Get Your Mojo Back Without “Pink” Viagra

Sexual desire is considered to be a life force in many cultures and feeling sexy and desired is a powerful part of being a woman. Fluctuating hormones during perimenopause and declining estrogen after menopause, however, can leave us wondering why we are feeling less interested in sex than we used to be.

I often see patients who are struggling with their libidos; changing sexual desire is one of the most common complaints women share with us at Women to Women. Many women come to us with physical symptoms that impact their interest in intimacy or diminish their pleasure, while others are experiencing emotional shifts or unresolved relationship issues that may make sex less appealing with their partners.

We often see that women who have not dealt with emotions from their past, be it from childhood or within their relationships, will find that these unresolved issues emerge and express, sometimes in new or surprising ways. Whether they are totally clear to you or completely catch you off guard, one thing is for sure: these emotions will not be denied and they will call to you for deeper exploration. Left unresolved, research shows that they will very likely impact your health as well as your sexuality.

Women, many of whom have enjoyed a healthy sex life until this point, often come to the clinic distraught and desperate to get their “mojo” back. They may even lament the fact that there is not a female Viagra, thinking perhaps that popping a pill would make their symptoms go away and make everything ok. (Ask any man on Viagra who experiences its high cost and the declining efficacy over time and he will tell you it’s not his preferred solution.)

While we’d all like a magic bullet, we know from working with our patients at Women to Women that there are no quick fixes. Desire can be restored but the most helpful thing to start with is diet and lifestyle changes, nutritional supplementation, and exploration of the relationship and emotional connection of the patient to her partner.

When you develop a symptom such as painful sex, diminished desire, or even surprising feelings and emotional reactions toward your partner, it is your body’s way of getting your attention and showing you what is really going on. Taking a pill to ignore the message may be convenient, but long-term, it’s much more effective to figure out the cause and treat it. In fact, that’s the only way to ensure your optimal health — and that of your relationship. Don’t get me wrong there are times that testosterone levels are low and adding testosterone can make a big difference for some women.

The New Female Viagra — How Flibanserin Works

As a health care practitioner who has been helping women to experience the best sex of their lives after menopause for over three decades now, I’ve been fascinated by conversations in the news recently about this new drug being called the “female Viagra” that pharmaceutical companies claim may potentially improve a woman’s libido.

After two rounds of rejection due to concerns about side effects and effectiveness, the drug has now been passed on to the FDA for potential approval later this summer.

Despite the current media attention, it’s not the first time pharmaceutical companies have tried to create a “Viagra for women.” In fact, that’s the approach taken previously by copying how Viagra works to increase blood flow to the genitals in men and trying to do the same for women.

This new drug, however, which was originally created as an anti-depressant, works on the largest female sexual organ instead: the brain. Researchers claim it increases dopamine and norepinephrine, the “excitatory factors for sex” and decreases serotonin, which can diminish libido.

The drug, flibanserin, is far from proven, demonstrating very mixed results, and it carries a number of side effects including nausea, dizziness and sleeplessness.

But that doesn’t seem to deter women who are clamoring for its approval.

One woman supporting the approval has claimed that her relationship with her spouse is better than ever but that her sexual desire has disappeared, leaving her husband to question whether or not they should get a divorce. She says that she’d risk any side effects “gladly.” She seems pretty clear on how far she will go for her relationship!

The way I see it, it’s just not that clear. There are so many ways to be loving and intimate in a relationship. Does desire need to be amped up in order to have a sexual relationship? She says that she has tried counseling and it has helped… but not enough. Is there is an emotional connection that might be missing on some level? Has she explored and treated the cause of her physical symptoms or is she reaching for a quick fix? It makes me wonder. Many physical issues may be at the root of the problem including adrenal dysfunction.

The Great Flibanserin Debate – Why It’s About More Than Sex

The debate about approval of this new drug, flibanersin, has become divisive and has turned into a much broader discussion around gender, sex and society; it’s one that we at Women to Women want to weigh in on.

The National Organization for Women, or NOW, feels that approval has not been forthcoming because there is a sexual bias against providing something to women to enhance sexual pleasure. They’ve gone on the record as saying that as a culture, men’s sexual health is extremely important but that women’s is not. There may be some truth to this as there may well be a sexual double standard in today’s society, but we think the reason approval has been a challenge thus far is so much more complex than that. And I am all for women having a libido, and enhancing their sexual enjoyment.

Other women’s groups are arguing that the primary considerations of drug approval should be safety and efficacy. The National Women’s Health Network, for example, has come out and said that the drug doesn’t work well, has some noted safety concerns, and has not been fully studied. They feel it’s about waiting to get a drug that really works — and is safe.

While we are not sure any drug can accomplish that when it comes to sexual desire because it’s not something that can be fixed with a pill, we definitely agree that if a drug is approved, it should be thoroughly studied first and should be proven to be effective — and safe – both over the long-term and in conjunction with other medications. This new drug does not meet those criteria.

Others are arguing that the campaign for the drug oversimplifies female sexuality and we couldn’t agree more: There is so much more to sexuality than the stress hormones dopamine and norepinephrine!

Some women (and men) who experience a waning libido at midlife don’t see it as a problem — at least not one worth taking a drug for. At Women to Women, we don’t think you should accept low sex drive as a new norm: we know it can be restored and that with some time and effort, you can experience the best intimacy of your life after menopause. So why settle? But we do agree a drug is not the answer.

And then there are those, and we are among them, who raise concerns that the pharmaceutical industry has a desire to take every circumstance and transition in life and turn it into a disease that needs a pill to fix it. This not only prevents looking at the true source of the problem, it creates a mentality that normal life transitions such as menopause are diseases.

The pharmaceutical industry then focuses on the convenience of popping a pill to problem solve instead of practicing what is now being called precision medicine: getting really precise about the root case and its effect and then treating the whole problem. Menopause is NOT a disease and a pill is NOT the answer: adjusting stress hormone levels artificially with a drug is NOT the answer to hormonal shifts that may just need some transitional support.

So while the debate in the news rages on about whether or not approval is warranted, whether the drug, flibanserin is effective and safe, or whether disapproving it is “sexist” because there is a bias against women’s sexuality as being a significant health concern, we find ourselves scratching our heads that someone could be willing to undertake drug risks without trying to understand what is going on within the body to cause this reaction in the first place.

How to Get Your Mojo Back

After more than three decades supporting women’s health and healing, we know that there are answers. When your body is out of alignment, it needs extra support. A high quality multivitamin along with an omega 3 supplement supports hormonal balance and symptom relief among our patients; even those who eat healthy diets of fresh local food find they need additional support during the menopause transition.

Diet and lifestyle changes such as stress relief, a good night’s sleep, exercise and movement, and a healthy balance of fresh fruits and vegetables along with high quality proteins and fats can further support this rebalance and accelerate relief, especially when combined with high quality nutritional supplementation.

We also recommend a probiotic supplement to restore the balance of healthy bacteria in your digestive system; it may not seem obvious that your digestion is connected to your hormones, but your ‘second brain’ plays a role in supporting all healthy body functions.

We also believe that it’s important to explore the emotions you are experiencing and use the transition time of perimenopause to examine your feelings, process them and to “speak your truth. “ Menopause is a time of release and clearing: it’s time to let go. Studies have shown that holding onto unresolved and unexpressed emotions will lead to the presence of physical concerns down the road and for many women, this catches up to them at menopause.

With a little time, attention and support, including some hormonal support if needed, you can experience a significant improvement in your health and wellness, restore that hormonal balance, and finally feel like yourself again… All without an untested drug that has numerous side effects.

At Women to Women, we have helped thousands of women alleviate their physical and emotional symptoms, restore a healthy sex drive and create the best intimacy of their lives. We can help you too.

To learn more about changes in sexuality around menopause, read our articles here.

To purchase our menopause support products, including multivitamin and omega 3 support, click here.

The Health Benefits of Sex, No Matter What Your Age

by Marcelle Pick, OB/GYN, NP

Happy senior man and woman embracing on a deserted tropical beach with bright clear blue sky PMS-E-X.  Sex.  For a small word, s-e-x evokes all sorts of varied emotions for people!  Some women tell me that sex was never discussed in their homes when growing up; others say that it was discussed infrequently and in hushed tones. Rarely do I hear that sex and sensuality were encouraged topics of conversation. Sensuality and sex are two wonderful facets of being human. Being knowledgeable about sex – everything from the how to’s to the risks – is so very important these days. Understanding sensuality and how that affects you and your relationship is important for all women to understand. Pushing this information aside or not recognizing your feelings isn’t healthy!

At Women to Women we’d like every woman to understand her own body, to be able to ask questions about topics she’d like to understand better and, most importantly, to know about all the positive benefits of sex.

There is good news!  It’s not too late for you to reap the health benefits of sex, no matter what your age may be. For those women who are menopausal, you are at the age where you can enjoy sex without fear that you might get pregnant!  Sex is good for your health!  Let me explain why.

Sex and Your Heart Health

Do you ever notice that when you are sexually aroused, that your heart and breathing often increase?  Your body actually does that to channel more blood to your genitals to get ready for sex. Mature Senior Woman Holding Heart ShapeHowever, there’s more to it than just that. An entire cascade of hormones released during your sexual arousal and climax – DHEA, prolactin, adrenaline, noradrenaline and testosterone are all called into action – and most of these have great cardio-protective effects.

Once you have an orgasm, your body releases the hormone oxytocin. One of the results of the oxytocin surge is lowering your blood pressure. It’s a well-publicized fact that healthy blood pressure makes you less likely to have a heart attack or stroke. In fact, there was a study done on more than 900 men (ages 45–59) that suggested that having sex two times or more per week might aid in preventing cardiac events, like heart attack and stroke. While this study didn’t include women, it still demonstrates a hope for both sexes, as much of the chemistry involved in the study applied to both men and women.

Sex and Exercise

Did you know that your body treats sex just like exercise!  Your heart rate increases, muscles contract and calories are released from fat to create energy just as if you were lifting weights, hiking or bike riding!  Not many people talk about this, but it’s a great benefit of having sex!

Sex and Sleep

What do you feel like after you have an orgasm?  If you’re like most women and men, you will want to relax and close your eyes. You feel very relaxed and can easily doze off – even if you usually have insomnia. This probably has to do with oxytocin and the release of endorphins at the time of orgasm. These are like natural sedatives. Sleep itself has amazing health benefits! It’s a time when your body rebuilds and rejuvenates – every body needs this!

Sex and Decreased Depression

Happy Young Woman Relieve Depression

Having sex releases endorphins in your body – and these endorphins can make you feel elated and even relieve pain!  Many women talk about the euphoric feelings they have right after having sex – and some even comment that sex makes them forget their aches and pains!

 

Sex and Stress Relief

There are additional benefits that oxytocin can provide as well. One of them is stress relief. You’ve probably heard some women describe their orgasm as the “ultimate release.”  That moment is the time when they can let everything go. Oxytocin is present in your body when you are in a stressful setting. Women with greater oxytocin levels are usually calmer and more relaxed. A study done at the University of California at Los Angeles (UCLA) showed that the estrogen that was present in women would enhance the calming effects of oxytocin, while testosterone might counteract it. This probably explains why so many women want to cuddle after sex.

At Women to Women we understand that sensuality and sex are very important pieces of a woman’s being!  We encourage all women to know their bodies, to ask questions and to express this part of themselves – both to promote good physical health and for their emotional wellbeing. It’s also good to recognize that sexual fulfillment doesn’t require a partner – masturbation is healthy way to meet your needs – and fulfilling these needs leads to a happier, healthier YOU!

For more on this topic, read our informative article, “Safe (and Enjoyable) Sex In Your Middle Years.”

Non-Hormonal Birth Control and IUDs

by Marcelle Pick, OB-GYN, NP

Some of you may remember the frightening stories related to the safety of IUDs (intrauterine devices) shortly after they were introduced many years ago. Since that time, the IUD has become one of the best methods of preventing pregnancy and it now comes with only minimal risk of adverse consequences for most users.

Years ago, there were two issues with the early IUDs. One was the incredibly poor design of the Dalkon Shield. Because of the design, it caused a huge increase in the incidence of pelvic inflammatory disease (PID). Many women thought that all IUD’s caused PID. It is now known that pelvic inflammatory disease is not caused by intrauterine devices. It has more to do with partners, and the infections that may occur because of exposure to various infections.

The type of IUDs that woman experienced problems with 30 to 40 years ago were designed differently than the products that are available today. Also, it’s good to keep in mind that IUDs may have been more readily prescribed for women who were already at risk for chlamydia, the infection that causes most cases of PID (Pelvic inflammatory disease). A good example of this is someone that has multiple partners. Years ago we didn’t have an effective way to test for this infection, so PID got severe before it was detected and the IUD was blamed, not only for the severe infection, but also for the resulting infertility in some women. Today we have tests that determine chlamydia quickly and women get treated immediately without developing PID.

Your Intrauterine Choices

The IUDs that are used nowadays are much better designed than in the past. In an attempt to get past the bad reputation IUDs had years ago, some companies are now referring to their products as IUS or intra-uterine systems. These newly designed devices provide a great birth control option for many women, especially for women who are approaching perimenopause and other women who want a convenient, easy method of birth control. Good candidates for IUDs are women who are free from infections, who are in a relationship with only one partner, and who have no uterine fibroids. IUDs often are easier to insert for women who have been pregnant at least once.

At Women to Women, we often suggest the 10-year copper ParaGard IUD and/or the 5-year Mirena IUD. The ParaGard is the IUD we prescribe as a first option for patients who have had blood clots in the past, or have a history of cardiac problems. We often find that the Mirena, which releases a synthetic progestin hormone in the uterus, may be a good option, especially if the patient experiences heavy blood flow during menses, and even heavy irregular menses. More than likely this occurs because it affects the uterine lining and makes it thinner.

An IUD provides a wonderful choice for those who are used to the spontaneity that oral birth control offers. After insertion, you can, for the most part, ignore that it’s there. If you think you may be interested in this option, speak to your medical provider to find out a few more key points. If you do decide on an IUD, it’s vital to keep your follow-up appointments.

Another wonderful birth control method we often prescribe is the NuvaRing, a 21-day vaginally inserted device that provides a constant and specifically measured, very low dose of birth control hormones. Since the hormones are delivered vaginally, your gastrointestinal system and liver do not have to metabolize them first. We’ve discovered the slow and consistent release and the low dose of hormone required make this product an excellent alternative to oral birth control for patients who have troubling side effects such as hormonal headaches. Another benefit some users notice with the NuvaRing is that vaginal dryness, common with oral birth control, is not as problematic. The only issue some women complain about is that they don’t like having to insert something in their vagina, but most women can overcome this and love this method.

Alternative Non-Hormonal Choices

Condoms and diaphragms are technically known by the term “barrier methods.” The “Today Sponge” is also back on the market, which is also a barrier method. These are fairly trustworthy ways of preventing pregnancy and they don’t rely on the use of hormones. The Sponge is currently being produced in New York State. At first it was only sold in Canada, but the Sponge is now available in the United States and it has been FDA-approved since the early spring of 2005. Many love the convenience of the sponge and were very upset when it was taken off the market. The good news for many is that it is now back.

For those who have decided that they don’t want to have children, or do not wish to have more, surgical interventions remain a choice for either the woman, or her partner. A woman may have her fallopian tubes surgically “tied,” in a procedure known as a tubal ligation, thus preventing pregnancy. Her male partner may choose to undergo a surgical procedure known as a vasectomy.

The Choice is Up To You

There are many factors to be considered when a woman is deciding which method of birth control is right for her. At Women to Women our goal is to help women find the method that fits them the best. Every person is a unique individual with her own needs. It’s good to take a look at several factors when making birth control choices and finding the one that fits you the best.

 

Low Sex Drive – Why It Happens and How To Change It

 by Marcelle Pick, OB/GYN, NP

With so much change occurring in our bodies (and our lives!) during the years of perimenopause and menopause, it’s not hard to imagine that our sexual experiences may be changing as well. Hot flashes and mood swings may impact how we feel about sex, while weight gain may leave us feeling less sexy. Diminishing sex drive may leave us wanting sex less or finding us enjoying sex less than we used to because of vaginal dryness and discomfort.

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In addition to physical changes, we may be experiencing changes in our lives on so many levels, with kids growing older and transitioning out of our homes into an empty nest scenario or perhaps life right now includes hormonally-charged teenagers.

There is a “settling in” that can sometimes occur in a relationship after being together for a while that can shift our view of sex, or there may be unresolved relationship issues that are suddenly entering into the bedroom for the first time. For some, it may mean being single again and re-entering the dating world may lead us to revisit our sexual desires and values or maybe even cause us to retreat into overwhelm!

Thoughtful Mature WomanOften there are concerns and challenges around aging parents to manage, stresses at work and then there is our own personal transition. Menopause is a time for us to question our priorities and our desires as we head into the second half of our lives and to find our true voices.

Not surprisingly, all of this can lead us to a place where sex isn’t the priority that it used to be. I believe it’s important for you to define the role you want sex to play in your life and to know that that role may well change over time. So if sex is on the back burner by choice right now, that’s totally ok. But even if it’s less frequent, sex shouldn’t be any less enjoyable.

A healthy sex life is an important part of who we are and research shows staying active sexually can bring benefits both physically and emotionally. At Women to Women, we want you to know that you deserve a satisfying sex life if you want one and that you CAN continue to have pleasurable sex at mid-life — and beyond. Just ask some of my patients in their sixties!

Read our article, “Safe (and Enjoyable) Sex In Your Middle Years,” for more on this topic.

So let’s look at what’s going on in our bodies and what we can do to maintain or restore a healthy sex life at any age.

Why Does Sex Drive Decline?

Patients sometimes ask me, “If it’s normal and natural to desire sex, then why does that stop or change as we get older?” It isn’t hard to see how that can happen when you look at all of the changes we just mentioned that are occurring in our bodies and our lives at this time – there’s a lot going on!

Signs_Early_Menopause_EditSex drive is affected by our physicality and the changes occurring within our bodies as well as by emotional factors. As with most things in our bodies, the physical and the emotional issues are interconnected and interdependent so we need to address both. Let’s begin with the physical factors, as I know so many of my patients struggle there.

One of the most obvious triggers of lower sex drive is hormonal imbalance (Click here to read our many informative articles on this topic). In addition to the common symptoms of insomnia, hot flashes, mood swings and weight gain that we see in perimenopause, sex drive is also affected by our changing estrogen, progesterone and testosterone levels. Usually, once hormonal balance is restored, so is libido. Let’s look at the key hormonal players and how they impact your sex drive.

Click here to take our Menopause Health Assessment.

One of the most important drivers of libido is the hormone testosterone. Many women in perimenopause have lower testosterone levels that can impact their sexual interest, arousal and response as well as their lubrication and orgasms.

Safe (and Enjoyable) Sex in Your Middle Years

by Marcelle Pick, OB/GYN NP

If you’ve been waiting in line at the supermarket or browsed a newsstand recently, you cannot help but notice the controversial and attention getting covers of today’s women’s magazines. If they are not sharing “the secret to losing weight overnight,” these magazines are offering up tips on how to have a better sex life or how to be and feel sexier.

They do this, of course, because sex sells – most of us wouldn’t mind feeling more sexy and having more enjoyable sex. If only it were as simple as a magazine checklist! So many women entering perimenopause or menopause have entered a new phase of their relationship lives – some may have been widowed while others may have ended a long-term relationship.

SS Mid Age Couple OceanHowever they got there, more and more of my patients are finding themselves navigating the dating scene once again and they are discovering that it’s a different world today than when they were last single. In addition to the media images about what is sexy and the magazine stories offering us “quick-fix sex solutions,” there is the presence of social media and internet dating sites that have changed the way people meet and date. These tools have made it easier for newly single people to connect with more people, even if it’s not for a long-term relationship.

Despite the ease with which we can meet people today, I’m often surprised when women come in for their annual exams and share that they have had unprotected sex. Whether pregnancy is a concern or not, they may have forgotten or just not been aware that there are other health concerns that come from being intimate with someone, regardless of your age.

In other ways, though, I am not so surprised. After all, sex is a wonderful, pleasurable experience. And being touched, held, caressed, and cuddled feels incredible, especially if you have not had that experience in a long time. Some of my patients tell me that after years without physical contact or connection, they couldn’t resist and the moment just got away from them.

Talking about sex can be difficult. Inquiring about your partner’s dating history may make you feel like a prude and you may even have no idea how to bring it up. But the same media that brings us information about the weight loss secrets of the stars is telling us that the incidence of sexually transmitted diseases among the 45-64 year old group has tripled in recent years.

We know it can be hard or awkward to discuss sex and sexual health. At Women to Women, we believe it’s important to talk about sex — it’s benefits and it’s risks — so that you are informed and you can make the best choices for your long-term health and well-being.

Whether you are single, divorced, or still committed to a long-term relationship, let’s start the conversation so you can enjoy the healthy, safe sex you deserve in the second phase of your life.

Sex, STDs, and Menopause/Perimenopause

Many women don’t realize that just because their periods are slowing down and becoming less regular, they can still become pregnant during perimenopause. Until you have gone 12 months without menstrual bleeding, you still need to protect yourself from the possibility of pregnancy.

But while there are many forms of birth control that can help you avoid pregnancy, only a condom can protect you from sexually transmitted diseases, or STDs. If you have had sex without a condom and you have not been tested recently, even in a committed relationship, you really should consider getting tested for your own health and peace of mind.

That may seem extreme, and it surprises some of my patients, but there are several important reasons why I tell my patients this.

First, whether you have been using condoms faithfully or not, the reality is that many of us have already been exposed. It’s estimated that about 1/3 of us have had or will have a diagnosed STD in our lives. If you’ve already been diagnosed, there is nothing to ashamed of – 15 million Americans get diagnosed each year and 65 million people are living with an STD that is considered “incurable.” STDs are becoming increasingly common.

Birth Control Methods

by Marcelle Pick, OB/GYN NP

 

Method Reliability* Protection against HIV/STDs? Pros and Cons
Intrauterine Devices (IUD/IUS)
  (All)

99%

No

Pros: Longevity/Low side effect profile/High initial cost, but low cost when averaged for the lifespan of device.

Cons: Recommended principally for women in monogamous relationships. Can be expelled or become dislodged. Not recommended for women with fibroids.

  •  ParaGard

(Copper T) IUD

ParaGard can stay in place for up to 10 years. Fertility usually resumes immediately when removed. Can be accompanied by an increase in volume and duration of menstrual flow.
  •  Mirena IUS
Mirena can remain in place for 5 years. Possible delay in return of fertility once Mirena IUS is removed. Releases levonorgestrel (LNg), a synthetic progestin, just in the uterus. Reduces menstrual volume eventually, but spotting can occur in initial 6–12 months.May cause benign ovarian cysts.Can rarely cause hormonal side effects similar to those seen with oral birth control pills, such as mood swings, breast tenderness, headaches, and acne.
Sterilization
  (All)

Greater than 99%

No

Pros/Cons: Surgical risks. Permanent way to no longer become pregnant. Cost-effective over time.These methods can in some (few) cases be reversed, depending on the method and the individual.
  •  Tubal ligation (female)
Tubal ligation immediately effective.
  •  Vasectomy (male)
Vasectomy is not immediately effective; it may take months before full sterility is achieved. The man must follow up with the practitioner to be sure that the vasectomy was successful.
Hormonal Methods
  •  Birth control pills (BCP)

(Oral contraceptive pills —BCPs/OCPs)

 

Options include:

 

—20–35 mcg combined pills

 

—Regular or extended-cycle use pills

 

—Pills with shortened pill-free interval option

 

—Progestin-only mini-pills

95–99%

No

Pros: High rate of efficacy. Relatively convenient. Multiple options available. Regulates menstrual cycle. Decreased risk of endometrial and ovarian cancer, endometriosis, pelvic inflammatory disease (PID).

Cons: Undesirable risks and side effect profile in some women. Not affordable for all women. May have drug interactions.

  •  Vaginal ring (NuvaRing)

About 99%

No

Pros/Cons: Same as w/BCPs, see above.

Other advantages: Privacy.Use allows for more normal vaginal moisture and flora, reducing yeast infections for some women. Protection from pregnancy one month at a time.

Other disadvantages: Contraindicated with certain pelvic conditions, for example, uterine prolapse, endometriosis, susceptibility to irritation, etc.

  •  Transdermal birth control patch

(Ortho Evra)

About 99%

(less reliable for women who weigh more than198 pounds)

No

Pros/Cons: Similar to those of BCPs, see above, except exposure to synthetic estrogen is about 60% higher, with resultant higher risk profile for thromboembolic events.
  •  Depo-Provera injection

 

99.7%

No

Pros/Cons: Same as w/BCPs, see above.

Other advantages: Effective 24 hours after injection.

Other disadvantages: Side effects can be significant and long-lasting, including reduction in bone density, depression, and weight gain.

  •  Contraceptive implants

99%

Pros: Longevity: Different systems last from 3–5 years.Fertility returns relatively quickly.

Cons: Can be difficult to remove. Potential for scarring. Side effects can in some cases be significant and long-lasting.

Barrier Methods
  •  Male condom

87–98%

Yes, except for sexually transmitted infections (STI) contracted from genital areas not covered* Pros: Convenience and availability.Multiple options.Inexpensive.Allows greater male partner participation.

Cons: Reduced spontaneity. Reduced sensation. Some users experience allergies.

  •  Female condom

79–95%

Yes; only abstinence provides better protection* Pros: Can be placed up to 8 hours in advance. Good protection against STIs. Does not require fitting by health care practitioner.

Cons: Only 1 style currently available. More costly than male condoms.

  •  Female cervical cap

Varies: 68–91%

No

Pros: Can be inserted up to 6 hours in advance. Very few side effects. Several designs on the market.

Cons: Relatively low efficacy, *especially in women who have given birth. Some types require fitting by health care practitioner; limited to 4 sizes. Not widely available.Some users experience allergies.

Spermicidal Methods
  •  Today Sponge

89–91**

No

Pros: Immediate and continuous protection for 24-hour period. One size fits all and easy to insert. 

Cons: Cost. Removal can be tricky for some. Some users experience sensitivities/allergies to spermicide.

  •  Diaphragm with contraceptive jelly or foam

80–94%

Some*

Pros: Few side effects. Can be inserted up to 6 hours in advance.Can be used for intercourse during menses to collect flow.

Cons: May reduce spontaneity. Requires fitting/periodic refitting. Some users experience allergies. Some consider method to be “messy”.

  •  Vaginal contraceptive film, foam, inserts
74–94%; efficacy maximal when used in conjunction with barrier method

No

Pros: Readily available. Relatively inexpensive.Lubrication.

Cons: No protection from STI/HIV infection. Some users experience irritation and/or allergies. “Messiness” factor. Must be inserted within an hour before intercourse.

Fertility Awareness Methods (FAM):
  Examples: 

  •  Basal Body Temperature (BBT)

 

  •  Sympto-thermal

 

  •  Billings Ovulation

 

  •  “Rhythm”

88–98%

No

Pros: Zero health risks or side effects. Enhances body awareness and partner intimacy. Inexpensive.

Cons: Requires significant partner education, cooperation, and daily attention. Relatively high failure rate. Not ideal in perimenopause years or for women with otherwise irregular cycles.

* Assumes perfect use, that is the method is used correctly each and every time. Actual effectiveness rates vary significantly. Statistics from Our Bodies, Ourselves (Boston Women’s Health Book Collective, 2005).

** McClure, D., & Edelman, D. (1985). Worldwide method effectiveness of the Today vaginal contraceptive sponge. Adv. Contracept. 1: 305–11.

Sex & fertility

Birth Control Method Comparison Chart

This comparison chart provides various methods of birth control, along with their reliability factors, pros and cons, and also advantages and disadvantages. This information will give you and your partner knowledge about a variety of conception methods, including intrauterine devices (IUD), hormonal methods (pills, ring, patch, injection, and implant), spermicidal methods, and family awareness methods (rhythm, body temperature, billings, and sympto-thermal).

While these mentioned methods are primarily female related, there are two methods that also include men. These are sterilization (tubal ligation for women and vasectomy for men) and barrier methods (male and female condoms). As a woman, or together as a couple, it is critical for you to be well informed about all available options. This chart is a compilation of currently available choices. It is wise to review the options with your health care practitioner from time to time to determine if the contraception method you are currently using is the best for your healthy lifestyle. I hope this knowledge will empower you.

Refer to our other articles about birth control for more information.

Laparoscopic Surgery For Endometriosis

by Marcelle Pick, OB/GYN NP

The procedure known as laparoscopy is done as surgery in a hospital operating room. The physician uses a telescopic camera that is introduced through a very small perforation in the skin, instead of using a full incision. The camera then will allow the surgeon to look at and evaluate the uterus, ovaries, and other internal female organs. The doctor may also choose to biopsy any lesions or growths that appear to be suspicious. At the same time small, externally dangling pedunculate fibroids can be removed.

Laparoscopic surgery for endometriosis  is increasing in popularity. This enables surgeons to eliminate endometrial implants by removing them with a special laser technique that is specific to each tissue type, while the reproductive system can be left intact. It allows all if not most of the endometrial implants to be removed with a less invasive procedure.

The outcome of this procedure is greatly dependent on the amount and extent of the endometriosis and the physician’s skill. In an ideal situation, it is best to see an endometriosis specialist, or someone that has done this procedure hundreds of times, who will be more familiar with this type of procedure. In some case, a repeat procedure might be recommended, because endometriosis can grow back.

Sometimes there is adhesion scar tissue that also can develop. Adhesion scar tissue is like internal filaments that adhere tissue together in the abdomen similar to a cobweb in nature.

It is not usually suggested to remove the uterus in cases of endometriosis, because the condition is systemic and not caused by the uterus. For more information, see our articles about symptoms, causes, and natural treatment of endometriosis.

Endometriosis – Start With A Natural Approach

by Marcelle Pick, OB/GYN NP

Endometriosis Hormone Estrogen WomanEvery woman needs to know and understand the basics about endometriosis. This insight can offer a way to better see how our bodies work – and what we can do to keep ourselves healthy. The diagnosis of endometriosis can be scary, but let’s look at why we at Women to Women feel it may not be so.

Endometriosis has been on the increase, and there is debate about why. We suspect that the high estrogen levels in American women and increasing number of women with auto immune disorders are a contributing factor. It also often runs in families. And we know from clinical experience that emotional issues are often involved. But in all these causes we find the theme of hormonal imbalance. And the good news is that we can usually do something about that – without drugs or surgery – and usually see great improvement.

What Is Endometriosis?

Endometriosis (sometimes misspelled endometreosis) is an outgrowth of the normal menstrual cycle. Each month the tissue inside the uterus—the endometrium—thickens as it intends to support a fertilized egg during pregnancy. If the egg is not fertilized and the woman does not become pregnant, then the uterus sloughs off the lining with the onset of her period. This is the bleeding that occurs during your monthly period. It is usually a healthy sign and a normal process of being a mature woman.

Endometriosis Fallopian Tube Estrogen Menstrual Cycle Moon StarsIn the case of endometriosis, the same type of tissue that lines the uterus grows outside the uterus in other parts of the body. And the same hormones that trigger a menstrual cycle will trigger sloughing of the endometrial implants in the abdomen. Endometriosis can appear on the Fallopian tubes, the ovaries, the outside of the uterus, the peritoneum, or the intestines. Each month this displaced tissue responds to the hormonal changes that regulate your menstrual cycle, engorging itself through the first half of the cycle, and often releasing a small amount of blood in the second half, which causes repeated irritation to the surrounding tissue.

Over time this can cause scarring or adhesions inside the reproductive organs, pelvis, and intestines. Adhesions are like spider webs inside the abdomen. It has been speculated that when the scarring occurs on reproductive organs it can contribute to fertility issues and increased menstrual pain. Some 3 to 10 percent of all women have endometriosis, while 9 to 50 percent of infertility is caused by this condition. A much newer understanding is that significant amounts of evidence associates endometriosis with high levels of dioxins, a type of environmental toxin.

Symptoms of Endometriosis

It is not easy to diagnose endometriosis. Some of the symptoms – such as chronic pelvic pain, menstrual pain, bloating, painful sex, or pelvic discomfort between ovulation and your period –  do provide a suspicion that a woman has this disease, but it is not a conclusive diagnosis. Notably, some women have the condition without symptoms, while others have the same symptoms but no endometriosis. An experienced practitioner can tell much from a pelvic exam, but the only way to tell for sure and have a definitive diagnosis of endometriosis is surgical. This is another reason we recommend a natural approach as a first step to see if it provides symptom relief.

The root cause of endometriosis just isn’t known, and while there are multiple theories, we still do not know for sure. It’s feasible that more than one particular idea is correct, and there are probably various paths to establishing the condition… One very likely contributing factor that can be reduced with natural methods is the estrogen-like chemicals that surround us, known as xenoestrogens.

Our Estrogenic Environment

Endometriosis Estrogen Xenoestrogens Plastics MicrowaveEstrogen’s natural function is to stimulate cell growth. But excess estrogen contributes to unnatural growth. We know that American women have the highest levels of estrogen in the world. And that is something we can do something about. We believe that most of that excess comes from so-called xenoestrogens, compounds whose molecular structure is so similar to estrogen that they have estrogenic effects in the body. These compounds consist of the development hormones prevalent in milk and meat production, agricultural pesticides, the chemical substances offered off by plastics when heated in microwaves, and a lot of other sources. Not surprising, for most of us such xenoestrogens are pervasive.

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Birth Control Questions To Consider

by Marcelle Pick, OB/GYN NP

Birth control is an important decision that a woman of reproductive age
faces. You will want what works best for you in your situation. This is one of
the most important health matters that will affect your lifestyle and
emotions, as you will deal with birth control several times during the course
of your lifetime. Becoming pregnant and giving birth can be an incredible
experience. You, as the mother, are empowered to decide when that time
is right for you by choosing birth control.

Naturally, I receive a considerable number of questions about birth control
from women at the clinic.  I’ve chosen an assortment of frequently asked
questions. I hope you will consider the most pertinent questions that are on
your mind and that these will help you choose your birth control wisely

1. Which is the best birth control pill?  Is there really one?

2. Is the drug Seasonale safe, with only four menstrual periods a year?

3. Does the pill cause cancer?

4. Does the Evra patch really work? Does it stay on? Is it safe?

5. Will my partner or I feel the NuvaRing during intercourse? What if it falls out?

6. How reliable are condoms?

7. I have always had my partner use a condom. How did I end up with genital warts and herpes?

8. Having the man “pull out” doesn’t count — does it?

9. Will I get osteoporosis from the Depo-Provera shot for birth control?

10. Are shifts in sex drive typical soon after tubal ligation?

11. Will the pill affect my sex drive?

12. Will I have trouble getting pregnant if I use the pill?

Choosing Birth Control

Choosing birth control—options for women

by Marcelle Pick, OB/GYN NP

It shocks me how frequently patients believe that when I ask them about contraception, I’m asking about birth control pills. This confusion tells me how little the majority of women are taught about contraceptive options and how they work, because the pill is just one of many different forms of ways to not become pregnant. There are so many birth control methods available to women nowadays, from patches, to rings, to implanted uterine systems, that the contraception you choose can evolve as your needs change throughout your lifetime.

Practitioners now have so many options to give to our patients. It means we can really work with you to find the best technique for your lifestyle, and for your sexual needs, thereby reducing unfavorable side effects and increasing your comfort level, satisfaction, and safety.

Women to Women’s approach to choosing birth control

So lets look at an easy approach to choosing a birth control method that is right for you. It’s my hope that you and/or your partner will use this information to choose the birth control method that meets your needs, and perhaps then you will be able to use it as a basis for discussion with your daughters—or sons. After all, birth control is not only a woman’s concern.

No birth control except abstinence (not having any sexual intercourse) is 100 percent fail-proof and no barrier method (blocking the sperm from entering the uterus) is 100 percent effective against sexually transmitted diseases. However, you will be better able to understand your options, if you have more information. It will be easier to find a method that works safely and efficiently for you. This also applies to women in perimenopause who may have distinct requirements because of symptoms of hormonal imbalance, or because they have been on birth control pills for many years and would like to discontinue hormonal contraception.

Preventing pregnancy

Initially, I always ask a woman to consider her birth control options by thinking about just how important it is to her right now to NOT get pregnant. I also try to establish how motivated she might be in using the method of her choice—no birth control will be successful if she forgets to use it or if she uses it incorrectly. These two items of discussion help narrow the methods that will most effectively support your goal in regard to preventing pregnancy.

For example, if a woman really does not want to get pregnant (perhaps she’s in school, or starting her career, or not married) but she does want to be sexually active, I would suggest a method that has the highest level of success—even a combination of methods for optimal reassurance against both pregnancy and sexually transmitted diseases (STDs) —such as using birth control pills and condoms. From a different perspective, if she’s in her late 30’s and is not opposed to a potential pregnancy if it occurs, but she would rather avoid becoming pregnant and having a baby at this stage of her life, and if she is also leery of taking synthetic hormones, she might use something other than the pill, even if it is slightly less effective, such as a diaphragm or a sponge.

Birth control methods

After we’ve discussed her personal preferences for a birth control method, I usually review the list of options, beginning with the most effective options, if used correctly every time (also reviewing what happens if the method is not used correctly every time, which reduces it’s effectiveness) and progressing to the least effective options. I like to use a visual aid of contraception options with pictures and information, and I also keep samples of a NuvaRing, intrauterine device (IUD), Evra patch, and diaphragm available for us to see and touch while we are talking about it.

As we move through the list, I ask my patient to consider any age, health, or lifestyle habits that may make her a better candidate for some options and a poor candidate for others. Personal medical history, family medical history, weight, smoking, or having multiple partners are all major factors.

As an example, some women could have a strong family history of a blood-clotting disorder and carry a genetic mutation that places them at greater danger for a clot when using hormonal birth control. Other women experience an increase in blood pressure when using the pill, and will usually choose to use another method.

Birth control pills are not ideal for smokers, and most practitioners won’t prescribe them to women who smoke if they are over the age of 35, because the risks increase greatly at that point. In addition, if a woman weighs more than 180 pounds, the pill may be less effective. In this case the extremely low-dose versions are specifically not advisable.

Most women with symptoms of depression or individuals who have already been sensitive to hormones in the past may want to steer clear of longer-acting hormonal approaches like the Depo-Provera. Women with irregular cycles at all ages uncover that it is difficult to predict ovulation, so the rhythm technique and its successors (basal physique temperature, Billings technique, etc.) are usually not the wisest selections for them simply because they depend on the ability to accurately predict the exact days they may be the most fertile.

When choosing the best method to prevent pregnancy, every woman should talk with her health care advisor about her personal needs and her health considerations. As always, we work from the inside out at Women to Women, within the framework of your whole health history. We want to consider your lifestyle, your nutrition, your emotions, and give you the best information that will be essential for you to make your best choice.

Preferences for contraceptives

I always ask each woman to consider the method of contraception that appeals most to them I remind her that she should consider and take into account her own fulfillment, satisfaction, convenience, ease of use, any side effects, fears, and, in most cases, she should also consider her partner’s cooperation and satisfaction with the birth control method that she chooses.

Making the best choice of birth control will take some time and a lot of thought. At the clinic, we use a comparison sheet that our patients take with them to process and/or discuss with their partners. The various methods are listed by type and from most effective to least effective. This list does gives a wide range of choices, but not every birth control method is included. We strongly encourage you to review and discuss these and other options with your health-care practitioner before deciding which method to use.

Sexually transmitted diseases and birth control

If you have more than one sexual partner, if you start new physical relationships often, or if you suspect your partner of infidelity (having a sexual relationship with someone else), any discussion of birth control needs to include a discussion about preventing STDs.

Barrier methods, such as condoms, are the best prevention from infections carried in the semen, such as the human immunodeficiency virus (HIV), but condoms will not protect you from infections that can be transmitted by skin-to-skin contact, such as herpes and the human papillomavirus (HPV).

Most birth control methods, such as the IUD or the pill, are not adequate in a circumstance of multiple partners or frequently changing partners, because although the mentioned methods do prevent pregnancy, they do not protect against STDs. Using a condom does provide better (though not total) protection from infections.

Carrying condoms with you and handing them to a potential partner may feel a little awkward, but remember that you are worth it. It is important to be proactive to protect your health. If you were to get onboard a boat, knowing that there was a high likelihood that it would sink, I’m fairly certain that you would want a life preserver—no matter how awkward you felt wearing it. I really encourage women to empower themselves and feel this self-worth—after all, if you are going to have sex with someone, shouldn’t he care enough to wear a condom to protect you? If he puts up resistance, ask yourself, is he really worth it? In the long run it is not worth getting something that you will have to have for the rest of your life.

However, there are times when a woman in a monogamous relationship is the last to know that her companion has been unfaithful and sex with another person has not been revealed. As clinicians we are charged with protecting our patients’ health, it’s our job to be unbiased regarding fidelity, but hopefully your discussion with your practitioner will be conducted in a sensitive and tactful way.

Most people understand that teens and girls in their early 20’s are at a higher risk for numerous STD’s, but menopausal females are within the most rapidly developing groups of HIV infections. The best protection in contracting any STD is not surprisingly abstinence, and then the next best protection is condoms. But discussing previous sexual histories also can safeguard you even when in a monogamous partnership.

What do you do to not get pregnant?

Phrasing the question this way tends to get a more accurate answer than if I ask “What do you use for birth control?” because if she doesn’t use a hormonal method such as the pill, she will often answer nothing. When I pose the question what do you do to prevent yourself from getting pregnant I hear things like, “Oh—my husband had a vasectomy,” or “I have an IUD,” or “We use the calendar for timing and he pulls out.”

Not surprisingly, not having sex with men or abstaining from intercourse also prevents pregnancy for our celibate or lesbian patients. It is also a woman’s right to choose not to use birth control when having sex, as long as she acknowledges that this is a choice that frequently results in pregnancy. This is a complicated concept for some teens to grasp, but highly vital. It is essential to emphasize that what your partner does about birth control also counts. It is not just the female in a relationship. We encourage you to try to have as open a dialogue about sex and birth control as you can together with your partner, your medical doctor, and yourself. It might take several visits to your practitioner’s clinic to finally determine what feels suitable for you. But taking the time to learn about your options is the best way to find a method that will meet your needs.

A healthy lifestyle for adequate support

Many conventional doctors do not venture beyond the call-and-response format of an appointment when you go in to discuss birth control—that is, if you don’t ask, they don’t tell. But don’t forget that good health, nutrition, and lifestyle habits are important considerations for all women of childbearing age (and beyond).

The way we eat, exercise, handle stress and take proper care of ourselves always matters. For instance, if there is a chance you might get pregnant, getting adequate folic acid (400 mcg per day) is vital because a woman needs folic acid in her system at conception — weeks before she finds out she’s pregnant — to prevent birth defects. Calcium is significant for bone wellness, particularly in case you are using the Depo-Provera shot, which is linked to lower levels in bone density. Females on the pill will want to supplement their intake of B vitamins, due to the fact birth control pills interfere with their absorption. We encourage all women – regardless of what birth control strategy they choose – to take a pharmaceutical-grade multivitamin every day.

If you have questions about birth control methods, you may want to read our answers to commonly asked questions about birth control.