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Contraceptives 101: Patch and rings

[00:00:00] All right, so we're talking about birth control this week and today we're gonna talk about the hormonal birth controls, like the patch and the ring, not the pill. Mostly because I have props. These are the props I have. So this is what we're starting with. I also think these are actually great. So we're gonna talk about these three patch and two different kinds of rings when we talk about contraception. 

we are talking about people who are purposefully, purposefully using something because they don't wanna get pregnant. And ladies nowadays, at least in America, even with health insurance being the broken system, that it is, access to birth control is very, very easy. So it's actually deeply sad to me that there are still so many, I hate the term unwanted, but so many unplanned pregnancies, surprise pregnancies. 

We don't wanna say unwanted because sometimes even the unplanned ones, Like my own third baby are very wanted in the end, and sometimes the unplanned ones are not wanted. And while I'm a vociferous supporter of our right to choose [00:01:00] what to do once we are pregnant, I would certainly say I think we should make every effort when we can to actually try not to get pregnant if we choose not to. 

That is not to say that if it. Without your planning that you should, um, rid yourself with sadness, anxiety, fear, guilt, any of those terrible terms, shame that I hate. But it is to say we have access, and even if finances are an issue, many doctors will do birth control prescriptions that are not very expensive, and there are so many services nowadays. 

I prescribe for one called Simple Health. There's a ton of other ones that are great and you can actually get birth control for fairly inexpensively as is Planned Parenthood, which is an amazing service. Planned Parenthood really dedicates themselves not to abortion services, which. A huge misconception, but actually to helping women's health in general, helping to promote women's health, helping to help women become more in control of their lives, especially in their contraceptive health. 

So with that, let's talk ring. [00:02:00] Patch ring. There's two different rings in one patch. So if you decide that you're going to use a hormonal form of birth control, of which there's a bunch of different kinds, pill, patch, ring, and i u d and shot and implant, those are all the different hormone. They can have different benefits and different side effects. 

The way the patch and the two rings worth work is the same as the pill, meaning it is systemically suppressing ovulation. In a normal cycle, a woman ovulates and then two weeks later, She either has a lining that's lush and thick and ready to have an embryo implant. If that egg that has popped out meets a sperm or that egg pops out and it just dies away and disintegrates because no sperm has come around to, in, to, um, create the embryo right to fertilize it. 

That was the word I was looking for. And therefore, that lining that has thickened up over that second half of that cycle sheds itself. Okay. Does that make sense? Ovulate either pregnant [00:03:00] or shed out your lining. Now, once you're on the pill, patch of the ring or the shots, you do not ovulate. That is the mechanism of the vast majority of these. 

Save for what we're gonna talk about in a couple sessions later, which is the mini pill. We'll discuss that later. The progesterone only pill. Other than that, the combined birth control pill. The ring, the patch, the. Depo-Provera shot and the Nexplanon injectable all suppress ovulation. That is how they stop you from getting pregnant, which means what about the lining? 

That means that the lining never thickens up as much because the hormones are keeping things, even the egg is not popping out, and therefore that thinner lining does not have to shed itself out. So I say that because with any of these that we're gonna talk about the pill, the patch, the ring, you can safely skip your. 

It's okay. The lining is not thickening up and just kinda getting stuck in there. It's not gonna transform into 10 something bad because again, over time the lining is being kept so incredibly thin that it doesn't [00:04:00] need to shed itself out. Okay, so why would you take the patch or the ring instead of a pill? 

Some of you will forget the pill, and that makes a lot of sense. Even those of us who think we're so organized to be able to have something that we take every day, and at the same time every day is sometimes hard. So ease of use and some people just feel better depending on different forms because every time I start in most gynecologists, start a woman on some form of birth control, whether it's hormonal or not, or the i u D that is not hormonal. 

I think we probably say some version of the same thing, which goes like, The next three to four months is your body's adjustment period. You might end up having, and I say this, literally spotting or bleeding every day, every other day, every 10th day. In other words, Anyone's guess can happen. You may or may not bleed or spot. 

Try to tolerate it for up to three to four months, because after three or four months is when your body has kind of adjusted. If it's going to adjust or it's declared itself that this form of birth control is not the right one for you. If after two weeks you're still spotting, you're annoyed and you [00:05:00] stop that form of either birth control, ring patch, and switch to something else, then we've never given that one form a chance and we don't know which one's the right one for you. 

And you have to kind of reset that cycle to like, okay. Three to four months, again, where I need to figure out if this is gonna be the right one for me. So in sh, in the absence of something really dramatic, like if you are soaking through pads every 30 minutes, that's too heavy. And then I would say, okay, stop. 

Whatever pill, patch ring you're on, go see your doctor. Short of that, I would try to stick it out. Pill patch, ring. all have the same potential. Other side effects. So besides irregular bleeding, these are meant to even out your hormones, which typically means improved acne, improved mood, lighter, shorter period, or you skip your period and less pain because you're not ovulating. 

Now, what could be caused by all that? All those things that we wanted to fix could get worse. Your mood could get worse. Your acne could get worse. You might have more irregular bleeding. Your pain should not get worse. Okay, now, What if any of those things happen Again, if it's dreadful, [00:06:00] stop. If it's less than dreadful, which it typically is, it's usually just an annoyance. 

Try to stick it out for three to four months as your body adjusts. But what about weight gain? Shiva, I've heard everyone gains weight and the answer is, Mm. No. A third of the patients will gain weight, but a third will lose and a third will stay the same weight. So you actually have two thirds chance of losing. 

We're staying the same, which means if you want to be on contraception, you should, cuz guess what? Getting pregnant, you're likely gonna gain more weight than you would on the pill after the ring. Okay? And that's the truth. I think some of us who tend to. The type like me, who gain weight easily and who are triggered very much by food and cravings and things like that, might actually have an stimulated appetite from the hormones, but it doesn't spontaneously make you gain 40 pounds. 

It might make you hungrier, and I would not be one to say, well, just control your hunger, because I find that very hard to do. . But again, the mechanism through which it might make you gain weight is actually increasing your hunger. It is not spontaneously making you balloon up. Are you maybe gonna retain a couple pounds of water weight? 

It's [00:07:00] possible, but the studies don't actually show that. That's necessarily true, though I would say we do see it anecdotally. But what about cancer? The good news is pill, patch, ring all decrease, decrease. Ovarian cancer by stopping ovulation because every month when you ovulate, your cells have to go through a bunch of changes that could potentially go haywire and lead to cancer. 

So decreased risk of ovarian cancer, decreased risk of uterine cancer because it thins out your lining and indirectly through the mechanism through which it stops. Ovulation, indirect, decreased risk of colon cancer. Three cancers that these will decrease. Breast cancer is still the conundrum where it does seem that it will increase the risk of certain hormonal breast cancers. 

Okay? But again, the risk is relatively small, so it is not a reason to not go on it. The risk of all of these hormones of getting a blood clot in your calf that could lead to a pulmonary embolism or a clot in your. Is there, and it's a very real risk, but it's a very small real risk, meaning we have all seen it as doctors, [00:08:00] all of us. 

If you've been practicing more than even six months, I would say you will probably have seen someone with a blood clot because it's just so common given the numbers of people we have on the pill. But it's still a safe thing to do because by the way, those women were predisposed to getting a blood. If they went and got pregnant as well. 

So that's, I'm gonna keep in mind. Okay. Now onward to the actual patch in the ring. This is a patch. This is not a real patch. This is a placebo that they give us for show and tell, but I just wanted to show it to you guys. So this is the actual patch. All right, and you can see that it's pretty thin and it peels off and you stick it onto your skin. 

We typically say on your abdomen, on your buttocks. Some people do it on the back of their shoulder, but it's meant to be one patch. It's impregnated, no pun intended, with hormones in here. It's meant to be one patch per week, so three weeks on, one week off if you want your period. Do you need your. Please answer correctly. 

No, you don't need your period. So what would you do? You would [00:09:00] just use three weeks. Three weeks. Three weeks, meaning the pack comes monthly as three weeks on and one week off. But instead you would use three weeks, three weeks. Three weeks consecutively. So what you need your doctor to do, if your insurance company will cover it three months at a time, your a doctor needs to write for the three weeks, skip placebo, which means they're gonna dispense ideal. 

12 patches. Okay? So they're gonna give you three weeks, three weeks, three weeks, times, three months, but an extra three patches. So they have to write for three weeks of patches. I mean, one month of patches, skip the placebos, times a three month dose, which is 12 patches. Okay? It's a pain in the ass, and insurance companies won't always cover it, but if they do, then you. 

12 patches from the insurance company. Three months worth, skip your period. Okay, next is Nuva ring. Nuva ring was the original vaginal ring. This is not part of it. This is just the display. So this ring, which in reality is actually clear-ish to Whiteish, but [00:10:00] for the display it's blue. You see, it's really soft. 

I always joke, I happen to be wearing my gummy bracelets. That is very much like these gummy bracelets. So all you do is literal. Squeeze this ring and put it inside your vagina. This ring is also impregnated with the hormones, the estrogen and progesterone hormones that the pill or the patch have, so they're in the ring. 

Instead of swallowing the pill and it absorbing through your stomach, you are putting this into your vagina and it's absorbing from your vagina. You have robust blood vessels in your vagina that will absorb the hormone. This ring again. So assume that this part wasn't there. You take the ring, you squeeze it, and just like you would either putting in a tampon, if you're standing up or sitting down, you're gonna push that into your vagina. 

Once you kind of, your fingers touch the, the labia on the outside, right, the vulva, you're gonna have to let go. It'll pop open and then you just shove it as far as you can in, but what if I put it in the wrong place? What if it goes too far? Well, it can't go too far because your vagina is actually a blind ended pouch. 

Okay? So you're not gonna shove it up into your pelvis in some [00:11:00] place that it can't go. It will not go into the wrong place, because the right place is merely the place where it sits, where you're comfortable. Just like with a tampon, if you stand up and go, yep, I don't feel the tampon. I'm. That means it's in the right place. 

If you stand up and go, Ooh, I feel the tampon a little bit, then you probably don't even know that you know this, but you would shove it in a little farther. Same thing with the ring, so you don't need to worry about where it's gonna go. This is not a diaphragm. It's not covering your cervix. It sits in your vagina in a certain direction based on the way your pubic bone is. 

It knows what to do. And again, this is formulated for three weeks in one week. Because again, women were taught that they wanna have their periods back 50 years ago when the pill makers were men. Now we know that women do not wanna have their periods necessarily. If you want it, you can have it. If you don't want it, you don't need it. 

And so you can put this in. Three weeks, three weeks. Three weeks at a time. There is actually enough hormone in here for 28 days worth, so this could be left in for 21 or 28 days. I find that when my patients leave it in for 28 [00:12:00] days and try to skip their period, they end up actually potentially having more irregular spotting in bleeding. 

So I tend to have them do it for 21, 21, 21 days. Same thing as the patch your doctor has to write for in this. Three rings, right? Because that'll be three rings would be nine weeks. They have to write for four rings if you're gonna use it consecutively every three weeks over the three month period of time. 

Okay. And that's if your insurance company will cover three months at a time. Okay. And lastly is the newest. To the market. Ann Vera. Oh, and by the way, the Nuva ring now has a generic, which is good as far as insurance coverage because if they won't cover the brand, they'll cover the generic. Is it exactly the same? 

Generics are not exactly the same. They will have. These same active ingredients, but they can actually fluctuate the dose of teeny bit and maybe different inactive ingredients, but they're all good. It just matters what your body gets used to. The same thing, by the way, with the patch. The original was called ortho ever. 

The generic now, which is the only thing really on the market is Zoo Lane with an X. Okay? The newest, which [00:13:00] does not have a generic cuz it's so new, is anno vera, which means the year right? Anno means the year in Latin. So anno vera also aang. This part is just for display. It is squish. It's a little squishier than the initial ring. 

It's a little bit thicker, but it's softer. Okay. Um, they're both excellent for different reasons. Then beauty of this is that it's one ring for the entire year, and while again, it's formulated for three weeks in and one week out, you can use one ring all year. The beauty of which is I'm traveling in the future after Covid to Europe, or I just don't feel like going to the pharmacy every month, or I can't go to the pharmacy every month because I'm, you know, I can't get outta my house. 

Whatever it. This ring is one ring for the whole year and it comes with the compact so that if you feel uncomfortable and you wanna take it out, you certainly can. Neither ring is felt during sex. They've done studies that men don't feel it, women don't feel it. And men who do feel it don't mind that they feel it. 

So while you're allowed to take it out during sex, I don't necessarily encourage it cause they worry, [00:14:00] people will forget it. The nice part about this ring, um, which again is newer, is that the claim is that it's got formulation of their, of. Progesterone is not derived from testosterone, meaning all birth control pills that we use that are combined have the same estrogen called ethanol, estrodiol, and a different progesterone. 

Each brand has its own proprietary progesterone. Essentially, those progesterones are derived from testosterone. This in particular derives its progesterone from estrogen, so they claim fewer side effects like. Acne and mood changes and all of those things that we consider that are more androgenic, more male side effects, and they claim that they have less breakthrough bleeding in irregular bleeding juries out. 

I'd say anecdotally, so far it seems true, but again, I like all forms of birth control equally. I would never say that one is the best one. Whatever's best is the one that you are going to use that you'll stick with. Okay, hope that all makes sense. That was a long one. Bye.