Not every horror story on the internet is going to happen to you:

“What brings you in today?” 

“I want to talk about birth control/my horrible periods/not getting my period” 

“Have you been thinking about anything in particular?” 

“Uhhh...” 

Most of the upcoming graphs will be from this 1300 page beauty, which is old enough to be in college...aren't you glad I read it for you?

For the next few posts, we’re going to assume that you haven't the foggiest clue about any of the hormonal options. You may have heard the birth control/hormone myths that your gynecologist wishes would die: 

I can’t/shouldn’t use hormones if _________ (fill in the blank): I don’t need birth control/ my periods are irregular or I just started to get them /I’m over 40/I’m perimenopausal 

• The first few years after periods start, irregular periods are the rule, not the exception.  Medication that leads to more predictable and tolerable periods can make life in middle school bearable.  Sort of.  

• Hormonal birth control options can actually be the ideal bridge from perimenopause and the cluster of symptoms that can accompany it to menopause. 

• Menopause is defined by when you haven’t had a period for a year, not a blood hormone level (except in rare cases) 

• If you are still having periods, your body isn’t likely to respond the way you want it to the lower doses in hormone replacement designed for post-menopausal women.  A discussion for another time.

• There are some women who really shouldn't use hormones. Again, another time.
  

“Natural” is always better. 

• There is no clear definition of “natural” or “bioidentical”.  Lots of poisons are natural (parts of castor beans, hemlock, deadly nightshade.  That google is a rabbit hole).   Synthetic hormone formulations in birth control are monitored and need to meet requirements set by the FDA.  Bioidentical or compounded substances aren’t monitored and can contain contaminants or doses that are higher or lower than needed.   
  

Hormones cause cancer/infertility/vampirism  

• Most decrease the risks of cancer, or show no change.  They do decrease the risk of unplanned pregnancy while using them, but not once you stop.  vampires are just to see if you’re paying attention.  
  

My body needs a break or a reset from the regimen that is working well for me. 

• My young self fell prey to this PRE-internet.  Fortunately, my doctor informed me that a diaphragm was not a great choice for a med student who really didn’t want to be pregnant, and that we could change the dose of the birth control pill I was on as needed.  
  

They will make me hairy/fat/moody/pimply  

• Most will decrease mood swings with periods or PMS symptoms.  Estrogen containing methods generally decrease unwanted hair growth and acne through their effects on the liver.   Depo-Provera, one of the progesterone only methods, can stimulate the appetite.   

• Weight gain with the pill has been studied where women took either the pill or a placebo, used a backup method, and tracked several symptoms.  These women didn’t necessarily know that weight gain was one of the primary study outcomes.  Weight gain was no different in pill users vs placebo; and can you imagine signing up for such a study? 
  

Starting hormonal birth control for her/their periods makes my daughter/child more likely to have sex.  

• Actually well studied, and the answer is no.   These questions are almost never from the person who wants to manage their cycles.   
  

“Why don’t we just take it (the uterus) out?  I don’t really need it” 

• While it isn’t a vital organ (required for your life), removing the uterus is a major procedure, with more risks.  It is definitive—without the uterus, you won’t have a period.  But it doesn’t cure all pelvic pain.  It doesn’t eliminate hormones unless we take out the ovaries.  And if something less risky works well for you, why wouldn’t you try that first? 

Some of the hormonal options involve a minor procedure in the clinic. 

• A procedure is anything that involves something more than a basic exam: an injection, insertion, biopsy, look-see, removal...Major procedures are surgery, like c-sections, hysterectomies.  We don’t do those in clinic, for reasons that should be obvious.    

Any procedure, major or minor, requires consent.  We use the same consent form for biopsy of a skin tag that we do for removing the uterus, tubes, ovaries, and/or a big cancer surgery.  The wording and details are different.  Consent is a process, not a piece of paper. Consent describes the procedure in detail, and the expected recovery.  For these minor procedures, we expect you to walk out of clinic and treat yourself to a fancy coffee. (Or maybe you get the fancy coffee ahead of time, as a hit of caffeine and sugar can help keep you from getting lightheaded if you're prone to that. You do you)

Consent also includes risks of NOT doing the procedure—in this case, your periods will continue to suck.  

Standard consent for procedures, even small ones, include:  

• Bleeding: usually minimal for minor procedures, potentially more for larger procedures. Anything we do in the office has a very low risk of severe or serious bleeding. 

• Infection: Any time there is a break in the skin, with a needle or a scalpel or inserter, there is a small risk of infection. Same if something goes into the uterus.  Infections can happen even when we clean the area, which we always do. If you notice pus or redness near the site, or a fever, you should let us know.  

• Injury to nearby things: this can happen at the time of the procedure, or if the device moves after it has been placed. Again, pretty darn rare for things done in the clinic. 
  

We do everything we can to decrease these risks, but we can’t make them zero. Nothing is risk free. If you google it, you can always find someone on the internet with a horror story about something. Grain of salt, people.  Also, the more bizarre or awful the thing is, the more clicks it gets and the bigger impact on the patient and those around her.   

If it happens to you, it doesn’t matter that the chance of something happening is <1%.  Nothing is risk free.