From March 2nd to May 30th of this year, we drove 15,000 miles across the US, from New York to California, on a reproductive health education tour. We offered 60 free classes in 43 states in order to share accurate, fair information about the menstrual cycle and hormonal health. We dubbed the project The Fifth Vital Sign, because we consider the menstrual cycle to be a vital sign, as indicative of our health status as blood pressure, heart rate, respiratory rate, and temperature, with the potential to give us information about thyroid issues, endometriosis, PCOS, infections, cancers, fertility and infertility, pregnancy, miscarriage, menopause and more.
By sharing information about how our bodies work, we hope people are better equipped to make fully informed choices about their health care and contraception in particular. If we’re not aware of the benefits of ovulation and menstruation, can we really make an informed choice about hormonal birth control, which prevents ovulation and menstruation? Beyond body literacy, without knowing or being presented with all of our contraceptive options, and the risks and side effects of each, how can we make an informed decision, which is our right, about our preferred method?
Informed choice in the context of contraception is one of our favorite parts of The Fifth Vital Sign curriculum, because we realize how critical it is. We were able to initiate our project, thanks in large part to a generous donation from Informed Choice for Amerika. Karen Langhart founded the organization after her daughter, Erika, died at the age of 24 from a double pulmonary embolism as a result of the NuvaRing. From then on, it became Karen’s life’s mission to catalyze research and communications that lead to informed contraceptive decisions for women. She didn’t want anyone else to lose their lives because they didn’t know the third generation progestin in NuvaRing is associated with a higher risk of blood clotting (between 3 and 12 women using combined hormonal contraception out of out of 10,000 will develop a serious blood clot, according to the NuvaRing website).
Body Literacy and Hormonal Contraception
So, how can you make an informed choice about contraception, both hormonal and non-hormonal? We always preface this section of our class by saying: our opinions do not belong in this space, and we are here to provide you with information so that you can make the best decision for your body, which you are the authority on.
We wrote about how body literacy is an important part of making an informed choice. Our recommended resources for menstrual cycle knowledge are listed on our website, but it’s a long list! A good place to start menstrual cycle 101 is Appleseed Fertility’s blog.
Know your rights. When you are speaking with your health care provider, you have the right to say no; the right to ask more questions because you have the right to informed consent; and the right to a second opinion. Depending on where you live and your personal, financial situation, a second opinion is not always available or accessible. If this is the case, know that you can always bring a patient advocate with you to an appointment, a trusted friend or support person who can help you advocate for yourself. Bring as much information with you to the appointment as possible. We will share some of our go-to resources for contraceptive information below. Also, request a long appointment time, so that you don’t feel rushed, and write down any questions you have.
Know why you want birth control. Ask yourself what’s important to you about contraception: STI protection, price, convenience, pregnancy prevention, inconspicuousness? Making what you want and need in contraception clear to yourself will help direct your choice. If you’re considering hormonal contraception for reasons other than contra-conceiving, like acne, decreased menstrual cramps or flow, be aware that hormonal contraception is not a treatment for these issues but a temporary relief. In Women’s Bodies, Women’s Wisdom, Christine Northrup compares taking hormonal contraception for these reasons to putting a piece of duct tape over the check engine light in your car and continuing to drive. There’s still a problem under the hood, but for the moment, you’re not aware of it. These issues can be indicative of hormonal imbalances, and treatment may be found in diet and lifestyle changes. This is one of our favorite questions to ask in order to make a fully informed choice: what are the alternatives to X option? In other words, if I’ve been on the pill for six years to decrease my acne, and I’ve just come off the pill and my acne is back, what are alternative treatments? Some of our favorite diet and lifestyle resources for hormonal balance and health are Nicole Jardim’s blog, Alisa Vitti’s Flo Living and Woman Code, Lara Briden’s blog and Period Repair Manual, other members of our health care team, including abdominal massage therapists, and of course the Hormones Matter blog! Also, if your cycle is irregular, hormonal contraception won’t regulate your natural cycle; instead, the synthetic hormones will induce an artificial one. An irregular cycle may signify hormonal imbalances, or it could just be your normal.
Research and ask for a comprehensive list of contraceptives. We use a combination of Scarleteen, Bedsider, Planned Parenthood, and ACOG to learn about contraceptive options prior to speaking with our health care providers. Once you’ve narrowed down your options, we also recommend looking at the pharmaceutical companies’ websites for more information. To facilitate an effective conversation with your health care provider, ask them three main questions about each option: what are the benefits, risks, and side effects?
Know your health history and your family’s history. Communicate this information to your provider. For example, does your family have a history of blood clotting disorders? Risks of combined hormonal contraceptives include blood clots.
Make sure you understand the instructions for how to use the contraceptive. Repeat what you understand back to the health care provider in order to verify your understanding.
Be sure to know what your insurance will and won’t cover. For example, some insurance companies will cover the insertion of the implant but will not cover the cost of the removal.
Real Risk Study: Birth Control and Blood Clots
Lucine Health Sciences and Hormones Matter are conducting research to investigate the relationship between hormonal birth control and blood clots. If you or a loved one have suffered from a blood clot while using hormonal birth control, please consider participating. We are also looking for participants who have been using hormonal birth control for at least one year and have NOT had a blood clot, as well as women who have NEVER used hormonal birth control. For more information or to participate, click here.
