birth control question

[bubblywatr]

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Hey guys, i have a quick birth control question for you biology folks:

What is the reasoning behind the recommended wait peroid of 7-14 days when using ortho tri-cyclin (28-day)? If started on last day of mensis (as opposed to the Sunday or First day starts)when would the pill become effective?

thanks a lot!

 

[doepug]

Hmmm... not familiar with the 14 day wait.

Most oral contraceptives need to be taken for a FULL cycle before they're effective. That means if a woman starts taking the pill halfway through, she'll need to take it for a cycle and a half before it's truly effective. The simple answer is that your body needs time to adjust to the new levels of estrogen and progesterone, and that timing with respect to a woman's cycle is important.

If a woman has unprotected sex before her body has learned how to metabolize the extra hormone load, she's actually more likely to get pregnant. It's the same when someone who's been on the pill for years takes certain drugs (e.g. Dilantin), only to become pregnant because estrogen metabolism is changed.

The idea is that the progesterone in the pill tricks your body to think it's pregnant, and the hormones also make the uterus less hospitable for anything that might get fertilized. Unfortunately, this doesn't happen overnight.

Hope this helps,

doepug
MS III, Johns Hopkins

 

[Gleevec]

Originally posted by Carbon
The 7 day placebo green pills are so your body will actually menstruate. If you begin the next pack immediately after taking the last active pill, you won't menstruate at all.

I have friends who do this, but I've never discussed it with a doctor.

Cant that cause long-term problems with the uterine lining? I thought the whole point of the placebos were to allow the lining to slough off monthly. Im not entirely sure though.

 

[CD]

It's my understanding that the 14 day wait is because you "just never know" when you might have ovulated. Although it is unlikely to get pregnant within the first week or so of your cycle....it can happen. (my daughter was conceived on day 5...imagine that!) Most birth control pills grow in the amount of hormone given over the month. If you weren't on the pill the previous month, your body hasn't had the hormones in it to keep it from "possibly" ovulating during the first few days of the cycle. This "carryover" is what usually causes women who have been on the pill to not get pregnant when they first go off the pill....even if they are trying to get pregnant.

It is also dangerous to take the pill without taking the green "placebo" portion of it. For one thing our bodies are naturally timed toward 28 day cycles. By FORCING it to go to a 21 day cycle you are constantly messing up the schedule of your body. The most dangerous aspect though, is that the lining of the uterine wall MUST be allowed to leave each month. Keeping it there increases the likelyhood of uterine cancer...not a risk I care to take.

 

[bubblywatr]

thanks guys, this has been quite enlightening

 

[paean]

Um, CD, can you back any of your statements up regarding longer cycles with references? Evolutionarily, women had far fewer menses than they do now, and the frequency of the modern women's cycles is postulated to have caused or contributed to the surge in breast and uterine cancers. This hasn't been proven (no way to do a double blind study on whether menstration causes cancer, or to randomize women into groups of more of less frequent menstrations). Ergo, menstrating every 28 days is potentially a bad thing. Additionally, many women have a natural cycle that is longer, and there is no evidence that they are in danger of anything from it.

Many gyns will tell you that it is okay to skip the placebo pills every other pack or so, so that you have your period evey 7 weeks instead of 4. And the FDA recently approved Seasonal, a 13 week cycle birth control pill. The most common effect of delaying bleeding is "break through" bleeding, when your baody decides that it isn't going to wait for you to take a week off from your hormones for it to slough off the uterine lining.

CD had a great explaination for why you are recommended to wait a full cycle (7 days is better than nothing, but the first cycle on the pill is the most risky for pregnancy).

 

[surfdevl02]

bubblywatr, are you curious cause you think you knocked a girl up.....

 

[CD]

Hmmmm......I can't personally give a reference. My information came from my OB/GYN seven or eight years ago. It is possible that new research has occured since then that would change the data that was available at the time. Women's cycles do vary considerably, although most fall around 28 days. A friend of mine was a 6 month cycle and her physician was VERY concerned about her and put her on birth control to encourage menses. There are a variety of birth control methods available that cause menses to cease and I for one, would love to see data centered around research on them!!!! As someone stated, it is difficult to do such research. (on a side light....recent research has indicated that there is a connection between the increase in breast cancer and the increase in abortions...I don't have the data in front of me but could probably find it)

Yes, there are times when a OB/GYN might encourage longer times between cycles...some of which are anemia, or excessive bleeding. As in most cases of medicine there are times when something is appropriate..... and times when the very same thing is not!

 

[Katie]

I think probably the best reason to NOT keep taking the pills with active hormone when you're supposed to be having a period is paranoia. I don't know, even though the pill is amazingly effective I would get paranoid about not being 100% sure that my missed period was due to my manipulation of the medicines and not pregnancy. When I was on the pill in college I drove my bf crazy b/c I was paranoid about the medication failing if I didn't take it at the EXACT same time every day, but then again my now ex did not have the same kind of interest in my taking the pill that the original poster shows. I commend the OP for showing an interest in your girlfriend/fiancee/wife's health and future; lots of guys out there could learn from you (even if you are worried about having knocked someone up as surfdevl puts it..)

 

[Katie]

Originally posted by CD
Hmmmm......I can't personally give a reference. My information came from my OB/GYN seven or eight years ago. It is possible that new research has occured since then that would change the data that was available at the time. Women's cycles do vary considerably, although most fall around 28 days. A friend of mine was a 6 month cycle and her physician was VERY concerned about her and put her on birth control to encourage menses. There are a variety of birth control methods available that cause menses to cease and I for one, would love to see data centered around research on them!!!! As someone stated, it is difficult to do such research. (on a side light....recent research has indicated that there is a connection between the increase in breast cancer and the increase in abortions...I don't have the data in front of me but could probably find it)

Yes, there are times when a OB/GYN might encourage longer times between cycles...some of which are anemia, or excessive bleeding. As in most cases of medicine there are times when something is appropriate..... and times when the very same thing is not!

I knew abortion would eventually find its way here.. However, the # of abortions is NOT currently increasing (except recently among poor women), and has been in fact decreasing (at least nationally) for some time since around the time Clinton first entered office. I read a study in a local paper that showed that the decrease is greatest among teenagers due to increased education about birth control (hence increased use of BCP and reduction of unplanned pregnancy) AND increased education regarding sexual abstinence. Increased proper use of birth control accounted for about 70% of the decrease, and abstinence/delay of sexual activity accounted for about 30% of the decrease. It's nice to know that both types of sex education can have a positive effect. I'll try to find the source tommorow, it's late on the East Coast and time for bed. peace.

 

[omores]

The new thinking is that your body does not "need" to have a period every month. One new regimen that is gaining popularity is to be on continuous hormones for four(?) months, and then have a week break, thus enabling you to have only three periods a year (or is it every three months, with four periods a year?) I believe there's even a new type of birth control pill specifically tailored to this regimen, but in any case there are women who do this with regular birth control pills (they just skip the placebo week) with their doctors' blessings.

 

[LadyLuck]

My doctor told me that women should bleed at least 4 times per year to prevent bone loss. I am not nearly educated enough on why the hormones are relevent to bone loss, but I do know that women in menopause are encouraged to take calcium because of the irregular and ceasing menstrual cycles. Like I said, I really don't know what I'm talking about, just what my doctor told me, and things are always everchanging in the medical world. Hope you find the answers you're looking for 🙂

 

[CD]

Oh dear...I didn't mean to introduce a subject that would cause problems. Nor did I mean to imply that the number of abortions PER YEAR is increasing....it is indeed as you said, DECREASING. However, the number of women who have had an abortion IS increasing and the number of women who are getting older that have had abortions is increasing due to the legalization of abortion. I don't want to get into the legal/moral implications (or discussion), I only wanted to state that recent research indicates a connection between having had an abortion and an increase in the risk of breast cancer later in life.

 

[slindsay198]

Skipping the placebo pills in the pack is no more dangerous than getting a Depo-Provera injection (the 3 month BC injection). It's virtually the same thing, resulting in continuously elevated estrogen and progesterone levels.

Scott-MSII
PCOM

 

[*sunny*]

I was just at the Dr. and asked about skipping the placebo pills b/c i'm an athlete and it would make my life just that much better. She said that on pills like ortho- tri it's not recommended, because the pills horomone levels vary between the amount of estrogen and progeterone throughout the cycle...so skipping the placebo would "shock" your body or something like that because of the jump in horomone levels from low to high. However, there are some pills which keep a constant horomone level throughout the cycle- and with these pills it is ok to skip the placebo- although i don't know the name brand. hope that helps

 

[Bounty]

Originally posted by paean
Um, CD, can you back any of your statements up regarding longer cycles with references? Evolutionarily, women had far fewer menses than they do now, and the frequency of the modern women's cycles is postulated to have caused or contributed to the surge in breast and uterine cancers. This hasn't been proven (no way to do a double blind study on whether menstration causes cancer, or to randomize women into groups of more of less frequent menstrations). Ergo, menstrating every 28 days is potentially a bad thing. Additionally, many women have a natural cycle that is longer, and there is no evidence that they are in danger of anything from it.

I read a really interesting article on this int he new yorker - it was all about the guy who created the pill and why it may not be so great that he made it 28 days, etc etc. (he was trying to please the catholic church etc) Hmmm....i'm gonna go look for it. Oh here it is - i know there have been lots of rebuttals to this article but i still thought it was interesting:

new yorker article

 

[dsomme]

Originally posted by CD
I don't want to get into the legal/moral implications (or discussion), I only wanted to state that recent research indicates a connection between having had an abortion and an increase in the risk of breast cancer later in life.

Recent studies by Sweden and Denmark have shown that there is no link between abortion and breast cancer. Both of the countries have a national registry for cancer and for induced abortion. Researches followed over 330,00 women who had abortions and found no increase in the risk of breast cancer due to having an abortion. See the abstract for the Danish study here.

The previous studies that suggested a link between abortion and breast cancer are believed to be flawed because of reporting bias. In those studies, reasearchers went around polling people about if they have had an abortion and/or breast cancer. Basically, people were more likely to admit to having an abortion if they had breast cancer because of a possible desire to find a cause for their cancer. This has been shown by conducting the same studies in regions of different religious/social climate in the same country and finding that the reported relative risk of breast cancer due to abortion varied greatly between areas. More conservative regions had a much greater reported relative risk than more liberal areas. Also, a similar study done in China, where abortion is common and has little social stigma, found no relation between abortion and an increased risk for breast cancer.

In the interest of objectivity, some researchers have found flaws in the Danish study. I'm sure this issue is far from being resolved, especially given the personal biases of many of the researches. Yet I believe there is not enough information demonstrating a link between abortion and breast cancer for such claims to be believed.

Finally, my apologies to the OP for this off topic response, but I felt I had to clear the air about an inconclusive claim that was brought up.

-dsomme

 

[wexy]

Originally posted by Bounty
I read a really interesting article on this int he new yorker - it was all about the guy who created the pill and why it may not be so great that he made it 28 days, etc etc. (he was trying to please the catholic church etc) Hmmm....i'm gonna go look for it. Oh here it is - i know there have been lots of rebuttals to this article but i still thought it was interesting:

new yorker article

I am interested in public health, and during my interview at downstate in october, i was grilled about this article!! The dean even copied it for me!

 

[Dr JPH]

Originally posted by LadyLuck
My doctor told me that women should bleed at least 4 times per year to prevent bone loss. I am not nearly educated enough on why the hormones are relevent to bone loss, but I do know that women in menopause are encouraged to take calcium because of the irregular and ceasing menstrual cycles. Like I said, I really don't know what I'm talking about, just what my doctor told me, and things are always everchanging in the medical world. Hope you find the answers you're looking for 🙂

Estrogen.

Estrogen inhibits osteoclast activity...those little cells that chew up bone.

When women age and go through menopause, the production of estrogen decreases, therefore the osteoclast activity is increased.

Funny...increasing calcium intake really isn't the best solution to the problem. For maintenance it works, but realistically it won't help build any new bone. HRT works, but with all the scary news being reported as of late (which, by the way, has been known to the medical profession for years) this form of treatment is under scrutiny.


What's the best solution? Stop getting older. 🙂

 

[LadyLuck]

thanks for clearing that up JPHazelton 🙂 I learned something new today now if only we could stop getting older......

 

[Mistress S]

I work at a reproductive health care clinic, to answer the OP's question the reason behind the 7-14 day wait for effectiveness of oral contraceptives is that the pills work primarily by inhibiting ovulation, and when you first begin pills it is possible that you already ovulated and the egg can live in your body for up to a week (although this is rare). So, using a back up method like condoms or abstaining is necessary until the pill has had time to take effect and any eggs you might have previously released are gone. We tell women they only have to wait for one week when starting pills before they can rely on them as their sole method of birth control, some doctors advise longer waits to ensure that women are careful during that time and get used to taking a daily pill before getting rid of their back up method but this is not necessary as long as you can remember to take the pill every day. Condoms are still important, though, for STD protection.

As for the concern about skipping monthly cycles, the reason it is okay to not shed the uterine lining monthly when you skip your spacer pils or on depo provera (the injectable contraceptive) is that the progesterone in these methods inhibits the build-up of uterine lining. If you take your pills continously, the progesterone in them will thin the uterine lining, usually (although not always) to the point where there is not enough to shed. So you don't bleed because there's nothing to bleed out, not because it's being "trapped" in your uterus and building up there each month.
This is no more or less safe then taking your pills the regular way.

I read that New Yorker article a couple of years ago and foud it quite interesting, women in this country are raised to think about menstruation a certain way (i.e., a monthly cycle is healthy and necessary) but this viewpoint might even be dangerous, and was certainly not the biological norm until the industrial revolution. Food for thought.

 

[klp14]

Originally posted by Bounty
I read a really interesting article on this int he new yorker - it was all about the guy who created the pill and why it may not be so great that he made it 28 days, etc etc. (he was trying to please the catholic church etc) Hmmm....i'm gonna go look for it. Oh here it is - i know there have been lots of rebuttals to this article but i still thought it was interesting:

new yorker article

Wow, that was really interesting. Thanks Bounty! I learned something new today.🙂

 

[Bonds756]

Originally posted by dsomme
Recent studies by Sweden and Denmark have shown that there is no link between abortion and breast cancer. Both of the countries have a national registry for cancer and for induced abortion. Researches followed over 330,00 women who had abortions and found no increase in the risk of breast cancer due to having an abortion. See the abstract for the Danish study here.

The previous studies that suggested a link between abortion and breast cancer are believed to be flawed because of reporting bias. In those studies, reasearchers went around polling people about if they have had an abortion and/or breast cancer. Basically, people were more likely to admit to having an abortion if they had breast cancer because of a possible desire to find a cause for their cancer. This has been shown by conducting the same studies in regions of different religious/social climate in the same country and finding that the reported relative risk of breast cancer due to abortion varied greatly between areas. More conservative regions had a much greater reported relative risk than more liberal areas. Also, a similar study done in China, where abortion is common and has little social stigma, found no relation between abortion and an increased risk for breast cancer.

In the interest of objectivity, some researchers have found flaws in the Danish study. I'm sure this issue is far from being resolved, especially given the personal biases of many of the researches. Yet I believe there is not enough information demonstrating a link between abortion and breast cancer for such claims to be believed.

Finally, my apologies to the OP for this off topic response, but I felt I had to clear the air about an inconclusive claim that was brought up.

-dsomme

Search the literature and you will find dozens of articles published citing a corolation between abortion and breast cancer. The evidence is particularly strong if the abortion occured following one's first pregnancy. Yeah, I am sure there is bias, but every retrospective article has it. So one article in NEJM isn't going to solve this issue. Intuitively, altering hormones and increasing estrogen should result in the corolation. Much the same as why birth control births have been shown to result in a small, but well documented and statistically significant increased risk of breast cancer.

 

[bubblywatr]

thanks mistress! that's a great explination.

 

[Mutterkuchen]

Originally posted by Bonds756
Search the literature and you will find dozens of articles published citing a corolation between abortion and breast cancer. The evidence is particularly strong if the abortion occured following one's first pregnancy. Yeah, I am sure there is bias, but every retrospective article has it. So one article in NEJM isn't going to solve this issue. Intuitively, altering hormones and increasing estrogen should result in the corolation. Much the same as why birth control births have been shown to result in a small, but well documented and statistically significant increased risk of breast cancer.

Actually, quite the contrary. If you search the literature, you will find dozens of articles stating that there is NO statistical correlation between abortion and breast cancer. In my cursory look at Medline, I could actually not find ANY articles where there is a correlation between the two, though I am sure one exists somewhere. I guess this can only be found in the religious literature, not the scientific literature.

 

[CD]

Actually I'm aware of three studies done on the connection between breast cancer and abortion. The initial study was done by a woman physician who is actively pro-choice. Her comments about her study were something along the line that she wished the outcome of the study had been different but that science should be impartial...independent of ones personal beleif. The second study was done by a pro-choice group and stated there was no corrolation between breast cancer and abortion. The third study was done by a pro-life group and found there was a connection between between the two. Personally I have doubts about the last two studies because of the researchers bias. I tend to side with the intial study because it was done by a pro-choice doctor who stated there WAS a connection. Obviously she wasn't trying to promote her own agenda.


On another note, I'm curious about the whole uterine lining thing. If oral birth control thins the lining to the point that there isn't any to shed, then how come there IS menses in birth control patients. Obviously (or at least it seems to me) there IS a building up of the uterine lining and it either stays there if no placebo is taken or is shed during the placebo portion of the birth control pack. Can anyone shed an light on this?

 

[Mistress S]

Regarding the uterine lining: patients who take their birth control pills in the regular fashion (with a week of spacer or inactive pills) will also experience thinning of the lining due to the progesterone, this is why pills are often prescribed to patients with heavy or painful periods for the purpose of reducing the amount of bleeding and cramping they experience. During the week without hormones, most patients will have period-like bleeding, although it is not really "normal" menstruation as the body's usual cycle is completely disrupted by the pills. Patients who use continous dosing (that is, taking only the active pills and skipping the spacer pills) usually have enough uninterrupted progesterone in their system to completely or mostly stop bleeding, although many women still experience occasional spotting when they do this, especially if they don't do it consistently. The estrogen present in most birth control pills also plays a role in regulating bleeding. In other words, most patients on oral contraceptives experience thinning of the uterine lining, although it is not complete, and using continous dosing of the pills usually thins the lining to the point where there is no or little bleeding. Depo provera, a progesterone-only method, is more effective at preventing bleeding; most women on this method over time stop bleeding completely as they are receiving a consistent amount of progesterone and therefore usually stop producing enough uterine lining to shed. When this method is first begun, however, irregular bleeding is very common as the body adjusts to the new hormone levels.

This is the information I have from the clinicians I work with and from reading the literature available at my work regarding this, and how I answer patients who have questions about their birth control. For more detailed information about the specific actions of the hormones in the body I would have to do some more involved research, but I hope this sufficiently explains the matter to anyone who was wondering. It is too bad that there are so many misconceptions about birth control, a lot of people aren't aware of all the options available to them or incorrectly use the ones they have due to misinformation or confusion. Anyway, I hope this is information is useful!

 

[ckent]

Interestingly, this whole abortion and breast cancer issue was recently made "political". I haven't seen the cdc website myself, but I saw on CNN that the cdc website used to have "there is no correlation between abortion and breast cancer" to "studies have been unclear whether or not there is a correlation between abortion and breast cancer" after Bush took office. I haven't seen the actual studies myself, but I wouldn't be surprised if the conflicting studies showing a correlation between pregnancy and abortion didn't take into account confounders like how women who have less children, or who spend less time being pregnant in their lives have increased rates of breast cancer. That's a hormonal thing, not an abortion thing. Or it could be whatever women take medication wise to have an abortion, particularly some of the hormonal stuff, leads to an increased risk of breast cancer. Or it could be because women who get abortions are not taking OCPs, which I think decrease your risk of breast cancer. Medical research is still very much under the influence of culture and politics. And of course money (ie drug company research, some of the shadiest research out there). That's why it's always useful to look to see who funded the research (like if NARAL or whatever pro-life group funded it, or if it was funded while George Bush was president or Bill Clinton).

 

[Random Access]

Originally posted by ckent
Interestingly, this whole abortion and breast cancer issue was recently made "political". I haven't seen the cdc website myself, but I saw on CNN that the cdc website used to have "there is no correlation between abortion and breast cancer" to "studies have been unclear whether or not there is a correlation between abortion and breast cancer" after Bush took office.

There were a few other changes too. Very shady stuff. It wasn't actually based on anything concrete. Definitely just political dealings.

 

[thewebthsp]

I think the main connection is NOT having kids and breast cancer. THe breasts are designed to feed the nascent child; without ever getting pregnant the cells that are destined to lactate never (or rarely do) and so are held in a static state longer than usual. Just a hypothesis, but might this be the connection?

 

[Bonds756]

Originally posted by JBJ
Actually, quite the contrary. If you search the literature, you will find dozens of articles stating that there is NO statistical correlation between abortion and breast cancer. In my cursory look at Medline, I could actually not find ANY articles where there is a correlation between the two, though I am sure one exists somewhere. I guess this can only be found in the religious literature, not the scientific literature.

In ten minutes I found a dozen articles in strong journals such as Lancet, NEJM, JNCI, Cancer, etc. They indicated that if you terminate your first pregnancy, your risk goes up. A few site an increase of 2.5 times the risk if done during the first trimester. I didn?t read each one carefully, but the point is the relationship is out there in the literature. And with most other cancer linkages (ie. high tension wires) regardless of the truth, there are going to be several articles saying there is no increase and the issue will remain non difinitive.

-Brind J, Chinchilli VM, et al. Induced abortion as an independent risk factor for breast cancer: A comprehensive review and meta-analysis. J Epidemiol Community Health.
1996; 50:481-96.
-Hsieh C, Wuu J, et al. Delivery of premature newborns and maternal breast cancer risk. Lancet. 1999; 353:1239.
-Senghas R, Dolan M. Induced abortion and the risk of breast cancer. NEJM. 1997; 336:1834.
-Krieger N. Exposure, susceptibility and breast cancer risk. Breast Can Res Treat. 1989; 1989; 13:205-223.
-Somerville S. Connections. Is there a link between the permination of first pregnancy and breast cancer? Monograph.Life Dy-namics. Lewisville, TX. 1994.
-Pike, M., et al. Oral contraceptives and early abortion as risk factors for breast can-cer in women. Br J Cancer. 1981; 43:72-76.
-Brinton, et al. Reproductive factors in the etiology of breast cancer. Brit J Cancer. 1983; 47:757-782.
-Parazzini, et al. Menstrual and reproduc-tive factors and breast cancer in women with family history of the disease. Int J Can-cer. 1991; 51:677-681.
-Olsson, et al. Her-2/neu and INT2 proto-oncogene amplification in malignant breast tumors in relation to reproductive factors and exposure to exogenous hor-mones.
JNCI. 1991; 83:1485-87.
-Olsson, et al. Proliferation and DNA ploidy in malignant breast tumors in relation to early oral contraceptive use and early abortion. Cancer. 1991;67:1285-90.
-Lindefors-Harris, et al. Risk of cancer of the breast after legal abortion during first trimester: a Swedish register study. Brit Med J. 1989; 299:1430-32.
-Howe, et al. Early abortion and breast cancer risk among women under age 40. Int J Epidem. 1989; 18:300-304.

 

[Random Access]

Originally posted by Bonds756
In ten minutes I found a dozen articles in strong journals such as Lancet, NEJM, JNCI, Cancer, etc. They indicated that if you terminate your first pregnancy, your risk goes up. A few site an increase of 2.5 times the risk if done during the first trimester. I didn?t read each one carefully, but the point is the relationship is out there in the literature. And with most other cancer linkages (ie. high tension wires) regardless of the truth, there are going to be several articles saying there is no increase and the issue will remain non difinitive.

Well...there are confounds. For example, I'd imagine a fair number of people getting an abortion aren't using protection (contraceptives or STDs) at all. This might say something about how they live the rest of their life, which may alter their susceptibility to cancer.

I suppose it could be related to something that happens during pregnancy that is unresolved because the fetus isn't carried to term. However, is there a similar result for people who have miscarriages? Is there research on that? Perhaps less research because it's not as politicized? I have no idea; I'm just asking.