BIRTH CONTROL 101: A Doctor’s Advice, Experience, And Tips On Getting It Right
For Filipino women the subject of birth control isn’t as openly discussed here as it is in the west. However, that status quo has been challenged by reproductive control issues and looming population growth. Also, for other hormonally related health concerns like acne or endometriosis, birth control medication has been prescribed by doctors for a long while now. There is also the subject of the usual fertility methods without medication, but when is it practical to apply these methods rather than rely on chemical contraceptives? Dr. Maria Del Carmen Castillo, a practicing OBGYN consultant warmly and openly shared what she advises patients younger and older. She also lets us in on the details about how certain types of contraceptives effectively do the job.
“My belief is that when you have a young person coming in to talk about contraceptives, you really have to lay out all the options. It’s not just because I’m a mom na I’m only going to tell you to use fertility-based methods and tell your boyfriend to just use a condom because I don’t want you to take a pill. I’m a doctor—my first role is to adequately prepare a person, so they have to know all the details.”
For people who have never tried birth control before but have been sexually active, what are their birth control options?
“I think for me that also depends on the age and maturity of the person who is consulting regarding contraceptives. So, if we’re talking about, let’s say the 17-20 year old age range, sexually active—college students, or sometimes high-school—I would say that the better choice would be to do combined oral contraceptives that have estrogen and progesterone. Only because there’s a system of taking it, there’s a visual aid, how they can see the pack, there are arrows leading to the next tablet—easier to teach.”
Dr. Castillo expounds that, quite often, people who are sexually active in their later teens are still not as responsible as older patients. For younger patients, the routine and scheduled intake of medical contraceptives is still more easily recommended than fertility-based pregnancy prevention. “I find that through my years of practice that this is a little bit hard for young people. They miscount, they’re not sure about whether the cervical mucus is thick or not, so I think it’s always better to have like a visual aid like in terms of the packet of the pills, so they can understand where they’re going from there.”
What are the kinds of medical contraceptives available and how are they different?
“So basically, yes, combined oral contraceptive pills which have both estrogen and progesterone. Why would I say that that’s the best choice? Because at least, it mimics their body cycle, because we do have estrogen and progesterone in our system, and having the combined pills will ensure that they menstruate.” She also points out that there are also progesterone only pill alternatives, however, these tend to stop menstruation and cause irregular bleeding or spotting. “It’s easier because they don’t have to think of anything—they get injected, then the next injection is after 3 months, they don’t have to remember to do something.”
The quarterly progesterone injectable she refers to is a more convenient option for young people, but it’s really used for those who have just given birth and are breastfeeding. Estrogen, as it turns out, isn’t allowed for people who are breastfeeding. Those who breastfeed can only have progesterone-only pills daily for 28 days, or the progesterone-only injection which is given intramuscularly every 3 months.
What are the non-chemical options available in terms of birth control?
Many people are concerned nowadays with whatever they take into their bodies that isn’t natural. Birth control in its various medical forms are basically still chemicals that work within your anatomy. Over an extended period of time after a certain age, any form of chemical intake is better off lessened, if possible. Dr. Castillo believes in balancing what’s available “Let’s face it, you’re going to have sex for a very long time. How long are you going to keep up the contraceptives? For all that is still useful, it’s still medicine going into your body— [I recommend] the fertility based methods, I would even urge condoms, because at least it is protective of sexually transmitted diseases. I also tell this to my young patients that if they’re going to start the pill I really would still want their partners to be wearing a condom. It’s very hard to convince young men to use condoms. They say things like they can’t ‘feel it’ or whatever.”
“For older women, if they’re in a stable relationship with a partner, and very motivated not to get pregnant—this is a personal take on myself—I really would prefer the fertility-based method of counting, calendar method or standard days, so that there are no chemicals entering your body.”
“There’s a whole slew of them [fertility based contraceptive methods]; there’s a calendar method, where you calculate based on your longest and shortest day cycle, there’s also the one based on body temperature—a bit tedious because you have to take your temperature everyday as you wake up , the cervical mucus method in which you—it might sound a little gross—but you feel the mucus in your vagina and you see if it’s watery, sticky, or mucoid. The thing with natural methods, almost 50% of people fall off them because they lose track, they’re not motivated enough, and want an easier way and when they’re young… it’s even harder to do that, because they’re up and about and they forgot to count na.”
What are the possible hormonal reactions or physiological effects when taking birth control pills for the first time or in general?
“If we’re looking at 18-35 year-olds, no other medical problems, just doing the combined oral contraceptives of estrogen with progesterone, at the beginning—when you start the pill—maybe nausea, for some vomiting, definitely breast tenderness. These are all initial, they don’t last all the time when you take it. It happens like for the first time when you get introduced to the pill.” Dr. Castillo explains that when retained water finds its way in between fat in the breast, patients may experience a fullness to the cup. You also have retention actually if you’re not on the pill, but you’re about to menstruate, like mid-cycle, you would also be retaining water simply because of your hormones, the pills just mimic that to a certain degree.
“There is no truth that you will gain weight. This is a common urban myth and that’s actually what stops a lot of people from taking it—thinking they’re going to get fat or whatever—no truth to it at all. Even when you read the product insert, maybe there may be some water retention but not enough to actually gain weight.” With regards to the weight gain, doctors can conclude that if you are actually eating a clean diet you’re actually burning calories during sex you so you shouldn’t be gaining weight.
Will using birth control pills affect the type of pregnancy you have if later on you want to have kids?
“Multiple studies have shown already that the use of pills doesn’t cause teratogens in babies, like abnormalities or what. To restore your fertility, it depends…if it’s the combined oral contraceptive, you stop it and within two or three months you should be back to your normal fertility. With the progesterone only, you don’t bleed because your lining is thin already without the estrogen and you have spotting, it takes a little bit longer to get back to a fertile state after you stop the injectable or the progesterone only pill. It’s faster with the combined [to bring back fertility] because it’s just mimicking what you have in your body, you have both...estrogen and progesterone.”