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On May 2, politico.com reported that an initial draft majority opinion from the Supreme Court had been leaked. This draft opinion stated that the Supreme Court will vote to overturn Roe V. Wade. This is a draft, meaning this overturn has not happened yet, but it is very likely, almost certain, that it will a few months from now when it is finalized by the Court. 

What is Roe v. Wade?

Roe v. Wade is a 1973 case that federally legalized abortion in the United States. Overturning Roe v. Wade would make abortion illegal federally, meaning that it would be up to each individual state to determine its own abortion laws. This is incredibly alarming for reproductive health, as well as the safety and health of people with uteruses. 

Experts are concerned for many reasons, based on the logic in the draft. The arguments the draft uses with its case to overturn Roe deal with a person’s right to choose. This same logic could potentially be used to overturn same-sex marriage, as well as interracial marriage in the future, although, at this point, that is just speculation.

Where have we seen this before?

Over the last several years, we have seen states enact incredibly strict abortion laws, such as the law in Missouri attempting to make it illegal to seek an abortion to treat an ectopic pregnancy (the only treatment for this type of pregnancy), as well as harsh laws in Texas and other conservative states making it illegal for someone to seek an abortion after only six weeks. Many people don’t even know they are pregnant after six weeks, and abortion is safe anytime within the first trimester, which is much longer than six weeks. If or when this draft passes, what does this mean for reproductive health?

How could this change reproductive rights?

This proposed overturning of Roe is troubling for many reasons. Many people and lawmakers that oppose abortion and seek to enact strict laws making seeking an abortion difficult identify as “pro-life.” If someone has an ectopic pregnancy, a non-viable pregnancy when the fetus grows outside of the uterus, the only treatment is an abortion. If the pregnant person does not abort the non-viable fetal tissue, it will rupture and they will most likely die. If someone is raped or a victim of incest, I would argue an abortion would be life-saving for the victim. Both of these examples directly contrast the pro-life argument. 

Why is this a matter of safety?

Before Roe, people were still having abortions, they were just incredibly unsafe. Women would use coat hangers or other sharp objects to try and puncture the cervix and abort on their own. Oftentimes these women would hemorrhage and die. Roe guarantees access to safe and legal abortions where women could make the choice, for whatever reason, to safely end a pregnancy without threatening their health. In fact, in the United States, abortion is safer than giving birth. Overturning Roe would threaten that. 

What could it mean if Roe is overturned?

With the federal law being overturned, it would be up to each individual state to make its own abortion laws. This likely means that conservative states would make abortion illegal or enforce strict laws about when someone can have an abortion, while more liberal states would stay legal. I am of course speculating, as this hasn’t gone into effect yet. If someone in a red state wanted to seek a legal abortion, they could potentially receive one if they traveled to a blue state. 

This might sound like a minor inconvenience, but it is not. In order to travel to another state for this procedure, you’d need to be able to take time off work, have access to a car, as well as money to pay for a hotel room in this other state. If you already have children, you need money to pay for childcare, or money to have a large enough hotel room so they can come with you. What if your job doesn’t give you time off, or taking a day off and traveling to another state means having to choose between making your rent payment or being forced to give birth? Privileged, wealthy women will still be able to access abortion once this goes into effect, but there are so many women who will not have that privilege. 

Could this affect contraception access?

I also worry that this will cause other laws not based on science regulating women’s reproductive health to go into effect. Louisiana is speculating about criminalizing IUDs and Plan B as part of their new abortion bill changing the state’s legal definition of human life. IUDs and Plan B, as well as every other type of birth control and emergency contraceptives, do not abort an already fertilized egg or fetus. These contraceptives prevent fertilization and implantation in the uterus from ever happening, meaning they prevent pregnancy. Period. Contraceptives are literally not abortion, however, conservative male lawmakers don’t seem to care about science. 

Having varying opinions on whether or not you as an individual would have an abortion is your right. You know what is best for you and your body. Male politicians who will never have the experience of being pregnant should not have a say in creating laws that force pregnancy and birth. The right to choose what we do with our bodies is just that – a right. Reproductive rights affect everyone, whether you have the capacity to get pregnant or not. If you have sex with people that can get pregnant, this draft affects you too. Overturning Roe v. Wade will not stop abortions. It will only stop safe abortions. This will kill women. Comprehensive sex education, as well as access to free or low-cost contraceptives, will stop abortions.

Here is the full Politico article outlining the specific arguments the Supreme Court used in its draft. If you have questions about abortion or reproductive health care, ask your doctor or visit Planned Parenthood. Those are both great resources for reproductive healthcare, even if you just have questions.

I love talking about birth control. If you’ve ever talked to me for an extended period of time, or heck, read any of these blogs on here, you know I love talking about birth control options. The pill, the patch, the shot, the ring, condoms, IUDs – the list goes on and on! It’s one of my favorite topics. Despite my passion for the pill (and other contraceptive methods), I found myself clueless recently when I realized I didn’t know what to do if I miss a birth control pill myself!

I’ve been on the combination hormonal pill (estrogen and progestin) for nearly a decade. During that time, I’ve never missed a pill. (Thank you for the applause!) Life got extra stressful recently and I was extra distracted because I opened up my pill pack one Friday afternoon to see Thursday’s pill staring me in the face. Since I had literally never missed a dose, I had no idea what to do. I immediately called my gynecologist and got some answers.

How does hormonal birth control work?

In order for the hormonal birth control pill to be most effective, you have to take it at the same time every day. The pill works in two ways: it thickens your cervical mucus so if sperm were to get into the womb, no implantation would occur. It also shuts down ovulation. This is the big one with the pill. If you’re not ovulating, no eggs are being released to be fertilized. If you miss a dose, this can throw off the delicate balance of hormones needed for ovulation to be shut down. This is why some people get pregnant immediately after coming off the pill. Of course, everyone’s body is different, but even one missed dose, depending on the timing, can cause problems. 

I called my gynecologist and asked to speak with a nurse. I told her I had forgotten to take yesterday’s pill, so I was 24 hours late on that dose. She said since I had only missed one pill this month, I could just take it with today’s pill, taking two pills at once. Since I only missed one pill in my monthly cycle, and I took it as soon as I remembered, I would still be protected contraceptive-wise. She did say that it’s possible I might have some breakthrough bleeding, or the length of my menstrual cycle at the end of my pill pack could be slightly different than normal, but I did not need to use any backup methods of birth control because I had only missed one pill. 

Protection if you miss a birth control pill

If I had missed more than one pill that month, I would not be protected contraceptive-wise and would need to use another form of birth control, such as condoms. If you miss more than one pill in a cycle, it throws off the process of stopping ovulation. If you miss more than one pill in a cycle, take your missed pill as soon as you remember, even if you have to take two pills in one day. Use condoms in addition to your pill until you have taken active pills for seven days in a row. You need active pills for seven days to reset your cycle. It’s also recommended to take emergency contraception such as the Plan B pill if you’ve had unprotected sex within the last five days if missing that second pill. If you have fewer than seven active pills left in your pack, take what’s left and skip the placebo pills to start your next pack early. 

In addition to not being protected against unwanted pregnancy during this time, you might also notice spotting. Your next menstrual cycle might be slightly longer or shorter than usual as well.

If you’re on a progestin-only pill, the protocol is slightly different. If you take your progestin-only pill anywhere between three and 12 hours late, then you’re late on your dose. Take the pill as soon as you remember, even if that means taking two pills in one day. It’s also recommended to use emergency contraception if you’ve had unprotected sex within the last five days of missing a pill. Use condoms in addition to taking your pill until you’ve taken your pill on time for two days in a row. Then your cycle is back on track. 

Backup methods when you miss a birth control pill

If you ever miss a pill and you’re unsure, call your gynecologist and ask to speak to a nurse. If you don’t have a gynecologist, call Planned Parenthood, and they can tell you what to do as well. Although this was my first missed pill in nearly a decade, people miss doses of their birth control all the time. Like I said earlier, the pill works best if you take it at the same time every day, but stuff happens and sometimes you forget. Take your missed pill as soon as you remember, and use a backup method of birth control if you missed more than one pill during your cycle. 

Trying a different birth control option

If you find that you’re missing pills frequently, consider a different form of birth control. Talk to your doctor to discuss what options are best for you. Birth control such as the ring or an IUD might be a good option since you don’t have to “take it” every day. If you love the pill, but find you keep missing doses, you can also have some strategies to help you remember to take it on time. You could set an alarm on your phone that goes off every day to remind you. You could also take it at a time of day when you know you’ll be doing the same thing, for example, if you eat lunch every day at the same time, take it with your lunch. Even if you’re not sexually active, taking the pill on time every day helps keep your hormones regulated and feeling good. When in doubt, call your gynecologist and ask for help.

If you take hormonal birth control, you probably spent hours researching the possible side effects that come with starting the pill. You’ve probably heard horror stories of women having adverse side effects, and you probably asked your doctor a bunch of questions before you started taking the pill to be sure it was the right birth control for you. I’ve been taking the hormonal birth control pill for years, and despite knowing all of the possible side effects before starting, I realized I only recall hearing a few side effects for when you stop taking the pill. A lot of people start taking the pill when they’re teenagers or young adults, so it’s hard to imagine a time in the future where you’ll be stopping birth control, but the side effects of coming off the pill are important to know about as well.

Most people stop taking the pill when they want to become pregnant, but some people come off the pill sooner to try a different type of birth control if their body didn’t react well to the pill. Just like how not all people on the pill experience all of the side effects of starting hormonal birth control, not everyone going off the pill will experience all of the side effects coming off the hormonal birth control. If you’re considering coming off the pill, however, here are some of the side effects you might experience.

1. Withdrawal bleed after stopping birth control

If you take the pill with three weeks of active pills and one week of placebo pills, you’ve already experienced a withdrawal bleed. This acts as your period during your cycle, but since hormonal birth control shuts down ovulation, you’re really experiencing a withdrawal bleed from the steady flow of hormones. When you are stopping birth control, you will have a week-long withdrawal bleed just like you would if you were taking your pills how you normally do.

2. You could get pregnant right away

Doctors say it takes people anywhere from zero to six months to have ovulation return and their cycle to regulate itself without the pill. Every person’s body is different and it is possible to get pregnant right away when you quit the pill. The hormones in the pill will leave your system within a few days of stopping the pill, but it might take your body a little longer to begin regulating your cycle with your natural hormones again. Your body could also begin its natural cycle right away, leading to pregnancy if you have unprotected sex.

Because it’s impossible to know specifically when you’ll begin ovulating again, use condoms or another form of birth control right away if you are not wanting to get pregnant. For some people though, it may take between three to six months to begin ovulating again, so if you are quitting the pill to get pregnant, doctors recommend giving yourself a few months to have your body adjust so you can get pregnant when you are ready.

3. Cramps and discharge from ovulating

Once you quit the pill you’ll begin ovulating again so you might experience cramps on one side of your body during your cycle. These cramps are from your body ovulating and getting ready to release an egg. Now that you’re ovulating again, you’ll also notice a change in your vaginal discharge. Discharge during ovulation is stringy and clear. Since the pill shuts down ovulation, you likely haven’t seen this particular discharge in a while, but don’t worry, it’s normal and a sign that you are ovulating again.

4. Breakouts, cramps, mood swings, and a heavier period

If you experienced bad breakouts, cramps, and mood swings leading up to your period before you started the pill, you might have those symptoms again. If you experience these symptoms when coming off the pill and you didn’t have these pre-pill, your body should adjust after about three months and these symptoms should level out, becoming less harsh after a few months. Additionally, your period will likely be heavier after you quit the pill. The pill uses hormones to regulate your cycle, so once you come off the pill, your period might return to how heavy it was pre-pill. People’s cycles change over time though, so your period will likely level out to a “normal” flow after a few months as well.

5. Increased libido from stopping birth control

Some people report experiencing an increased libido after coming off the pill. During your cycle, you will feel the most frisky when you are ovulating. This is your body’s way of saying, “We’re the most fertile we’ll be all month, let’s make a baby!” Since ovulation is shut down when you’re on the pill, you of course can still feel frisky, but some people report having an increased sex drive once they are ovulating again. For some people, however, there is not a noticeable difference. Conversely, some people report feeling less sexy after coming off birth control because they no longer feel a sense of ease being protected from unwanted pregnancy.

6. Change in weight and breast size

Some people notice their breasts shrink a little when they stop taking the pill. This has to do with the hormones from the pill leaving your body and your natural hormones regulating your cycle again. If you didn’t notice a change in breast size when you started the pill, however, you likely won’t notice a change when you stop the pill.

Some people also report losing a bit of weight when they quit the pill. This isn’t super common either, but when it does happen it is due to a loss of water weight. The progesterone-only pill can cause people to retain water, which can cause a bit of weight gain. If you’re on a progesterone-only pill, you’ll lose this water weight when you come off the pill.

7. Hair loss

Admittedly, this is the only side effect I had never heard of, and this is the only one that scared me when I first read about it. This side effect isn’t very common, and when it is present it’s not as scary as it sounds! If you have polycystic ovary syndrome or some other condition that caused hair loss before starting the pill, you might experience hair loss again when coming off it.

If you don’t have a condition that affected hair loss prior to the pill, you likely won’t experience a noticeable amount of hair loss, if any. If you do experience hair loss, though, this should stop within six months of quitting the pill. This is due to a temporary condition called telogen effluvium, which causes your hair to shed. In most cases where hair loss is present after quitting the pill, however, it is usually due to stress, diet, or some other factor and not the pill, so don’t worry too much about this side effect if you’re considering quitting the pill.

If you’re considering coming off the pill, the biggest things to keep in mind are that you can get pregnant right away and that the levels of side effects you experience will vary depending on you and your body. You might not experience all of the side effects, and the ones you do experience will likely have varying levels compared to someone else you know. When you come off the pill, your body adjusts from being regulated with synthetic estrogen and progesterone to being regulated with those hormones naturally in your own body. This does require a bit of time to adjust, so know that for the first few months at least, your cycle and body will likely not feel back to “normal.” If after six months you are still experiencing severe side effects or your period hasn’t returned to normal, see your doctor.

It’s good to be educated about our bodies every month of the year, but with Endometriosis Awareness Month observed in March, it’s an excellent time to learn about this condition that up to 10 percent of people with uteruses have—endometriosis.

What is endometriosis?

Endometriosis is when the tissue that lines your uterus grows outside of your uterus as well. This tissue is called the endometrium. During your menstrual cycle, the endometrium tissue builds up, sheds if you have no fertilized eggs, then leaves your body through your period. When this tissue grows outside of the uterus, it still builds up as part of your menstrual cycle, but then it has nowhere to shed and exit the body. Endometriosis develops over time, usually several years after your first period, and affects up to 10 percent of people with uteruses ages 25-40.

What are the symptoms?

Since everyone’s bodies are so different, endometriosis symptoms can be mild to severe and vary for everyone depending on their body. The severity of your symptoms does not indicate the severity of the actual tissue buildup. This tissue can grow on your ovaries, bowel, and pelvis, and comes with a wide variety of symptoms. Because this tissue is building up and isn’t shedding, it can become increasingly painful over time. The most common endometriosis symptom is pelvic pain and cramps. This pain and cramping hit you in the same areas you might feel period cramps, but it’s much more intense. This cramping can be just during your period, but for some people, there’s constant pelvic pain. These cramps aren’t like normal period cramps. Some people experience cramps so intense they can’t go to work or function normally.

In addition to painful periods, other symptoms include pain during or after sexual intercourse, pain with bowel movements or peeing, as well as diarrhea, constipation, and bloating, heavy bleeding during your period, or bleeding between periods, and in some cases, infertility. About 30 to 40 percent of people with endometriosis experience fertility issues. These issues can be discussed with your doctor, and there are options to maximize your fertility with endometriosis.

Because the tissue can grow in several places in your body, it can affect these places in different ways. Another symptom is developing scars on your ovaries and pelvis, as well as adhesions or tissues growing so that they bind your organs together. Because the symptoms are so general, endometriosis can be hard to diagnose initially. People can be misdiagnosed with Pelvic Inflammatory Disease, ovarian cysts, or even Irritable Bowel Syndrome.

Are there treatment options?

Although endometriosis is not curable, there are several different treatment options. The growth of your endometrium outside of the womb is due to varying levels of estrogen in your body. Your changing hormones during your menstrual cycle that promote the growth and shedding of your uterine lining are the exact hormones promoting the growth of this tissue as well. Remember, the only difference is this tissue has nowhere to go once it’s grown. Hormone therapy or hormonal contraception can be used as an effective treatment. Hormonal birth control pills are a popular treatment for endometriosis because they shut down ovulation. If you’re not ovulating, your uterine lining is not building up to shed, so it should stop the growth of this tissue outside of the uterus as well. Any hormones that help stop menstruation could help treat endometriosis. Gonadotropin-releasing hormone agonists and antagonists can be used to treat endometriosis as well. GnRH is used to essentially create early menopause by stopping the production of estrogen in the body. Because it puts you in an early menopause, side effects would include vaginal dryness and hot flashes. This treatment sounds intense, and I’d guess it would likely be used for severe cases. Danazol is another medication that can stop your period and help stop the growth of endometrium tissue. These treatment options can help with pain and help stop tissue growth, but they don’t necessarily help with fertility.

If you are wanting to get pregnant or have a severe case of endometriosis and hormones haven’t helped, surgery is another option. During the surgery, the excess tissue growing outside of the uterus is removed. The surgery is called laparoscopy, uses lasers, and is minimally invasive. Again, this is the only treatment option that can help improve fertility. In extremely severe cases, and if you are not wanting to get pregnant, you could also have a total hysterectomy. This is a surgery to remove your uterus and cervix. This is usually only recommended for severe cases or for someone who knows they do not want to get pregnant. Once your uterus and cervix are removed, you won’t be able to get pregnant because your uterus will be gone.

What is the cause of endometriosis?

The exact cause of endometriosis is not known, which can be frustrating. One theory is that during menstruation the blood flows back into the fallopian tubes, causing build-up, while another theory suggests that hormones transform cells outside of the uterus into ones similar to those inside the uterus, confusing the body. If you experience any of the symptoms listed above, or even just have incredibly painful periods, go see your gynecologist. They will likely do a physical exam and an ultrasound to see what your uterine tissue looks like. Once diagnosed, your doctor will discuss the severity of your case with you. If left untreated, endometriosis can get worse over time because of the continuation of tissue building up. Once your doctor tells you the severity (minimal, mild, moderate, or severe) you can work together to discuss treatment options. Although endometriosis isn’t curable, you can still live a relatively pain-free life with it. If you are planning on having a family and want to maintain your fertility, be sure to mention that to your doctor.

If you suspect you have endometriosis or have incredibly painful periods, speak up and talk to your doctor about it. Intense period pain isn’t normal or something you should live with! It can indicate there’s a deeper issue going on. Talk with your doctor to find a solution.

There are many birth control options available for people these days, which is great because you can find a method that works best for you and your lifestyle. Condoms, hormonal birth control pills, IUDs, Nuva Ring, the shot, the implant—the list goes on and on. One of the most popular forms of birth control is the hormonal birth control pill.

A refresher on the hormonal birth control pill

Typically, the hormonal birth control pill uses either a combination of estrogen and progestin, or just progestin to shut down ovulation in your body so you don’t release an egg for fertilization. These hormones are naturally occurring in your body, and the pill just provides you with amounts of these hormones so your body essentially thinks it’s pregnant and doesn’t ovulate. These pills also thicken your cervical mucus so if an egg is released, your womb isn’t in a state where implantation could occur. The pill needs to be taken every day at the same time to be most effective. Even missing one pill can cause some people to get pregnant, so the pill isn’t the best option for someone with a super unpredictable schedule, someone who travels between time zones frequently, or someone who just isn’t punctual. Not brag, but I could win an award for taking my pill on time.

Since the pill is such an effective method (99% effective when taken perfectly), it is a popular option. It’s also popular because it’s non-invasive, can be stopped at any time, is covered in full by most insurance or is fairly inexpensive if it’s not, and doesn’t affect your fertility. Starting in late 2019, studies have begun to help develop a birth control pill that just needs to be taken once a month. What? Sounds too good to be true, right?

How would a once-a-month pill work?

Because of the stomach’s acids and the way our bodies take in and digest medicine, the pill, and most other medications, needs to be taken daily. Doctors at Brigham and Women’s Hospital and MIT discovered a new design for a slow releasing pill while doing research on drugs for HIV and malaria treatment. After doing some research on these other drugs, the team discovered this same design would work for birth control bills. With this once a month design, the birth control hormones for the month are distributed on six little “arms” extending from the center of the whole pill. When the pill capsule is open and spread out inside your body, it looks like a little starfish with six arms full of hormones. The pill is made out of body-safe polyurethane and is taken all folded up in a capsule. Once in the body, its arms will spread out and slowly release the hormones over a period of 29 days. This is the same cycle for most birth control pills, you would just take this one capsule at the beginning of the month and be good to go until 29 days later.

The initial trials on this capsule design were tested on pigs, and the results were really promising. The little legs of the starfish design broke off and passed safely through the body after the hormones were released, and the starfish didn’t obstruct anything from entering or leaving the body either. Pigs have more similar insides to humans than rats, so the positive results in pigs were a good sign. The scientists behind this hope to build artificial stomachs next, and eventually begin testing on humans.

When could this birth control pill be released?

If this birth control ends up being developed, in theory, it should be as effective as the daily pill, that is if the user is taking it at the same time every month. One of the complaints of the daily pill is having to remember to take it at the same time every day, but I would argue that remembering to take a pill at the same time just once a month might be harder to remember because it’s not part of your daily routine. Birth control options that you must take orally, or even the shot, is most effective when taken on time. So this design might make birth control seem like less of a hassle for some women, but it might be harder for others to remember to take it.

Human trials haven’t even begun yet, so it will likely be several more years until this type of pill is available on the market. Either way, it’s incredibly exciting that people have more options for how they want to take their birth control and be in charge of their reproductive health.

Talking Birth Control Options with Your Friends

From the pill to the IUD to the non-hormonal IUD to condoms to the injection…(should I go on? there’s more) there are MANY options for birth control in this good year of 2020, so how do you know which option is right for you, or which ones to even consider? What are the pros and cons of all these different ways to prevent pregnancy, stabilize hormones, or manage periods or acne? If you’re considering starting a form of birth control or changing to a new form of birth control, it’s essential to talk to your doctor about it before making any changes! But, sometimes it’s helpful talking birth control options with your friends before you take your big questions to the doc. 

Talking openly about birth control with your friends is not only helpful and educational, but also helps normalize women talking openly about birth control methods. There seems to be a stigma around women talking about birth control methods unless they can clearly state that they are on said birth control for a medical reason other than not wanting to get pregnant. Yes hormonal birth control can help treat many conditions such as cystic acne, PCOS, or endometriosis, but it’s also just as valid to be on birth control just to prevent pregnancy. Openly discussing your preferred method, as well as your reasons for being on birth control, help bond you and your pals in friendship, normalize this conversation, and help you make informed decisions. 

Because of the varying levels of hormones in hormonal forms of birth control, such as the pill, implant, shot, NuvaRing, or IUD for example, everyone has a different reaction to these birth controls. Talking about how your body reacted to your preferred method, or even an old method you tried and didn’t like can help inform those around you! It’s also interesting to hear about how hormones affect us differently and see how people consider the pros and cons for themselves. Also, a lot of the time women’s health issues are dismissed, our pain is minimized, or all of our symptoms are blamed on our periods. Our hormones and reproductive systems are complex, and sharing our experiences, struggles, and preferences finding what works best for us helps us be more educated and make more informed and empowered decisions in advocating for our reproductive health. 

Maybe you’ve been on the pill forever, but are wanting something with less hormones. Ask your friends if they have an IUD and hear about their experience getting it inserted, adjusting to having something in their uterus full time, and see what they think. Maybe your friend is considering starting the pill, but is fearful of having bad side effects. Tell them about your experience and how the pill did or did not affect you. Do you have really bad periods and cramps so intense you can’t get out of bed? Ask your friends about their periods, their symptoms, and how they manage it! Not only will you learn more, but having these vulnerable conversations will also bring you closer together.

After chatting with your pals about birth control options, be sure to make an appointment with your doctor and tell them everything you’ve learned and are considering. Make sure you don’t make any birth control changes without consulting your doctor first.