Category Archives: Health

You Can Now Get Birth Control From an App, Without Seeing a Doctor. Here’s What to Know Before You Try It

In this day and age, you can order pretty much anything online and get it delivered to your door—including protection against unplanned pregnancies. A number of companies have sprung up in the last few years that allow women in certain states to request birth control pills and other contraceptive methods via the Internet, sometimes without even seeing a doctor.

These suppliers—with catchy names like Maven, Nurx, Lemonaid, and Pandia Health—offer convenience and confidentiality to women who may be too busy to squeeze in a visit to their gynecologist or nervous about picking up their prescription at a local pharmacy. And according to a recent NPR article, they’re gaining popularity in rural parts of the country sometimes called “contraception deserts” that lack easy access to women’s health services.

But is getting a birth control prescription online really safe? And is it a good option for everyone? Health spoke with Sophia Yen, MD, CEO and co-founder of Pandia Health. (Yes, she’s got skin in the game, but she’s also got real medical cred: She’s a clinical associate professor of pediatrics and adolescent health at Stanford University and a member of the Association of Reproductive Health Professionals.) Here’s why Dr. Yen jumped into the online market, and what experts say about the science and safety behind these services.

Online consultations can do almost everything in-person visits can

Customers can use companies like Pandia Health to fill existing birth-control prescriptions they receive from their doctor—but if they don’t have an Rx, they can usually get one in just a few simple steps.

On Pandia’s website, for example, users answer a series of questions about their health and are asked to submit a blood-pressure reading. “If you’ve been to a doctor’s office in the last year, you can ask them to send it over—or you can go to most pharmacies or grocery stores to have [blood pressure] checked, too” says Dr. Yen.

Some birth control delivery apps require a phone call or video conferencing instead of an online questionnaire. Regardless, the point of these evaluations is for a doctor to make sure that women don’t have existing health issues that could raise the risks associated with birth control pills. If you get certain types of migraine headaches, have a history of blood clots or stroke, or if you smoke, for example, your request could be denied.

RELATED: 7 Health Benefits of Birth Control Nobody Talks About

Doctors support the idea of fewer barriers to birth control

In 2012 and again in 2016, the American College of Obstetricians and Gynecologists (ACOG) issued position statements advocating that oral contraceptives be sold over the counter, without a prescription. “That’s already the case in China and in many European countries, because they know that the benefits of preventing unplanned pregnancies and making women’s lives easier outweigh the risks,” says Dr. Yen.

In fact, ACOG’s position statements cite research showing that when women use a self-screening checklist—similar to the health questionnaires used by these apps—they are more likely to identify risk factors that could make birth control dangerous than their doctors are.

While a doctor’s prescription is still required in most states, Dr. Yen says ACOG’s statements gave her the confidence to invest in telemedicine and to issue prescriptions over the Internet. And it’s paying off, she says: Already, her company has helped many women get contraception who never had it before.

“We thought we’d get a lot of 18-year-old customers, but we’re also getting 23-year-olds who have never been on birth control,” she says. “When we ask them what they’ve been doing for protection, they say condoms, withdrawal, and prayer. Thank goodness now they have a better option.”

RELATED: The Most Effective Birth Control, Ranked

Cost can still be an issue

Thanks to the Affordable Care Act, birth control is free for most women with health insurance. But these apps may still charge a fee for a doctor’s consultation. Pandia Health’s fee, for example, is $39 if you opt for mail delivery of your meds, or $59 if you choose to fill your Rx at a pharmacy.

Uninsured customers, on the other hand, must pay upfront for birth control pills. These companies offer medications at several different price points, but even low-cost, generic options (which run about $15 a month) can be prohibitive for low-income women, says Kyl Myers, PhD, a sociologist and research associate in the University of Utah’s department of obstetrics and gynecology. 

“These apps can be really great for people with insurance or who can afford out-of-pocket care,” says Myers, who leads a University of Utah and Planned Parenthood initiative to provide free birth control to women in Salt Lake County. “But we need to make sure that all women have access to affordable contraception.”

RELATED: 5 Times Celebs Got Candid About Their Birth Control

In-person visits are still a good idea, if they’re doable

Dr. Yen still recommends seeing a doctor in person “if it’s doable for you,” especially if you have questions about which type of birth control is best for you. (Pandia Health offers the pill, the patch, or the ring.) “We’re here to give you access,” she says, “but having a provider talk you through your options is always better if you’re a newbie.”

Seeing a doctor in person is also a good way to make sure you’re up-to-date on important screenings. A face-to-face visit can give you a chance to bring up any health-related questions or concerns you might have as well. But it’s those issues that should determine when and how often a woman sees her doctor, says Myers. “If nothing’s changed with your health or your sex life, you shouldn’t have to go every 12 months just to get your prescription renewed,” she says.

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If you want an IUD or implant, you still need to see a doctor

Another drawback of these online subscription services is that they can’t provide implants or intrauterine devices (IUDs), which have been shown to be the most effective forms of birth control on the market. “I always encourage patients to learn about and consider the IUD, but you do need to visit a doctor to have it inserted,” says Dr. Yen.

Myers agrees. “These apps are a step in the right direction, but we need to be making sure people have access to a whole range of effective contraceptive methods,” she says, “not just to user-dependent methods like the pill, the patch, or the ring.”

Birth Control Pills May Help Prevent Some Cancers

In the U.S., nearly all sexually active women have used a form of birth control at some point in their lives, and 11 million women rely on the pill.

In a new study published in JAMA Oncology, researchers explore how oral contraceptives, which affect women’s hormone levels to prevent pregnancy, affect cancer risk. They found that women taking the pill lowered their risks of ovarian and endometrial cancer—a known benefit of the pill. The researchers also analyzed other factors that might affect the risk, including obesity, smoking status and physical activity levels.

In addition to finding that the risk of endometrial and ovarian cancers were lower among women who used the pill, the study found that the longer women were on oral contraceptives, the lower their risk was. For those taking the pill for 10 years or more, the risk of ovarian cancer was 40% lower compared to women who had never used the pill or used them for less than a year, and 34% lower for endometrial cancer.

That confirms what earlier studies found, but the current study also delved deeper into how oral contraceptives and cancer risk differed among women with different risk factors for cancer. When the scientists looked at lifestyle factors that might affect the cancer risk among pill users, for example, they found that women who used the pill and were obese, smoked or did not exercise had among the lowest ovarian cancer rates. It’s not clear why, but the researchers speculate that in the case of smokers, there may be some interaction among the hormones associated with oral contraceptives and tobacco.

“We found long-term oral contraceptive use reduced ovarian cancer risk universally — it didn’t matter how healthy you were later in life or if you had a family history of the disease; all women experienced the benefit,” said Britton Trabert, the study’s senior author and epidemiologist from the division of cancer epidemiology and genetics at the National Cancer Institute (NCI).

MORE: Birth Control for Men? Researchers Will Test a Hormone Gel in 2018

For endometrial cancer, women who were obese and used the pill for 10 years or more lowered their risk of developing the cancer, while women who were normal weight and used oral contraceptives did not.

The study’s findings about breast cancer were less conclusive. Previous studies found that women who use oral contraceptives, which include both estrogen and progestin hormones that have been linked to cancer growth, have a 20% to 30% higher risk of developing breast cancer compared to women who don’t use the pill. The current study found no significant change in breast cancer risk among oral contraceptive users compared to non-users, but the researchers say that may be due to the fact that most of the women in their study were older and past menopause, meaning they had likely stopped using birth control for many years.

Though the results don’t establish the pill as an anti-cancer therapy quite yet, the authors say, they are intriguing enough for women to start discussing with their doctors their personal risk factors for cancer and how going on the pill could potentially affect that risk. “Oral contraceptives are primarily used for preventing pregnancy and managing menstrual cycle symptoms,” says Kara Michels, the study’s lead author and a postdoctoral fellow at NCI. “Our study indicates that for women with different underlying cancer risks when they are older, their earlier oral contraceptive use is likely still beneficial for cancer prevention. Better understanding of the risks and benefits of these medications may help physicians and their patients make informed decisions about using oral contraceptives.”

16 Worst Birth Control Mistakes

The antibiotic rifampin can undermine hormonal contraception, including the pill, the patch (Ortho Evra), or the vaginal ring (NuvaRing).

Some anticonvulsants, oral medications for yeast infections, HIV drugs, and the herbal supplement St. John’s wort can also be a problem for these types of birth control, as well as for contraceptive implants (Implanon), according to Planned Parenthood.

Bottom line? Check with your doctor about possible interactions and medications that can make your birth control less effective.

7 Guys Explain Everything They Know About Birth Control

Are men really that clueless about birth control? We asked them.

In case you missed it, we’ve started a series where we ask men to tell us everything they know about women’s bodies and health topics, such as menopause, boobs, and birth control. As you’ll see in the clip above, their responses are often questionable, sometimes (sort of) accurate, and always hilarious. 

For this installment, we started off asking seven men to explain what an IUD is. Once they established that it was different from a UTI (those pesky abbreviations!), they took a stab at what the letters actually stand for. “Infectious urinary tract disease?” one guessed. Other attempts included words like ‘incision’ and ‘diaphragm.’ Luckily one participant correctly labeled an IUD as an intrauterine device, the T-shaped birth control method that is inserted into the uterus by an ob-gyn and prevents pregnancy for up to 12 years. 

WATCH THE VIDEO: 6 Birth Control Mistakes You Didn’t Realize You Were Making

Next we discussed diaphragms. Two in-the-know dudes got it right when they said a diaphragm is a device that goes inside the vagina to block the cervix and stop sperm from entering a woman’s body. Bravo. 

Finally, we wanted to see how many birth control methods the men could name. Apart from thinking that the birth control pill and plan B (which is a form of emergency contraception) work the same way, they did fairly well. Condoms, diaphragms, the pill, the morning after pill, IUDs, shots, implants, vaginal rings, and abstinence all made the list. Other options that went unmentioned include the birth control patch or straight-up sterilization. Good job, boys! 

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What You Need to Know if You Take the Pill and You’re Worried About Your Breast Cancer Risk

As convenient and reliable as it is, hormonal birth control is not without its risks. In a new study of 1.8 million Danish women published in the New England Journal of Medicine, researchers found that current or recent use of hormonal contraceptives increased a woman’s breast cancer odds by 20%.

That sounds alarming, but should you trash your pill pack over it? “This is certainly nothing that would damn someone from taking the pill,” says Mary Jane Minkin, MD, clinical professor of ob-gyn at Yale School of Medicine. “This is another study that shows a very slight increased risk of hormonal birth control—especially with long-term use.”

RELATED: The Most Effective Birth Control, Ranked

Previously studies, she explains, have shown that a woman’s likelihood of developing breast cancer rises slightly while she is on hormonal birth control, but that small uptick disappears several years after she stops. The new study focused on women who were currently on or had recently gone off hormonal BC; it also looked at shorter and longer-term use. Women who used hormonal birth control for less than a year had a 9% higher risk of breast cancer, while those on it for 10 years or more had a 38% higher risk, researchers found.

Those numbers seem pretty major, but in general, they translate into a modest change in breast cancer risk. That 20% increased odds amount to approximately one extra case of breast cancer for every 7,690 women using hormonal birth control per year, according to the study.

So is the ease of the pill worth the additional risk? It depends. “Medicine is about risks, benefits, and alternatives,” says Christine Greves, MD, ob-gyn at Orlando Health Hospital in Florida. “You need to weigh the risks of hormonal birth control against the benefits.” For some women, simply not getting pregnant is top priority, and “hormonal contraception is excellent at preventing pregnancy,” she says.

RELATED: 25 Breast Cancer Myths Busted

Or maybe it’s more important to you that hormonal birth control offers protection from ovarian, endometrial, and colorectal cancers, if one or more of these cancers runs in your family. Perhaps the pill makes your killer menstrual cramps disappear. “There are a lot of variables and a whole lot of health benefits of hormonal birth control,” Dr. Minkin says. “It’s not an automatic, ‘No you shouldn’t take it’ or ‘Yes you should.’”

Ideally, women should talk to their healthcare provider and go through the pros and cons of different types before selecting the best method for their needs. This is when you should take into account any individual health risks (like if you already have an increased risk of breast cancer due to a genetic mutation, says Dr. Greves) and your personal preferences (such as your level of comfort with having an IUD inserted).

If you don’t want to totally give up hormonal birth control but are worried about breast cancer, consider using it for a shorter amount of time. “The shorter the time, the less of an issue” breast cancer risk becomes, Dr. Minkin says. If you’re really nervous, you and your doctor might decide to go off it because of that fear alone. “If you’re anxious about it, stop!” Dr. Minkin says. “If someone says ‘Every time I take a pill I’m going to be terrified!’ I’m going to say, ‘Let’s not use the pill!’” 

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Just remember, once you drop hormonal birth control, you need a backup method if you don’t want to get pregnant, Dr. Minkin cautions. “If you’re terrified, pick up some condoms, start using them today, then go talk to your healthcare provider” about other options.

Here’s What Happened When I Went Off Birth Control Pills for Two Weeks

I’ve been taking birth control pills since I was 15. My gynecologist at the time wrote me a prescription because my periods were coming every two weeks, which was unbearable (and messy!). Now, at 23, I’ve been taking some form of hormonal birth control for seven years, and I didn’t realize how much I truly needed it until recently, during one terrible two-week stretch when I lost my pack. The resulting side effects and hassle trying to get a new prescription were truly a nightmare.

I’m not usually a forgetful person, but somewhere between rushing to catch a train, packing for a weekend trip, and bundling up in the cold weather, I dropped my pill pack. I noticed they were missing the next day, and I practically tore apart my apartment and still couldn’t find them. Searching my desk at work didn’t yield any results, either. After one more round of turning all my bags and pockets inside out, I was resigned to the fact that this pack was lost, and I’d have to get a new one. 

RELATED: 16 Worst Birth Control Mistakes

It was day four of no pills by the time I submitted a refill request to my pharmacy, and I was already starting to feel a little weird. I was getting moodier, very anxious, and super achy all over—basically normal PMS but on steroids. By day five, my pharmacy told me it was too soon to fill my prescription and my insurance wouldn’t cover it. My symptoms were getting worse, but they weren’t bad enough for me to want to fork over $50 for a new pack when I should be getting it for free. 

I’m busy and I hate talking on the phone, so I wasn’t in a huge rush to call my insurance company. I’ll just go off them and get my period and then start a new pack at the normal time, I thought. It’ll be annoying but overall no big deal. I was wrong, wrong, and wrong. I started spotting the next day, but I also started getting awful headaches. I’m no stranger to headaches, but these were much worse than I had experienced. The pain would start behind my eyes and radiate sharply to the back of my head. Ibuprofen did nothing, and so I would sit for hours saddled with an unbeatable headache on top of my cramps, achy joints, and generally moody attitude. 

After a little over a week, I gave in and called my insurance company. I explained that I had lost my pack and I needed an emergency refill. They were less than helpful. It turns out that it’s really, really hard—at least with my insurance—to get a pill pack refilled before the normal time. They gave me the runaround for days. Meanwhile, my bad headaches turned into something I had never experienced before: migraines. Sitting at my desk at work and looking at a computer monitor bathed in florescent lights made me want to throw up. Relief only came after lying down in a quiet, dark room with my hands over my eyes. 

RELATED: The Most Effective Birth Control, Ranked

At this point, it was actually the normal time for my prescription to get refilled. With a massive headache, I rushed over to my pharmacy and got a new pack of pills for the usual price of $0.00 per my insurance. I’m happily back on them with no side effects to report. But the whole experience made me wonder if this is a normal thing. Do women everywhere have weird withdrawal symptoms when they stop taking hormonal birth control, or was I a special case?

I posed the question to Sara Twogood, MD, assistant professor of clinical obstetrics and gynecology at the University of Southern California Keck School of Medicine. She said these symptoms aren’t unheard of, but they likely had nothing to do with “pill withdrawal” and everything to do with biology. If you had bad period symptoms before you went on birth control pills, she says, those symptoms will return once the hormones in them are out of your system.

“A lot of women go on it for acne or PMS, there are so many different benefits,” Dr. Twogood says. “If you went on it to begin with because of irregular periods, for example, when you stop it, there’s a pretty good chance you’re going to have irregular periods again.”

RELATED: 11 Health Risks Linked to Migraines

Because most women have been on hormonal birth control for years by the time they decide they want to stop taking it, Dr. Twogood says it’s common to not put two and two together and realize the symptoms they had before the pill have returned. But what about the migraines I experienced? I had never in my life suffered such bad headaches, and I definitely didn’t get those before I started the birth control pills.

Dr. Twogood says I probably developed a propensity for having migraines in the seven years since I started taking hormonal birth control, and the pills were just suppressing them. So I guess I have that to look forward to when I decide to go off of them again. As for women who are struggling with their symptoms after saying goodbye to their birth control pills, Dr. Twogood urges them to take four months and track their symptoms to try to spot a pattern—because it’s not always the birth control pills that are to blame.

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“If women are having irregular cycles or some irregular symptoms, I would really want them to monitor those symptoms as long as they weren’t severe,” she says. “I would want them to monitor it for about 3 to 4 months. Keep a journal and track your period and see if you can find any other associations.”

As for me, I’m happy my symptoms only lasted as long as it took to get a new pill pack. I’m not looking forward to the migraines I’ll get once I decide to go off birth control pills. For now, I’m keeping much better track of where I leave my pill pack—so I never lose them again. 





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