progestins

What is birth control?

Birth control, also known as contraception, is the use of medicines, devices, or surgery to prevent pregnancy. There are many different types. Some are reversible, while others are permanent. Some types can also help prevent sexually transmitted infections (STIs).

What are the different types of birth control?

There are several different types of birth control, and they work in different ways:

Barrier methodsMale condomA thin sheath that covers the penis to collect sperm and prevent it from entering the woman's body. Condoms that are made of latex and polyurethane can help prevent STIs.Female condomA thin, flexible plastic pouch. Part of the condom is inserted into the vagina before intercourse to prevent sperm from entering the uterus. The uterus, or womb, is the place where the baby grows during pregnancy. Female condoms can also help prevent STIs.Contraceptive spongeA small sponge that you put into the vagina to cover the cervix (the opening of the uterus). The sponge also contains a spermicide to kill sperm.SpermicideA substance that can kill sperm cells. It comes in a foam, jelly, cream, suppository, or film. You put it into the vagina near the uterus. Spermicide can be used alone or with a diaphragm or cervical cap.Diaphragm and cervical capCups that are placed inside the vagina to cover the cervix. They may be used with spermicide. They come in different sizes, so it's important to see your health care provider to figure out which size works best for you.Hormonal methodsOral contraceptives ("the pill")Pills that a woman takes every day. They may contain only progestin or both progestin and estrogen.Contraceptive patchA patch that a woman puts on her skin each week. The patch releases hormones into the bloodstream.Vaginal ringA thin, flexible ring. The woman inserts the ring into the vagina, where it continually releases hormones for three weeks. She takes it out for the fourth week. After that week, she puts in a new ring.Injectable birth controlAn injection of a hormone that a woman gets once every three months. This is done in your provider's office.ImplantA single, thin rod that a provider inserts under the skin of a women's upper arm. It is done in your provider's office. The implant can last for four years.Long-acting reversible contraceptives (LARCs)Intrauterine device (IUD)A small, T-shaped device that a provider inserts into the uterus. This is done in the provider's office. IUDs can last from 3 to 10 years. There are two types: hormonal IUDs and copper IUDs.SterilizationTubal ligationA surgery that prevents a woman from getting pregnant. It is permanent.VasectomyA surgery that prevents a man from getting someone pregnant. It is permanent.What are some other forms of pregnancy prevention?

There are some types of pregnancy prevention that do not involve medicines, devices, or surgery:

Other forms of pregnancy preventionFertility awareness-based methodsThey are also called natural rhythm methods. They involve tracking the woman's fertility cycle and avoiding sex or using barrier methods on the days when she is most likely to get pregnant. This method may have higher pregnancy rates than other types.Lactational amenorrhea method (LAM)A form of natural birth control for breastfeeding mothers. It relies on the new mother feeding her baby only breastmilk for up to six months and having no periods or spotting during that time.WithdrawalDuring intercourse, the penis is pulled out of the vagina before ejaculation. The goal is to keep sperm from entering the vagina . But the sperm can leak out before the penis is pulled out, so this method has higher pregnancy rates than other types.What is emergency contraception?

Emergency contraception is not a regular method of birth control. But it can be used to prevent pregnancy after unprotected intercourse or if a condom breaks. There are two types:

• Copper IUD, which is a small, T-shaped device that a provider inserts into the within 120 hours of unprotected intercourse.
• Emergency contraceptive pills (ECPs), which are hormonal pills which the woman takes as soon as possible after unprotected intercourse.

What else should I know about birth control?

When deciding which birth control type is right for you, there are many different factors to consider:

• Do you want to have children someday? How soon?
• Do you have any health conditions?
• How often do you have sex?
• How many sex partners do you have?
• Do you also need protection from HIV and other STIs?
• How well does the birth control method work?
• Are there any side effects?
• Will you be able to use it correctly every time?
• How much does it cost?

Your provider can answer your questions about birth control to help you select the best type for you.

NIH: National Institute of Child Health and Human Development

What is endometriosis?

The uterus, or womb, is the place where a baby grows when a person is pregnant. The uterus is lined with tissue (endometrium). Endometriosis is a disease in which tissue that is similar to the lining of the uterus grows in other places in your body. These patches of tissue are called "implants," "nodules," or "lesions." They are most often found:

• On or under the ovaries
• On the fallopian tubes, which carry egg cells from the ovaries to the uterus
• Behind the uterus
• On the tissues that hold the uterus in place
• On the bowels or bladder

In rare cases, the tissue may grow on your lungs or in other parts of your body.

What causes endometriosis?

The cause of endometriosis is unknown.

Who is at risk for endometriosis?

Endometriosis can affect anyone who menstruates. Certain factors can raise or lower your risk of getting it.

You are at higher risk if:

• You have a mother, sister, or daughter with endometriosis
• Your period started before age 11
• Your monthly cycles are short (less than 27 days)
• Your menstrual cycles are heavy and last more than 7 days

You have a lower risk if:

• You have been pregnant before
• Your periods started late in adolescence
• You breastfeed your babies

What are the symptoms of endometriosis?

The main symptoms of endometriosis are:

• Pelvic pain, which often happens during your period.
• Infertility

Other possible symptoms include:

• Painful menstrual cramps, which may get worse over time
• Pain during or after sex
• Pain in the intestine or lower abdomen
• Pain with bowel movements or urination, usually during your period
• Heavy periods
• Spotting or bleeding between periods
• Digestive or gastrointestinal symptoms
• Fatigue or lack of energy

How is endometriosis diagnosed?

Surgery is the only way to know for sure that you have endometriosis. First, however, your health care provider will ask about your symptoms and medical history. You will have a pelvic exam and may have some imaging tests.

The most common surgery to diagnose endometriosis is a laparoscopy. This is a type of surgery that uses a laparoscope, a thin tube with a camera and light. The surgeon inserts the laparoscope through a small cut in the skin near your belly button. Your provider can make a diagnosis based on how the patches of endometriosis look. They may also do a biopsy to get a tissue sample.

What are the treatments for endometriosis?

There is no cure for endometriosis, but there are treatments for the symptoms. Your provider will work with you to decide which treatments would be best for you.

Treatments for endometriosis pain include:

• Pain relievers, including nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and a prescription medicine specifically for endometriosis. Providers may sometimes prescribe opioids for severe pain.
• Hormone therapy, which stops the ovaries from making hormones. This may slow the growth of the endometrial tissue and may prevent new areas from growing. Types of hormone therapy include:
  • Birth control pills.
  • Progestin therapy.
  • Gonadotropin-releasing hormone (GnRH) medicines (GnRH agonists and antagonists). These medicines cause a temporary menopause. After your stop taking the medicines, your menstrual periods will start again, and pregnancy is possible.
• Surgical treatments for severe pain, including procedures to remove the endometriosis patches or cut some nerves in the pelvis. The surgery may be a laparoscopy or major surgery.

Treatments for infertility caused by endometriosis include:

• Laparoscopy to remove the endometriosis patches
• In vitro fertilization

NIH: National Institute of Child Health and Human Development

What is cholesterol?

Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your liver makes cholesterol, and it is also in some foods, such as meat and dairy products. Your body needs some cholesterol to work properly. But having too much cholesterol in your blood raises your risk of coronary artery disease.

What are HDL and LDL?

HDL and LDL are two types of lipoproteins.They are a combination of fat (lipid) and protein. The lipids need to be attached to the proteins so they can move through the blood. HDL and LDL have different purposes:

• HDL stands for high-density lipoproteins. It is sometimes called the "good" cholesterol because it carries cholesterol from other parts of your body back to your liver. Your liver then removes the cholesterol from your body.
• LDL stands for low-density lipoproteins. It is sometimes called the "bad" cholesterol because a high LDL level leads to a buildup of cholesterol in your arteries.

How do I know what my HDL level is?

A blood test can measure your cholesterol levels, including HDL. When and how often you should get this test depends on your age, risk factors, and family history. The general recommendations are:

For people who are age 19 or younger::

• The first test should be between ages 9 to 11
• Children should have the test again every 5 years
• Some children may have this test starting at age 2 if there is a family history of high blood cholesterol, heart attack, or stroke

For people who are age 20 or older::

• Younger adults should have the test every 5 years
• Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years

What should my HDL level be?

With HDL cholesterol, higher numbers are better, because a high HDL level can lower your risk for coronary artery disease and stroke. How high your HDL should be depends on your age and sex:

GroupHealthy HDL LevelAge 19 or youngerMore than 45mg/dlMen age 20 or olderMore than 40mg/dlWomen age 20 or olderMore than 50mg/dlHow can I raise my HDL level?

If your HDL level is too low, lifestyle changes may help. These changes may also help prevent other diseases, and make you feel better overall:

• Eat a healthy diet. To raise your HDL level, you need to eat good fats instead of bad fats. This means limiting saturated fats, which include full-fat milk and cheese, high-fat meats like sausage and bacon, and foods made with butter, lard, and shortening. You should also avoid trans fats, which may be in some margarines, fried foods, and processed foods like baked goods. Instead, eat unsaturated fats, which are found in avocado, vegetable oils like olive oil, and nuts. Limit carbohydrates, especially sugar. Also try to eat more foods naturally high in fiber, such as oatmeal and beans.
• Stay at a healthy weight. You can boost your HDL level by losing weight, especially if you have lots of fat around your waist.
• Exercise. Getting regular exercise can raise your HDL level, as well as lower your LDL. You should try to do 30 minutes of moderate to vigorous aerobic exercise on most, if not all, days.
• Avoid cigarettes.Smoking and exposure to secondhand smoke can lower your HDL level. If you are a smoker, ask your health care provider for help in finding the best way for you to quit. You should also try to avoid secondhand smoke.
• Limit alcohol. Moderate alcohol may lower your HDL level, although more studies are needed to confirm that. What we do know is that too much alcohol can make you gain weight, and that lowers your HDL level.

Some cholesterol medicines, including certain statins, can raise your HDL level, in addition to lowering your LDL level. Health care providers don't usually prescribe medicines only to raise HDL. But if you have a low HDL and high LDL level, you might need medicine.

What else can affect my HDL level?

Taking certain medicines can lower HDL levels in some people. They include:

• Beta blockers, a type of blood pressure medicine
• Anabolic steroids, including testosterone, a male hormone
• Progestins, which are female hormones that are in some birth control pills and hormone replacement therapy
• Benzodiazepines, sedatives that are often used for anxiety and insomnia

If you are taking one of these and you have a very low HDL level, ask your provider if you should continue to take them.

Diabetes can also lower your HDL level, so that gives you another reason to manage your diabetes.

What is menopause?

Menopause is the time in your life when you stop having your period and can no longer get pregnant. You have reached menopause when you have not had a period for 12 months.

The time leading up to menopause is called the menopausal transition, or perimenopause. This transition usually begins in when you are in your 40s, but sometimes it can start earlier. It can last for several years. The most common age for reaching menopause is between 45 and 55 years old.

What is early menopause?

Early, or premature menopause happens when your ovaries stop making hormones and periods stop before age 40. This can happen on its own (with no known cause). It can also happen because of surgery to remove the ovaries or uterus. Medical treatments such as chemotherapy or hormone therapy to treat breast cancer may also cause early menopause.

A condition called primary ovarian insufficiency (POI) happens when your ovaries stop working normally before you are age 40. But this condition is different from early menopause. If you have POI, you may still have periods, even though they might not come regularly. And you might still be able to get pregnant.

What are the symptoms of menopause?

During the menopausal transition, your ovaries start to make less of the estrogen and progesterone hormones. The changes in these hormones cause the symptoms of menopause, which can include:

• A change in your periods; they may be:
  • Irregular, with more or less time in between periods.
  • Shorter or longer.
  • Lighter or heavier.
• Hot flashes, a sudden warm feeling in your face, neck, and chest. They may cause you to sweat. If they happen at night and cause sweating, they are called night sweats.
• Trouble sleeping, such as trouble falling asleep or getting back to sleep when you wake up. Over time, a lack of sleep can lead to fatigue and memory problems.
• Vaginal dryness, which may cause pain or discomfort during sexual intercourse.
• Mood changes, which can make you feel moody, anxious, or more irritable.
• Bladder issues, such as urinary incontinence (loss of bladder control) and urinary tract infections (UTIs).

You may also have other physical changes which could put you at risk for certain diseases. For example, the loss of estrogen can:

• Cause you to lose bone density. This can lead to osteoporosis, a condition that causes bones to become weak and break easily.
• Raise your cholesterol levels and increase your risk of heart disease and stroke.

What are the treatments for the symptoms of menopause?

You may not need treatment for the symptoms of menopause. But if you do, there are several different types of treatments:

Lifestyle changes

You may find that you can manage your symptoms with lifestyle changes. Here are some changes that might make you feel better:

• If you have hot flashes, dress in layers that can be removed at the start of a hot flash. You may want to carry a portable fan to use when you get a hot flash.
• Avoid alcohol, spicy foods, and caffeine. They can make your menopause symptoms worse.
• If you smoke, try to quit, not only for hot flashes, but for your overall health.
• Try to maintain a healthy weight. Being overweight or having obesity can make hot flashes worse.
• Have good sleep habits. Keep your bedroom dark, quiet, and cool.
• Get regular exercise. It can help you sleep better, improve your mood, and help lower your risk for many age-related diseases.
• Lower stress, for example by using relaxation techniques such as meditation, deep breathing, and muscle relaxation exercises.

If lifestyle changes are not enough to improve your symptoms, you may want to contact your health care provider. They will talk to you about your symptoms, family and medical history, and preferences. They also can explain the risks and benefits of the treatments.

Non-hormone treatments

There are various non-hormone treatments for menopause symptoms, such as:

• Medicines for hot flashes, including certain antidepressants, a medicine just for hot flashes, an antiseizure medicine, and a blood pressure medicine. Some of these medicines may also help with sleep problems.
• Medicines for urinary incontinence.
• Medicines to treat or help prevent osteoporosis.
• Low-dose birth control pills for very heavy bleeding or periods that are close together.
• Water-based lubricants to treat vaginal dryness.
• Medicines for painful intercourse that is caused by vaginal changes from menopause.
• Cognitive behavioral therapy (CBT), a type of talk therapy, for trouble sleeping.

Hormone treatmentsmenopausal hormone therapy

Like all medicines, MHT has benefits and risks. Talk with your provider about whether it is safe for you. If you decide to take MHT, your provider may recommend taking the lowest dose that works for the shortest time needed.

Supplements, herbs, and "natural" hormone creams

There are various products that are marketed for menopause symptoms. They include supplements, herbs, and over-the-counter "natural" hormone creams. There has been research on many of these products. So far, none of them has clearly been shown to be helpful. Also, there is little information on the long-term safety of these products. Some supplements can have harmful side effects or interact with medicines. Check with your provider before you take use any of them.