Dr. Djinge Lindsay is a practicing gynecologist in Washington, D.C. She’s got her M.D. and M.P.H. and is board certified in family medicine.
BuzzFeed asked Dr. Lindsay questions we had about our bodies, birth control, and sex. Here are the answers to those questions:
1. How frequently really should you be doing self-breast exams? Like, every month? Every three months?
Depends on who you ask. The U.S. Preventive Services Task Force recommends against breast self-exams because there is good evidence that doing the exams does not decrease deaths from breast cancer. ACOG and cancer organizations recommend health providers teach breast self-awareness, i.e., what a normal breast should look and feel like. Many doctors, myself included, have known women who have found cancerous lumps, so it is hard for us to tell patients to not check at all. The best advice is to talk to your doctor about your personal risks for breast cancer, and the potential benefits and harms of performing self-exams.
2. Is it true that there’s a male form of birth control that isn’t widely available because there’s no market for it? Why does everything have to fall on us?
There is ongoing research into contraceptive options specifically for men, but none approved for use so far. Most of the methods are looking at ways to decrease or stop semen emission during intercourse, or preventing sperm from fully maturing. In the meantime, condoms are a great male-focused method and have the added benefit of preventing sexually transmitted infections.
3. How risky is it to not take your birth control at the same time every day? What if you take it the next day?
Birth control pills are most effective if taken the same time every day. That being said, if pills are taken off-schedule, the risk can vary depending on the type of pill (combination or progestin only) and the week of your cycle. Birth control pills are made of hormones that help prevent the ovaries from releasing an egg, and change your mucus to make it harder for sperm to reach eggs. By taking them regularly, you will keep the correct level of hormones in your body.
Combination pills (with both estrogens and progestin) allow for a little bit more leeway. If you miss your normal time, just take a pill as soon as you remember (even if that’s taking two pills at once). If the time has been more than 24 hours, to be on the safe side, use a back-up method (like condoms) for a week after the missed pill. If the time has been more than two days, consult a health provider for instructions (written instructions can usually be found in the package insert). With progestin only pills, if you miss your normal dose by more than three hours then the pills may be ineffective. Still take the pill when you remember, use backup for the next 48 hours, and consult with your provider. Missing doses can also cause irregular bleeding.
4. How common is TSS, and how do you REALLY know if you have it? Like, if I sleep with a tampon in, will I get it?
Toxic Shock Syndrome (TSS) is extremely rare, estimated as low as 0.52 of 100,000 tampon users [getting it] annually. It is caused by bacteria that release toxins into the body that can lead to serious illness and even death. In the 1980s, TSS was found to be related to tampon use, particularly super-absorbent tampons. Over the next decade, tampon manufacturers pulled certain types of tampons from the market, and the incidence of TSS declined. Bottom line, it is very unlikely to have complications from sleeping with your tampon. Try to change your tampon at least every eight hours and use the lowest absorbency you need.
5. My friend said she was able to skip her period by not taking the placebo-week pills and going straight to the next pack. I’d like to know if this is true.
Most birth control pills come in a 28-pill pack. The first 21 pills are the active hormones, and the last seven are the inactive, or placebo, pills. The week of inactive pills should correspond with your period. For many women, starting the pack on a Sunday can help to avoid menses on the weekends.
Extended-cycle (or continuous-cycle) pills allow women to have their period every three months, or with some newer regimens, not at all. For the three-month regimen, you can take your regular active combination pills continuously for 84 days (12 weeks) and then no pills for one week. Irregular bleeding (spotting) is common when starting a continuous regimen. For most women this will resolve within the first few months. If you have a big event coming up, talk to your health care provider a couple of months beforehand to plan any changes in your regimen.
If you want to change to continuous cycle, after the 21 active pills, it is OK to skip the placebos and start a new pack of active pills. You basically would take active pills for 84 days in a row. (You’d need four packs per cycle). If you want to stay on a monthly cycle, then you’d take 21 active pills, then no pills or placebos for seven days.
6. When I was younger, my gyno told me an IUD is something that isn’t recommended until someone is finished having babies. But all the sudden that changed? What happened?
In the past, IUDs were thought to cause higher rates of pelvic inflammatory disease (PID) that can lead to infertility, so IUDs were not commonly recommended to women who had not yet given birth. It was also thought that IUDs were more likely to fall out of women who haven’t had babies. As we’ve learned more, those ideas have proven to be false. Types of IUDs have also changed over the last few decades, and newer IUDs are much safer than some of the original types. The American College of Obstetricians and Gynecologists (ACOG) supports IUDs as the first line contraception for adolescent and adult women, regardless of child-bearing status, because of their high effectiveness and patient satisfaction.
7. If you get UTIs a lot, does that mean you’ll have serious issues when you’re older? LIKE PEE CANCER?
If your UTI is treated properly (with the correct antibiotics) and early in the course, it will very rarely lead to long-term complications. Untreated UTIs can lead to kidney damage, and in extreme cases, death. Long-term (like weeks and months) bladder inflammation from infections has been linked to bladder cancer, but it is not clear if chronic urine infections can cause cancer. If you have recurrent UTIs (more than three infections in 12 months), talk to your doctor about methods to help prevent them.
8. How soon do you have to pee after sex for it to be effective at warding off UTIs? Like, immediately? Three minutes later? Ten minutes?
UTIs are commonly caused when bacteria from the bowel invade the bladder. They’re more common after intercourse because of the hustle and bustle around the anus and urethra during the act, and more common in women because the distance to travel from outside to inside (length of the urethra) is quite short. Male urethras average about 8 inches, while [female urethras] only 1.5 inches. The practice of urinating after intercourse is to flush out any bacteria that may have found their way into the bladder. It will likely take more than 10 minutes for those bacteria to multiply and cause infection, so you have some time, but sooner is better than later.
9. Why is it that so many women have PCOS, but no one seems to know how to effectively treat it?
As with many medical conditions, we are learning more about polycystic ovary syndrome (PCOS) as research continues. At this point, the medical community is not even quite sure the exact cause of PCOS. Most available treatments focus on managing the symptoms of PCOS, like obesity, acne, infertility, and unwanted facial hair growth. If you are affected by PCOS, you should talk to your doctor about what treatments may be right for you.
10. Can birth control make you gain/lose weight?
Historically, weight gain has been thought to be a side effect of birth control, but newer studies show there is no link between weight gain and taking combination birth control pills. Progestin-only methods, like Depo, have been shown to cause weight gain, though researchers aren’t quite sure why. If weight is a concern, you should discuss options with your doctor before starting birth control.
11. Is copper toxicity a real thing to consider with a non-hormonal IUD? Also, what is really the deal with the copper IUD?
There is no evidence that the copper IUD can increase the levels of copper in the blood or cause copper toxicity. Copper IUDs are used by more than 150 million women worldwide, and are generally known to be safe and effective. The decision between hormonal and copper IUD is usually based on patient preferences and potential side effects. For example, if you are considering an IUD to help with heavy menses then the hormonal IUD may be more appropriate. If your goal is contraception then either IUD may work well for you. If your provider refuses to insert a copper IUD without a good explanation, consider getting a second opinion.
12. Lots of women are having babies at 40 these days, and I need to know how healthy that really is.
In recent years it has become more common for women to delay pregnancy into their late thirties and beyond. Many of these women are able to have uncomplicated pregnancies and deliver healthy babies. That being said, there is extensive research showing increased pregnancy risks as we age. Women 35 years and older are more likely to develop gestational diabetes, high blood pressure, chromosomal abnormalities (like Down syndrome), and miscarry. If you are over 35 and pregnant, or hope to be, talk with your doctor about what you can do to help minimize those risks.
13. What are the chances of my birth control causing me to form a blood clot and die?
In most healthy women, the risks of getting blood clots from combined birth control pills is pretty low. If you take 10,000 women who do not use birth control pills and follow them for a year, between 1 and 5 of them will develop a blood clot. For birth control users, that number increases to 3 to 9 women. That is still far less common than women who have recently had a baby, where 40 to 65 of those 10,000 can be affected by blood clots. While taking combined pills, the risk of getting a blood clot also increases if you smoke, are obese, are over 35 years old, have a genetic clotting disorder, or have diabetes, high blood pressure, or high cholesterol.
14. Is HPV really that big a deal if 80% of women get it in their lifetime? Why is there no test to check for it in men if it’s such a prevalent thing?
There are more than 100 different types of human papillomavirus (HPV). Of those, about 40 or so types can cause genital warts and lead to cervical cancer. Some of the more common types that cause warts and cancer can be prevented with the HPV vaccine (available for males and females starting at age 11). Since the start of the vaccines, we are already seeing a decline in HPV infections, so I highly recommend.
What we have learned in recent decades is that even though younger women are more likely to have HPV, their young and healthy immune systems are usually able to clear the infection, and they will not commonly develop cervical cancer. Because of this, you may have noticed in recent years that your doctor has changed your screening timing from once yearly to every three to five years, depending on your age and risks. Men often carry HPV, but because they do not have a cervix, they are not at risk for cervical cancer. Other HPV-related cancer of the penis, anus, and throat are uncommon, however there are screening tests available for men at high risk.
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