certainly can happen if patients are still getting periods. Many people safely use combined oral contraceptions through their 40s, but it's usually not our first-line choice. I tend to recommend the IUD, since it's long-acting and not something you have to worry about every day. It's also super safe for people over 40s. But it's super personal!

How do you handle a patient that wants to be sterilized?

Great question. Sterilization (that's either a bilateral tubal ligation or vasectomy) is a permanent procedure. I don't actually perform either of them as a family physician, so I always refer them to my colleagues who are surgeons (usually OBGYNs or urologists). I try to ask my patient questions about what they know about sterilization and why they want the procedure, and I give them some materials to read about what to expect with the procedure. Do you have more specific questions that you're getting at? I know this can be a really emotional and complicated topic for many people, so please feel free to ask away!

I'm a doctor of a dying breed -- broad-spectrum family medicine with obstetrics including operative delivery, and regularly caring for very high risk pregnancies.

In my world, I'm a first-person witness to our increasingly-aging and increasingly-ill obstetric population, and I see the stark contrast in the continuity of care for women cared for by family medicine before, during, and after their pregnancies vs women who have separate primary care and obstetric providers. Clearly my bias is that the continuity of care in the family medicine scenario is of immense value to our patients and the healthcare system as a whole. However, it is becoming exceedingly uncommon that physicians practice the way I--and the rest of my group--practice.

Do you see any road that could change the forces that are causing this constant erosion (lack of training, medico-legal, turfwars, etc) and start to increase the role of new family medicine physicians in the continuity of reproductive care?

Yay for family docs! I love getting to care for patients of all ages. I think patients are eager to have a doctor who knows them well taking care of them at all stages of life, and that includes reproductive health care. I'm also so grateful for my OB/GYN and midwife colleagues' perspectives and expertise — I love working with a team of all sorts of providers who care about reproductive health

Why is it so difficult for women to get tubal litigation in America? I know I never want children and due to medical reasons I am unable to take hormonal birth control. Yet I am unable to get the one type of birth control I want -- permanent sterilization.

What an important question. This is really complicated, and it's related to our dark history of forced sterilization — we talk about it in our Life Kit. Doctors REALLY want to make sure their patients aren't getting pressured — either by their partners, their families, or other doctors — into making a permanent decision. But that can mean that patients who are sure they want a tubal ligation have a harder time accessing the procedure, which isn't good either. Some states or hospitals even require patients to sign a consent form a certain number of days in advance. If you're sure this is something you want, I'd make an appointment to discuss it with an OBGYN, and write down a list of your questions and concerns beforehand. A good doctor will listen to you carefully and make sure you get the care you need.

For many types of birth control, like mine, Mirena, there haven't been any/many very long term studies. Even though IUDs have been around in some capacity for decades, there aren't enough data points to measure long term health effects. Does any part of you wonder weather, say 30 years of a hormonal IUD use could have long term side effects on the body?

For me I know Mirena is better than the alternative, I just cant help but wonder weather a decade of IUD hormones before pregnancy and another decade or 2 of Mirena after pregnancy could negatively impact the endocrine system, brain, or uterus.

I know for many people the benefits outweigh the risk of the unknown, I'm just curious your thoughts on the matter.

That's a great question, and I think it's totally fair to wonder about long-term effects. But with everything in medicine, we weigh the costs and benefits — I think it's important to consider the long term effects of undesired pregnancies, too. All the data we have points to the fact that IUDs are very, very safe in the long term, and that it's safe to use multiple IUDs throughout your life.

Thank you so much for doing this. I have been on some form of Yaz for almost a decade now. I’ve switched between several generic versions. Most recently, I was put on Gianvi birth control and I have experienced anxiety attacks (never have dealt with these), crying fits, and several other emotional issues. I’m not positive that the BC is the culprit, but the timing lines up very well.

I talked to my Dr. and she has put me on a different generic, one created by Glenmark Pharmacy. I have compared the brochures and they are nearly identical. I guess my question is this:

Are there differences in generic forms of same name brand of birth control? Is it a possibility that this new generic version will affect me differently?

I’m also on birth control for acne. Are there other pills that will help keep my acne under control besides Yaz?

I'm so sorry to hear you're having a distressing experience, and I'm so glad you're talking to your doctor about it. In general, I tell my patients that the generic version of a medicine is the exact same molecule as the branded version. They are all approved by the FDA. But if you're having a bad experience, please don't be afraid to ask for help and find a solution that works for you. And yes, there are lots of pills that help with acne! Most of the methods that contain both an estrogen and a progestin together can help clear up acne, although it depends on your body, of course.

How did you end up doing this as a career and what is a normal working day for you?

Thanks for asking! I am so lucky to have an awesome job where I get to do lots of different things every day. I take care of patients of all ages, ranging from newborns to people over 100! I also teach medical students. I work as a contributor for NPR, where I get to do fun things like host Life Kit and talk to all of you. My days totally vary — some days I see patients all day, and sometimes I teach, and sometimes I do interviews or writing for NPR.

How can the pill impact libido?

That is a very, very common question! We have a lot of conflicting data about the role of combined oral contraceptive pills and libido. Some studies show that there's an association between decreased sex drive and COCPs, while other studies show that sexual activity and sex drive seem to increase with COCPs. It's hard to study, because other factors can confound how patients report their desire — relationship problems, stress or other mental health issues, physical activity, other medical problems, etc.

I'm in my late thirties and still think I want to have a family, but not in the next couple of months. What is a good short term birth control that wouldn't negatively impact fertility when we're ready to try?

That's a great question. I recommend oral contraceptive pills, the NuvaRing, or condoms.

Hey Doc, thanks for the AMA. Are there any negative/possible physical side effects on men after having a vasectomy?

Vasectomies are generally really safe and well-tolerated — it's usually an office procedure, so you don't even need to have anesthesia! It can cause some discomfort after the procedure, but people tend to do well taking NSAIDs like ibuprofen or naproxen. There are risks to any procedure, but a vasectomy is considered pretty safe.

Hi doctor! Do you know why there exists so many generic versions of the same pill, and why my pharmacy randomly switches me? I’m on the generic Yaz and I’ve also had Nikki/gianvi/Loryna. Maybe even more I’m not remembering!

Oh my gosh, you can do a PhD on the topic of drug pricing and insurance coverage in the United States! It's really, really complicated. I'll leave it at this: Most forms of oral birth control pills are really similar both in their hormonal makeup and how effective they are. I wouldn't stress about it too much, unless you're having new symptoms that you're concerned about.

I have had no luck with anything hormonal. Implanon- bleeding. Pill - unable due to regular overseas travel and inability to take it regularly. Nuvaring - unable to skip periods and annoyingly long periods when they come. I’m terrified of the Mirena. I’m out of options it seems? Would you suggest anything else?

I have so many patients who love the hormonal IUD — it's worth learning more about! You can read more about it at Bedsider.org. I'd write down all of your concerns and make an appointment with your doctor to go through them one by one.

Is there any BC aside from orthotricyclen that clears up acne?

Yes! Definitely. There are lots of different birth control pills that can help with acne. Here's a nice review article that summarizes a lot of the research on using combined oral contraceptive pills for treatment of acne.

I'm currently on the Pill, and it's working fine but I'd like a longer term version. The Depo-Provera shot has been linked to decreased bone density? How worried should one be about making that switch to using depo long-term?

If you're interested in a longer-term method of contraception but worried about the side effects of depo, I'd encourage you to consider an IUD or implant — much, much lower doses of hormones, and they can last for years. The American College of Obstetricians and Gynecologists says that for many patients, the benefits of pregnancy prevention outweigh concerns about bone density. In general, it looks like Depo can reduce bone mineral density, but it's not clear if it's a long-term effect, and pregnancy prevention is super important for many people! This is from UpToDate: "One of the contraceptive actions of Depo results from suppression of gonadotropin secretion, which in turn suppresses ovarian estradiol production. In hypoestrogenic states, bone resorption exceeds bone formation, resulting in a decline in bone mineral density (BMD).The rate of bone loss is not linear; the greatest loss is during the first one to two years of use, after which BMD appears to plateau (figure 2). Compared with nonusers, BMD at the hip and spine of Depo users decreases by 0.5 to 3.5 percent after one year of use, 5.7 to 7.5 percent after two years of use, and 5.2 to 5.4 percent after five years of use." However, studies involving premenopausal women and adolescents treated with Depo for up to five years reported that the decline in bone mineral density associated with Depo was substantially reversed after discontinuation.

What reading or resources would you advise for a junior doctor to refresh their limited knowledge from med school and improve their understanding?

Thanks

That's a great question. I love reading the American Family Physician for general updates on family medicine, and I love Journal Watch for summarizing medical research and keeping me updated. I also use UpToDate literally hourly when I'm in clinic — what a great resource!

Thanks for the AMA!

What advice related to this would you give a 14 year old?

I have lots of teenage patients, and I LOVE taking care of them (although they often make me feel uncool because I don't use TikTok or Snapchat). The American Academy of Pediatrics recommends that all teens have access to comprehensive reproductive health care, including access to contraception. They also recommend that teens consider long-acting reversible contraception (LARC) — that's the IUD or implant. These methods can be particularly effective for teens because they don't need to remember to take a pill every day or come in for depo shots.

Hi! How does birth control effect people with graves disease, but went through RAI? I hate my period, but I also have hormonal issues due to my thyroid. My levels are normal and I haven't been on meds for over a year.

Hi there! I think you should bring this up with your doctor — the specifics really can vary with the details of your medical history. Good luck!

Hey everyone! We're running out of time together, but I wanted to say thank you all for your thoughtful questions! There's so much to talk about with contraception. I'd love it if you'd give a listen to our Life Kit episode. And as always, please talk to your doctor or other health care provider about any lingering questions. We truly are here to help, and we'd love to help you find a method of contraception that works for you. Thanks!

Do you think colleges and/or universities should provide free condoms to prevent transfer of STDs? If no, what might be the disadvantages?

Yes, I do! I often give my patients condoms, too — many insurance plans will cover them.