The brakes on birth control: When to regulate the reproductive roller coaster

From the first menstrual cycle to menopause, the female reproductive experience is a volatile roller coaster filled with hormonal twists. Thankfully, this wild ride can be decelerated with contraceptives.

Commonly referred to as birth control, these medications and devices prevent pregnancy, but that’s a tunneled view of all they can do. “Beyond contraception, birth control is used to treat a lot of medical conditions,” says Roper St. Francis Healthcare OB/GYNDr. Jessica Wade. OB/GYNs and primary care doctors prescribe birth control to manage polycystic ovarian syndrome, endometriosis, abnormal uterine bleeding, recurring ovarian cysts, premenstrual syndrome and premenstrual dysphoric disorder (even that name sounds like a terrifying coaster!). As patients journey from puberty to perimenopause, birth control may be the ticket to boarding and exiting the thrill ride.

Gaining Momentum

Even if a woman doesn’t require pregnancy prevention, she might start taking birth control anytime between her teens and middle age to help manage heavy or irregular periods. “Low-dose birth control can act like hormone replacement therapy to treat a lot of perimenopausal symptoms, including hot flashes, night sweats, mood changes and irritability,” explains Dr. Wade.

Some contraceptives, like the pill, can also decrease ovarian cancer risk. “I’ve had patients choose birth control for added protection after having a positive genetic test or a family member diagnosed,” notes the OB/GYN.

Proceed with Caution

If a woman wants to ride the kiddie coaster, of course, she’ll want to cease taking contraceptives. The body usually returns to its normal ovulatory pattern within one to three months, opening the possibility of pregnancy.

Besides trying for a baby, “there are other clear-cut medical reasons that a woman should stop birth control,” advises Dr. Wade. Birth control isn’t safe for patients who suffer unexplained uterine bleeding, take certain seizure medications or have certain types of liver disease. Other considerations include if a female experiences:

• A blood clot, like deep vein thrombosis or pulmonary embolism, or has a family history increasing that risk. She should stick to progestin-based contraceptives such as an intrauterine device (IUD) or progestin-only pill.
• Migraines with aura. She should avoid the combined pill, but other forms are safe.
• Breast cancer. Hormonal contraception is a no go here, making a non-hormonal IUD the only safe option.

No matter the reason, stopping birth control cold turkey is just fine. “No specific weaning needs to happen,” Dr. Wade assures. With oral contraceptives, quitting mid-pack isn’t harmful, though finishing a round may ease the body’s cyclical adjustment. With an IUD, a doctor simply removes the device.

In Control

With respect to these guidelines, a woman can choose whichever form of birth control works best for her. The most commonly prescribed is a combination pill with both estrogen and progestin, but progestin-only pills and IUDs exist as well. As a non-hormonal option, a copper IUD functions via an inflammatory reaction in the uterus. Depending on the type, contraceptives may cause mild side effects like breast tenderness, nausea, spotting, cramping and headaches.

“Finding the right contraceptive is a Goldilocks scenario,” says Dr. Wade. “With help from a doctor, the patient has to figure out which method works best for her body and lifestyle.” The OB/GYN stresses that everyone processes medications differently, so it’s important to listen to your body. “If you have any concerns or experience side effects you believe are related to birth control, talk with your doctor.”