Contraceptives

With a flash of his magic wand your male partner could soon banish the fall out from low dose birth control pills for ever!

Mood swings, irritability, weight gain et al may soon be the archived side effects for women if your male partner is the sensitive, macho type who could handle 15 mins. of scrotum exposure, a teeny weeny invasion of his private parts and a band aid down below. Of course, the issue of ‘trusting men with the responsibility for birth control’ is a whole different ball game (sorry!) and not for today’s post but it’s good to know the latest ‘foreplay’ on this controversial subject.

RISUG (”Reversible Inhibition of Sperm Under Guidance”) is getting close to being made available to men outside India where it has been trialled for 15 years. The RISUG injection method into a man’s vas deferens (sperm tube) was invented by Prof. Sujoy K. Guha but the Male Contraception Information Project has purchased rights to begin studying RISUG in the U.S. and developing it for the rest of the world. 2015 may see RISUG marketed to US men as a far less invasive option to vasectomy. Issues with the syringe design slowed down the project somewhat but in May 2011 these were resolved. A potential manufacturer has been selected and clinical trials beginning in 2012 will develop the ‘VASALGEL ‘ birth control method for men. Funding for the $5million project however, needs to be kept up - MCIP are encouraging people to sign a petition to encourage large funders to financially back the project through to the end.

VASALGEL/RISUG procedure : imagine making a teeny, weeny hole in a Lilliputian’s bean bag through which is pulled a little loop of ‘spaghetti’. Into that little thread of spaghetti 60mg of polymer gel is injected, the loop is then released whereupon it snaps back inside the weeny bean bag before a little band aid is applied over the almost invisible hole. There you have it -VASALGEL or  from our viewpoint- “low dose birth control side effects begone!”

For additional excellent and fascinating, detailed information on the current stages of play with RISUG development GO HERE. The petition form is also there if you wish to sign it and for the bravehearts amongst you can even watch a video of the procedure.

Effectiveness of Vasalgel The gel doesn’t need to block the sperm tube (vas deferens) fully because the active ingredient it contains kills the merry swimmers as they pass by. A minimum of 7 years of contraception is achieved for guys after only 15 mins. in the hands of a skilled doctor - the procedure is reversible at any time with no discovered ill effects or damage to future sperm. There is only a 10 day ‘condom backup’ period after the procedure as compared with up to 3 months for a vasectomy. With vasectomy some men report prostate issues but to date no similar reports have been logged with RISUG. The fact that the gel does not completely block the sperm tube works in its favour since no ruptures or ‘backup’ of sperm occurs.

WomenCare Global- Once Vasalgel has been proved to be safe and effective, it is hoped that the project will be turned over to a nonprofit organisation called WomenCare Global which specialises in supporting the completion of reproductive health products and then getting them onto the market.　

My last statement on my previous post was “I am not aware of any proven, reliable herbal form of birth control“- this was true for women’s birth control but when it comes to male birth control in Indonesia it is a different bunch of leaves.

Male birth control pill available next year in Indonesia? Not so far away from my desk here in Oz, a 6ft tall leafy shrub called Gandarusa is growing in a forest on the eastern coast of Java. Gandarusa, used by the Indonesians as an herbal remedy for stress, has been found to also reduce fertility in men. Testing Gandarusa specifically for use in male birth control has been carried out at Airlangga University since 1987. With a 100% success rate to date, trials on 350 couples are expected to be completed by the end of this year which means 2012 could be the year that the ‘long laboured’ male birth control pill will be ‘born’, in Indonesia anyway.

How does Gandarusa work?

It changes the chemistry of the enzyme on tip of each sperm making them unable to pierce the outer wall of the egg- if the enzyme is inactive or reduces the activity, the egg cannot be fertilized.Don’t get too excited about Gandalusa being available in the states yet though. The FDA’s strict testing process could take years. The risk will be yours remember if you fancy a quick holiday in Indonesia to shop for Christmas stocking fillers!

Are there any side effects? - as I understand it, the good news for the guys is:

• few side effects, if any, reported
• no diminished libido reported – in fact quite the opposite with one guy!
• no altering of male hormones – wouldn’t ya know it?
• contraceptive effect is not permanent - fertility is reversed within 2 months after stopping the daily pill

The fact that this method is not permanent and possibly will not harm the body, should meet with the approval of the Islamic leaders but the age old question still remains-

Will men use it?  In Indonesia (?) most men think contraception is a woman’s responsibility (currently only condoms and vasectomy are used) fewer than 2% of men participate in birth control. Even if the male birth control was to be available to the world tomorrow, it still begs the question - how do we ‘sell’ a male birth control pill?

I’ll post a free copy of my book ‘Happy Vaginas for the Over 40s’ to the person who sends in the funniest ‘ad script’ for the male birth control pill to this post by Christmas!

While guys and their ‘contraception careers’ are the flavour of the posts this week, I’ll bring you up to date on the current RISUG state of play in my next post.

Several brands of low dose birth control pills are reviewed on this site, including Yaz and Yasmin, which along with Beyaz/Safyral are currently in the news because of a fear that a particular hormone they contain, drospirenone, increases the risk of blood clots. I am waiting for the outcome of the latest study by the FDA on 800,000 women as to the effects of drospirenone on blood clotting and will adjust or remove the Yaz information accordingly. The results of the study are due later this Summer, in the meantime I encourage those of you who are ‘happy’ with this low dose birth control pill to watch out for possible symptoms of blood clots such as chest pain or leg pain or talk to your doctor about using an alternative form of low dose birth control.

Estrogen in low dose birth control pills is the ingredient that is thought to make blood more likely to clot. As drospirenone is a type of progestin, not a type of estrogen, and in Yaz 3mg of it are combined with 30mcg of ethinyl estradiol (estrogen), it will be interesting to see what the study reveals about this cocktail- I’ll leave you to make the leap I did.

Yaz has its followers due its success in reducing the common side effects of other low dose birth control pills and in reducing acne. However, the manufacturer Bayer, is reputed to be facing several thousands of lawsuits. Lawsiuts are brought for a wide range of reasons (some marketing, some medical) so don’t jump to wild conclusions here, get as much information about the details as you can.

What increases the risk of blood clots forming? It is the estrogen in low dose birth control pills and other forms of hormonal contraception containing estrogen (also HRT) that is thought to make blood more likely to clot, this is called hypercoagulability. Estrogen itself doesn’t form a blood clot.

Progesterone/Progestin only forms of birth control such as the ‘mini pill’, Depo Provera shot, Implanon and Mirena are ’safer’ to use from this aspect and would certainly be a better choice for women over 35, who smoke, who are overweight or who are breast feeding. Reminders for the mini pill -

• progestin only pills MUST be taken at the same time every day to give maximum protection
• for the first month of usage, a condom must also be used, as with other BC pills
• even being 3 hrs late in taking your mini pill means you should use a condom for the rest of that cycle (not 48hrs only )
• while you may take 2 mini -pills in one day, you can’t take 2 mini - pills the next day to make up for the missed one as you can with a combined birth contol pill

Combined low dose birth control pills prevent most women from ovulating whereas progestin only birth control types act mainly to thicken cervical mucus and change the uterus lining to prevent pregnancy- about 50% of women also stop ovulating on progestin only contraception.

To highlight vegan condoms again I recommend this site below as they seem to keep abreast of the latest products, offer value bonuses and have a good selection of other items.

Undercover Condoms Deal of the Month: Buy 1 12 Pack of Sir Richard’s Condoms, Get 1 FREE.

If you are not planning to welcome a new little soul into your arms anytime soon, you may wish to join the growing number of women who are forsaking their low dose birth contol pill in favor of a long acting, reversible contraceptive (LARC ) such as an IUD or an implant. A recent bulletin by the American College of Obstetricians and Gynecologists show that today’s much improved IUDs and implants are the most effective forms of reversible contraception.

IUDs are now considered suitable for the majority of women, including adolescents, women who have had a miscarriage or an abortion, women who have had ectopic pregnancies and also women who have never had any children. HERE is an earlier post with details and a video of a copper IUD insertion.

My earlier post is HERE if you want details of implants but today’s post is just to bring you up to date with the latest increase in popularity of these two low maintenance LARCs.

“IUDs and implants should be considered first-line contraceptives for a majority of women,” says Eve Espey, MD, MPH, an associate professor of obstetrics and gynecology at the University of New Mexico in Albuquerque. Espey also says that available evidence suggests that IUDs do not cause PID (pelvic inflammatory disease) which prevented many doctors recommending them to women who had not had children.

“The majority of unintended pregnancies among contraceptive users occur because of inconsistent or incorrect contraceptive use, and this is where implants and IUDs stand out from the pack. They are maintenance-free, which means there is virtually no margin of error,” she says.

Implanted, contraceptive ’rods’ were approved in 2006. You do need to go to a doctor to have the implant inserted just underneath the skin on the inside of one arm and protection against pregnancy usually lasts for 3 yrs. Yes, you can feel it if you press on the insertion site as seen here http://youtu.be/4TNEtyu1WUU but the idea is to forget about it once it’s in so don’t worry that it’s going to catch on your clothes! These two videos show insertion and removal if you’re interested in the procedure.

INSERTION

REMOVAL- don’t worry about the foreigh language on this video, the procedure is clearly shown.

An IUD can provide 5-10 yrs of protection depending on the type. Paragard is a copper IUD and will protect you for up to10 yrs, while Mirena is a hormonal IUD releasing progestin and will protect you for up to 5 yrs. IUDs also need to be inserted by a doctor.Warning: Neither of these contraceptives will protect you from STIs so condoms come into their own as rescue special ops! Your doctor may or may not offer these two options. Implants and IUDs should not be used if you have been diagnosed with any form of PID, reproductive cancer or Wilson’s disease (too much copper in your body).   If you are a vegetarian did you know that you can buy Vegan/Organic Condoms on this site (search for Sir Richards brand) Undercover Condoms Sales - Click here to view this month’s sale items including Condoms, Lubricants, and more!!Downsides in brief:

• irregular menstrual bleeding, possible acne and weight gain in a few women (no different to other forms of hormonal birth control) and sometimes temporary cramping following an IUD insertion which usually diminishes after a while
• very rarely (1 in 1,000) an IUD pushes through the wall of the uterus and has to be removed
• the contraceptive skin implant may cause a mild insulin resistance in some women 
• initial high cost of several hundred dollars for each type but when averaged out over several years, the monthly cost compares favorably to the cost of a low dose birth control pill

“CatSper “ and nanoparticles could be the vital link in the development of a new contraceptive gel or birth control pill - for women AND MEN.

What is CatSper? CatSper, discovered and named by David Clapham, a researcher at the Boston Children’s Hospital, is the key element in sperm that influences its swimming capacity.  Researchers in Germany and the US have discovered that progesterone around an egg seems to activate ‘CatSper’ or in other words, turbocharge sperm to give them that extra little swimming boost once they get close to an egg. With their ‘motor’ severely disabled, the sperm would lose the energy to make that last minute dash to the finishing line.

 With the Bill and Melinda Gates Foundation funding David’s research team, there is an 18 month window to develop a prototype drug which will block CatSper (‘disable’ the little motor in the sperm’s tail so to speak) at the time of sexual activity. With the aid of nanotechnology, we could then see the birth of a completely NEW type of contraceptive.“Sperm are the only cells known to make CatSper, so such a drug is unlikely to have many side effects. It would also, presumably, work regardless of whether it is men or women who take it because it could act on sperm regardless of their location”, says Polina Lishko,  a reproductive biologist at the University of California, San Francisco.

What’s nanotechnology got to do with it? I’ll explain this as simply as I can. Nanoparticles would be used to carry the CatSper blocking‘drug’ to ‘bomb’ the sperm. The nanoparticles would also be coated with specific antibodies which are ‘sperm seeking’ so the drug would be released only on reaching the ‘target’ (the sperm) and would not be left in any mucus or on the wall of the vagina. “Twenty million of these missiles (sperm) are released at once, and you have to get all of them before they make it to the target (egg),” says Clapham….“(CatSper) It’s an anti-missile device that doesn’t cause any collateral damage.” 

If Clapham and his team successfully develop a blocking compound, a trial with animals is likely which could then lead to a new contraceptive gel or oral birth control pill for men or women. Hands up if you’d vote for the bombs to be dropped BEFORE the missiles leave the factory! To avoid or reduce the cocktail of synthetic hormones currently found in low dose birth control pills has to be a step in the right direction. As to the lack of ‘collateral damage’ anticipated with this new form of birth control, well, any synthetic/chemical substance which is absorbed into the body has the potential to cause side effects so let’s keep the jury out on this one until the proof is in the nano pudding.

References: Strünker, T. et al. Nature 471, 382-386 (2011).Lishko, P. V., Botchkina, I. L. & Kirichock, Y. Nature 471, 387-391 (2011).

Here are a few more myths about low dose birth control and a link to that extraordinary book I mentioned in the last post.

MYTH 6.  The Pill makes you infertile

No it doesn’t. It can take a few months before your body readjusts itself back to it’s own natural hormone levels but you may believe this myth if you are 30+ and have fewer eggs left which are of a less than ‘prime’ quality.  If you’ve always taken a low dose birth control pill, how do know if you have fertility problems without it?  A low dose birth control pill may actually help you to avoid fibroids, endometriosis and similar uterine conditions so may ‘preserve’ your fertility. 

MYTH 7.  The Pill causes cancer

Not necessarily.  Even a low does birth control pill offers some protection from ovarian cancer and endometriosis. Research shows that if you take a combination birth control pill (estrogen and progestin) you are at a higher risk of cervical cancer but no actual causal link has been found yet.  Please do not increase your risk of cervical cancer further by exposing yourself to the contributing factor, the human papilloma virus , by having unprotectd sex. There is also a slightly higher risk of breast cancer for women on the pill which diminishes after use and disappears altogether after 10 years. Cancer findings here.

MYTH 8.   It doesn’t matter what time you take your pill each day.  It does if you want to get the maximum protection and efficiency from it so ‘attach’ the pill taking time to a daily routine you already practise well.  MYTH 9.    All birth control pills are the same  Not true.  Low dose birth control pills may all have the same end result of preventing pregnancy but there are many different types, while the estrogen may be identical (ethinyl estradiol) the type of progestin could vary.   Within those, many different brands (including generic brands). Not all pills will suit YOUR body in the same way as your friend’s body so talking to a doctor or family planning professional is the best way to find a ‘match’ that suits your metabolism and medical history. 

NEW ‘must have’ BOOK - You’ll never see your vagina in the same light again

 Now for the link to that remarkable book I mentioned.  I have been waiting awhile to recommend this extraordinary work of art to you- and it is SO much more than that. At a time when women fall victim to media propaganda, when sadly, labiaplasty is growing in popularity and  young girls’  body image is at an all time low, this beautiful book of 164 full colour photographs celibrates and honours the uniqueness and true beauty of every women’s genitals.

Heart of the Flower: The book of yonis is an unflinching exploration of the beautiful diversity of women’s genitals, free of judgement, shame and embarrassment.

To watch a short video about Heart of the Flower book before buying, http://www.youtube.com/watch?v=PztE75RNKbQ

Have you ever wondered if any chemical residues (synthetic estrogen and progestin) from the millions of low  dose birth control pills consumed, ever get into our drinking water or into the oceans and possibly harm the fish?

Where does almost 90% of the total estrogen in the environment come from? Can pesticides mimic estrogen and add to the pollution of water supplies?

More importantly- can most of the pollutants, including estrogen be removed? I recently found a synopsis from the mission of Environmental Health News on this issue which I felt was worth passing on.

The mission of Environmental Health News is to advance the public’s understanding of environmental health issues by publishing its own journalism and providing access to worldwide news about a variety of subjects related to the health of humans, wildlife and ecosystems.

Towards that end, journalists write and publish articles on the EHN site. These stories are provided to newspapers and other media through EHN’s news service. These articles meet high journalistic standards of non-advocacy, and the content is under the control of the Editor in Chief.  EHN also offers timely, daily access to the hundreds of other articles on environmental health topics that are published each day in the world press, and its searchable archives date back to 2002. EHN does not accept funding from interest groups.

World Aids Day is almost over in the US.  I am tapping this wondering just how many people around the globe actually DID anything related to this important awareness day.  Did you?  If not, well I urge you to have your own aids day tomorrow or the next day or the day after that …then …..why not EVERY DAY? 

YOU are the boss of you. You can wear a red ribbon whenever you like. You can make love whenever you like…You can wear a condom whenever you like..You can talk to your partner and friends about ’safe sex’ whenever you like…but once infected with HIV, it’s no longer ’whenever you like’.

Don’t know anyone with HIV or aids? Not sure what YOU can do to bring curb those rising statistics?

Simply remember that you can:

• give a real (or virtual) hug to someone when they tell you they are HIV positive
• stay in touch with and be a true friend to someone you know who’s suffering from Aids
• stuff a few Christmas stockings with some fun condoms (yes- even for Aunty Barbara who’s dating again!)
• avoid sharing injecting equipment with anyone (if you use needles, syringes etc.)
• always use condoms

People with HIV  can live healthy, active lives if they receive treatment.

Worried that you may have put yourself at risk of HIV?  Take this quiz to find out.

Obese women can now have the confidence to change to a brand of low dose birth control pill without worrying if the dose of estrogen it contains will be high enough to be give them effective contraception. There have always been greater health risks with birth control pills that contain higher doses of estrogen so this is good news for obese women who are already at a greater health risk with their weight and who may be putting up with unecessary side effects because they have been taking a higher dose contraceptive pill.

Obesity is a major health issue now and while the risk of developing blood clots is still associated with all types of birth control pills , it remains higher for overweight women. Pregnancy can also be riskier too if you are carrying too many extra kilos.

Carolyn Westhoff, professor of obstetrics and gynecology and director of the Division of Family Planning at Columbia University College of Physicians and Surgeons, New York investigated the effects on ovulation supression of varying strengths of oral contraceptive pills on a group of normal weight and overweight women aged 18-35 over a period of 3-4 months. Many ultrasounds and blood tests were carried out and the results showed that weight did not appear to have an effect on suppression of ovulation but that CONSISTENCY of pill taking did.  Regular pill taking is best practise for all women of child bearing age who select this method of birth control though isn’t it?

If you are overweight and want of peace of mind over your family planning - be especially vigilant about taking your low dose birth control pill every day… and maybe this is just the little nudge you need to help you think  about how you can improve the health of your body overall? Your future child will blossom for it.

If you are happy with your current low dose birth control pill, don’t think you are missing out because it doesn’t contain folic acid. You may already be taking folic acid alongside your low dose birth control pill anyway and not realise it (your daily multivitamin may include 400 mcg of folic acid in its ingredients). The Food and Drug Administration has recently approved a new birth control pill, Beyaz,  that contains this synthetic form of Vit B9 which helps to prevent spinal cord defects, like spina bifida in babies.  

Some women accidentally become pregnant while taking the pill or may choose to get pregnant soon after stopping the pill so maintaining a decent level of folic acid in a low dose birth control pill is a good idea. 

Since Beyaz is a new low dose birth control pill and also the only one currently on the market which contains folic acid, I have no  first hand information for you regarding any possible side effects so please let me know how you get on if you try it.  It is prescription only. Here is a link to some further information on Beyaz .

In clinical trials on users of Beyaz, the most common side effects were: headache/migraine, menstrual irregularities, nausea/vomiting, breast pain/tenderness, fatigue, irritability, decreased libido, weight gain and mood changes.

If you do become pregnant when taking Beyaz- stop taking it straight away but continue to take at least 400mcg of folic acid per day.

Beyaz contains the same progestin type as Yaz which is drospirenone (which can increase levels of potassium in some women)

This is the Bayer warning on the Beyaz.com home page:

Do not use Beyaz if you have kidney, liver, or adrenal disease, or if you have or have had blood clots, certain cancers, history of heart attack or stroke, or if you are or may be pregnant. Beyaz is associated with increased risks of several serious side effects, including blood clots, stroke, and heart attack. Risk of these conditions is highest during the first year of use.

Like all the other low dose birth control pills, Beyaz does NOT [protect you from STIs so make sure you are well stocked with your own supply of condoms ladies.