Does Birth Control Affect Future Fertility? 8 Questions Answered

Mother’s Day is a day when we celebrate our mothers, past and present, biological and otherwise. It is also a time when many women who have yet to take on this role may begin to wonder if they ever will.

When I was in training, one of my Attendings used to say that women spend their youth trying not to get pregnant, and then their middle age trying to. Is it not true? Even in my profession, I educate women about both abstinence as well as sexual practices to control pregnancy. There are so many effective methods for preventing pregnancy, but eventually that patient who has been seeing me for the last five to ten years will ask…

“Doctor, how do I know if I’m still fertile? How much longer do I have before I should try to have a baby?”

Well, I am going to try to answer that and many more questions in this post. I hope that this information will allow women to feel comfortable with their reproductive choices without feeling like they are forfeiting future fertility. A woman should be able to have a baby because she wants to and is ready to, not because she feels like she has to “birth now or forever hold her peace.” Get it?

1. Do IUD’s and other forms of birth control decrease future fertility?

Intrauterine devices, commonly known as IUDs, do not impair women’s future fertility, according to a new study. When women are age matched after using an IUD for years, the 30-year-old who had had an IUD for 5 years had the same fertility as the 30-year-old who had never had an IUD, but both were less fertile than the 25-year-old. The same is true for women on the pill. In fact, in some cases, birth control can increase your fertility (see #8).

2. Is getting pregnant while on birth control harmful to the baby?

It does depend on the type of birth control. If you are on the pill and get pregnant, presumably because of a missed or late pill, there should be no adverse affects on the baby. If you get pregnant while using an IUD (which occurs less than 1% of the time), as long as the IUD is removed, there shouldn’t be risk. If the IUD cannot be removed, the risk of miscarriage or preterm delivery is increased.

3. Should I give myself a break after birth control before trying to get pregnant?

You can but you don’t have to. Some people want to see their period become normal before getting pregnant. I don’t know that this is necessary, especially in light of the fact that some believe that you are most fertile immediately after stopping birth control.

Some women worry about increased risk of birth defects if you get pregnant right after or while on birth control. There is not evidence to support this claim. Some of the best babies come from birth control failures (lol, kidding but this may be true.)

4. Am I more fertile immediately after stopping birth control?

There isn’t great evidence one way or the other to support this claim. One thing is true though, you are FERTILE even within the first month after stopping birth control. Be ready or use condoms or another form of contraception if your are not ready.

5. Am I more fertile after having a miscarriage?

First, I’m sorry for your loss. Grieving is important for all loss, even an early miscarriage. Allow yourself that time and capacity to just be sad. Once the sting isn’t so fresh, you can try again but you should give yourself three criteria to meet.

1) Make sure your pregnancy hormone levels have fallen to pre-pregnancy levels.

2) Have at least 2 months under your belt from the miscarriage.

3) See a normal period before trying again. If all three of these criteria haven’t been met, you run the risk of starting a new pregnancy before the previous one is over and that can be harmful to your body in addition to increasing your risk for having another miscarriage.

6. How old is too old to have a baby? Am I too old?

I wrote a whole article about Advanced Maternal Age pregnancies, formerly known as geriatric pregnancies. You are never too old to be mother, but those eggs can get a little on the mature side. Do your eggs expire? Check out this post to learn more.

At the end of the day, fertility decreases steadily with age, more rapidly after the age of 37-38. Also risk of pregnancy complications and birth anomalies increases with age, but not so much that you should be afraid to have a child over the age of 35.  In fact, I regularly care for women well into their early 40s with normal, healthy pregnancies. I even had the chance to talk about this on WTTW regarding Tammy Duckworth’s pregnancy in her early 50s. Click here to see that appearance.

7. Can you use your birth control to skip your period and still prevent pregnancy?

I could write an entire post just about this question, but the short answer is ABSOLUTELY. Skipping periods when done with external hormonal control is not unhealthy. Said differently, if you take hormones, ie birth control pills, and skip your period as a result, that is okay. If you just skip periods without being on birth control, this may signify a problem. You should see your doctor. I wrote another parody song about this topic. Stay tuned and subscribe to my YouTube channel to know when that drops.

If your doctor agrees, while on the pill you can skip the “placebo pills” and go straight into the next pack. Some pills come in three month packs with the intention of you having only one period every 3 months. Some low-dose pills will make you not have a period for months, or even years. This is not unsafe in most circumstances. Certain types of IUDs can also lead to infrequent periods.

8. If I have Endometriosis, does birth control help or hurt my future fertility?

Endometriosis is a disorder that causes pain and can decrease fertility. Taking certain types pf birth control (pills and the implant especially) can lessen the effects of endometriosis by making it dormant along with the ovaries. This often improves the pain. Regarding fertility, keeping the ovaries dormant and less affected by endometriosis can improve fertility. While birth control doesn’t treat the problem, it holds it off from wreaking havoc in the pelvis.

Motherhood can come in so many forms. Even if you have not or will not birth a human from your uterus, you can be and probably already are a mother-figure to someone. It’s all about love.

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You Sexy Mother You… Get your freak on! Avoid a Sexless Marriage

Well, this is Mothery Love with a twist. Let’s talk about decreased libido.

First of all, Happy Mother’s Day. I really like TED talks. I aspire to give one sometime in the next few years. Late one night on call I was scrolling through YouTube, in search of my next parody song. (You all know how I do.) I was stopped by this one about sexless marriage.

With 14 million views, I was intrigued. Also, I started to think about how many of my patients come see me for the annual exams and just as I put my hand on the door on the way to leave their seemingly complete and comprehensive visit, I am stopped by a,

“There is one more thing, doc.”

These reluctant women have finally mustered up the gusto to ask about their decreased libido and what advice I can offer. My questions to investigate the issue usually include, “Are you having pain? Is or has anyone ever hurt you sexually? Do you have fun once you are actually having sex but just lack the desire on the front end?” I ask about foreplay and orgasm etc., but only because these are things that I have learned throughout the years are components to sexual enjoyment. In all of our vast gynecologic training, the psychology of sexual desire is rarely if ever explored.

I sat in that call room and watched this entire TED talk. I think I may have even watched it twice. If you have a sec, go to minute 11:50 in the video. And I quote:

The desire to have a baby will rev up any woman’s sex drive. The problem is, having that baby is likely to kill it…

Prior to this statement, the speaker talks about the inadequacies in female sexual education. Go to 7:52 and see how she breaks down what many girls are taught about sex and what that can do to a woman’s relationship with sex as she matures. She also delves into how a part of it is this notion is that motherhood and being sexy or interested in sex are discordant. I’m not going to lie. The thought that my mom and dad had sex even the two times to make my brother and I still turns my stomach just a little.

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I can’t tell you how many pregnant or new-ish mothers I see who have a take-it-or-leave-it relationship with sex. I say new-ish because all women need to wait the 6-8 weeks postpartum, but for many, not a lot changes after that. Priorities change from sex to sleep, laundry, sleep, dinner, sleep, baby or small child tasks and sleep.

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“Sleep is the new sex.” If I had a nickel for every time I heard that one, my student loan repayment non-for-profit would be up and running by now. (It’s going to be called The RobynHood Foundation and it will be grand! I’m coming for your principles.) I don’t fault pregnant or new moms for not being interested in sex, but there are a number of reasons to get back on that horse again, no pun intended (lol). A sexless marriage is defined by the experts as less than 10 sexual encounters in a year. Here is how you can bump (and grind) that number up (I just can’t help myself).

Health Benefits of Sex- Avoid a Sexless Marriage

(From a comprehensive list supported by solid evidence.)

  1. Less stress: From another well sourced and quoted article,“Ambardar says touching and hugging can release your body’s natural ‘feel-good hormone.’ Sexual arousal releases a brain chemical that revs up your brain’s pleasure and reward system. Sex and intimacy can boost your self-esteem and happiness, too, Ambardar says. It’s not only a prescription for a healthy life, but a happy one.”
  2. Better Sleep: After orgasm, the hormone prolactin is released, which is responsible for the feelings of relaxation and sleepiness” after sex, says Sheenie Ambardar, MD.
  3. Less physical pain: Endorphins function similarly to morphine.”Before you reach for an aspirin, try for an orgasm. ‘Orgasm can block pain,’ says Barry R. Komisaruk, PhD, a distinguished service professor at Rutgers, the State University of New Jersey. It releases a hormone that helps raise your pain threshold. Stimulation without orgasm can also do the trick. “We’ve found that vaginal stimulation can block chronic back and leg pain, and many women have told us that genital self-stimulation can reduce menstrual cramps, arthritic pain, and in some cases even headache,” Komisaruk says.”
  4. Fewer colds: Women who have sex once or twice per week had higher defending antibodies than women who were less active. “Sexually active people take fewer sick days,” says Yvonne K. Fulbright, PhD a sexual health expert.
  5. Better skin: Sexually actively women have a youthful glow that makes them look years younger than their sex-less counterparts. In a study conducted at the Royal Edinburgh Hospital in Scotland, a panel of judges viewed participants through a one-way mirror and guessed their ages. Those who were enjoying lots of nooky with a steady partner—four times a week, on average—were perceived to be seven to 12 years younger than their actual age.
  6. Lighter, less crampy periods: This one goes in part with the decreased pain, but there’s more. “When a woman orgasms, her uterus contracts and, in the process, rids the body of cramp-causing compounds,”
  7. Better muscle tone: Sex counts as exercise. Sex uses about five calories per minute, four more calories than watching TV. It gives you a one-two punch: It bumps up your heart rate and uses various muscles.

And these are just the health benefits. We haven’t even touched on the known relationship strengthening that goes along with increasing intimacy. Your partner came before the kids AND the children benefit from seeing healthy affection in the household. (Not seeing you do the do #ew, but love and affection are palpable.) They know when you are happy and intimacy, in many circumstances, contributes to this.

So how do I increase my desire to have sex?

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Get help for pain or dryness. If sex hurts, you can’t enjoy it. An ultrasound, vaginal culture, skin evaluation or different lubrication may be needed.

Put down your device. Nothing will distract you from a desire for sex like a work email or a social media thread. Put it down and spend time with your partner.

Have sex. Tell your partner what you like, or do it yourself. Sexual stimulation will increase desire, especially in women. The longer you go between sexual encounters, the less interested you’ll be. Schedule it if you need to. A fireplace needs logs added to keep the fire ablaze. Feed your fire.

Don’t be afraid to see a marital counselor or a sex therapist. I have seen wonderful improvements in women’s expressed libido after seeing a sex therapist either by themselves or with their partner.

“Settle all marital arguments in the bedroom, naked.” – Maureen McGrath

Lastly, take a page out of the book of Nicky Minaj. In the space of owning her sexuality, I think she can be considered #goals.

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Feel sexy. Be sexy. Own sexy. Even if you are doing this,

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… don’t worry, your partner surely sees this…

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You sweet sexy thang you…

Please like and follow us with the Facebook Like Box and any one of the email subscribe boxes above or below. Thanks sexy!

Doc, Make Vaginal Discharge Clear: When is it normal?

Vaginal discharge. Even though the words illicit a little laugh, an embarrassed look away, and even cause the listener to squirm, it is an ever present issue and normal physiologic thing women deal with. Often I hear women say “I just couldn’t tell if this was normal so I figured I’d take the time off work, and pay the co-pay and get naked in the exam room to hear you tell me it was normal….” As our loyal blog followers know, Dr Every Woman aka Dr McDonald and I are passionate about vaginal health and hygiene. I’ve included some of our past blogs in case you want to revisit and freshen up (lol. pun intended!!) on them. ( The Truth: Vaginal Health and Hygiene Myths Revealed). Dispelling the myths (thanks Goop (insert side eye here)….Vaginal Steaming: Yay or Nay? It may be okay…), reviewing the dos and donts, and overall just knowing the general anatomy and health of your lady bits (Lady Bits Exposed: Why Knowing Your Anatomy Matters) are great reads before visiting your gynecologist.

Let’s start with normal and less concerning discharge. Hormones cause changes in the pH of the vagina, and also cause changes in the discharge. It can become a bit stickier, thicker, thinner etc, based on the timing of your cycle. A great way to know if your

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Photo by Giagkos papadopoulos on Unsplash

vaginal discharge is related to your cycle is to keep a symptom diary of when you actually have the discharge in relationship to your menses. Most commonly, changes are seen about 2 weeks before your cycle during ovulation. Often it’s an odorless, colorless discharge that lasts 3-5 days. The big key is it resolves on its own. No medications, no changes in practice and all of a sudden you realize it is gone. Pregnancy is another big hormonal shifter that causes changes in discharge as well.

Now, let’s discuss some things that are maybe not so normal (That Itch You Just Cannot Scratch: Vaginal Itching (Vaginitis). As you can probably deduce, anything that does NOT go away on its own after a week or so should probably be looked at. If there are other symptoms associated with the discharge, for instance swelling of the vaginal or vulvar canal (Lady Bits Exposed: Why Knowing Your Anatomy Matters), itching, burning with urination, blood in the discharge, odor that is different

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Photo by YIFEI CHEN on Unsplash

from normal or a discharge that looks abnormal from your own normal are all reasons to get an exam and be checked out. Sometimes even changes in the season can irritate the vagina and necessitate some medication to “reset” the system. As I mentioned before, pregnancy can cause normal changes in the pH, but it can also make things more sensitive to abnormal shifts in bacteria.

Often times when women have a noticeable change in their vaginal discharge, it is worth it to examine any changes that have occurred in your other daily life. A new medication, diet, underwear, sexual partner, even birth control can affect the pH and subsequently the discharge. If you have changed something, try removing it for a week or so and see if that improves things.

In general, it is important to remember everyone has their own normal. Any time you are worried or feel there has been a change it is always best to get an exam before things get unbearable. Probiotics, drinking water and staying away from home remedies are a good way to avoid exacerbating the problem. And remember. Happy Vagina.  Happy Life.

Leaking Urine? Here’s how to fix it…

I call leaking urine “the post-baby golden shower.”

Just kidding. I absolutely Do Not call leaking urine that. I just thought that that was funny and could not help myself. After all, a baby shower is a thing. A golden shower is a euphemism. And here we are… explaining the joke.

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… and the rim shot

Leaking urine, also known as incontinence, can happen to anyone. It can happen even when a woman hasn’t had a baby. The causes are vast, but in the setting of post-baby, it is often due to weakness in the muscles of the pelvic floor. Those muscles can easily get weaker during pregnancy and after both vaginal or c-section deliveries.

In this post I will explain:

  1. The types of urine leakage, or incontinence.
  2. Some of the causes.
  3. Some ways to treat it naturally and with your doctor.

Yes, no one is safe from the possibility of incontinence.

Not even a c-section can spare you from this possible fate. But why does it happen? You have to think of the urine mechanism as a faucet connected to a hose. There is a sphincter or muscular valve that keeps urine in. There is also a hose-like structure called the urethra that works with that sphincter to keep urine in. If the muscles of the pelvic floor aren’t strong, that sphincter can open and turn on the faucet.

The “hose” can also unkink and let out urine during sneezing, coughing, laughing, running and any abrupt physical movement that allows an unstable pelvic floor to shift abruptly.

Wait, pause for Popcorn.

Many of you already know that I wrote a whole book about all things female. Consider the remainder this post, a preview/snippit of the treasures held within It Smells Just Like Popcorn.

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Types of incontinence

Urinary incontinence is divided into types- two of the most common being Stress and Urge. If you remember the “Gotta go, gotta go, gotta go right now” commercials, those were for a medication that treats the urgent sensation to urinate that would make you push a grandmother and her toddler grandchild out of line in bathroom. Stress incontinence is the type that catches women off guard with a sneeze, cough, run or laugh. You think that your co-worker doesn’t think any of your jokes are funny, but really she just doesn’t want to wet herself laughing at your terrible jokes.

splashing-splash-aqua-water-67843.jpegThere are various levels of evaluation and treatment for urinary incontinence. Fecal and flatus (gas) incontinence are also symptoms that should be evaluated by a physician. A woman can start to treat minor symptoms of urinary incontinence with Kegel, exercises. If symptoms persist, don’t just deal with it, get evaluated. I mentioned that I like treating this because it IS often something that I can help improve.

Kegels: Who, What, When, Where, Why, How?

You know that you are both old AND wise when a sneeze comes with an automatic Kegel. It shows forethought and prevention of an accident that you used to think only happened to potty-training toddlers. Alas, if you have been through my section on incontinence, you know that the bladder does not have eyes or ears. It does not always know when you are on the toilet versus when you are sitting at your desk, standing in line at the grocery store, or watching a movie that is just getting to the good part. If your pelvic muscles tend to relax at the most inopportune time, you may need to call in reinforcements in that pelvic floor.

A Kegel exercise is a voluntary contraction of the muscles of the pelvic floor. These are the same muscles used to hold urine, hold in gas, and push out bowel movements or babies (or both at the same time in some cases). A person, in theory, should be able to stop their urine midstream by contracting these muscles. I say “in theory” because that is not a very comfortable action to perform and is often an unnecessary test of the strength of the pelvic floor. A Kegel is not an abdominal muscle work out. Your face does not have to move to perform a Kegel exercise. If I coach a woman to isolate these muscles, I make sure her abs are relaxed and she is not using her thighs either.

pexels-photo-111085.jpegI once saw a woman holding a surf board with her vagina. She was posting on some news or social media platform, and had a series of pictures of her holding various heavy items from a string emerging from beneath the leg hole in her shorts. This woman had an ovule of some sort attached to a string, attached to items weighing more than many items I would want to hold with an outstretched arm, let alone with my vagina. Why would she do such a thing? She claimed that having rock-hard Kegels (that doesn’t even look right on paper) helped her have stronger orgasms and not leak urine.

I can support her desire to stay dry, but an orgasm from a vagina strong enough to hold a surf board sounds like it would do more damage than good to the partner. The anticipation alone seems like it would make a man nervously limp. If you haven’t already guessed, I don’t recommend a woman hold anything in her vagina for any purpose. Having strong Kegel muscles can, however save a woman the embarrassment of wet clothing.

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This guys Kegels, though

So what is the best way to perform Kegel exercises? I recommend that my patients perform ten 2-3 second contractions of the pelvic floor at least twice daily. I also think it helps to have triggers to remember to do them. A reminder in your phone, a radio morning show, or a meeting at work can all be times and places triggering your recollection of the need for this much needed regular exercise. My best trigger is while I am coaching one of my patients to push out a baby. While I am counting to 10 during each of her intense pushes, I am counting out my own Kegel session so that nothing falls out of my own vagina without my consent.

If all else fails…

If Kegels don’t work, the first thing that you should know is what type of incontinence you are dealing with. Your doctor will often first want to rule out infection. Then he or she will likely ask you a bunch of questions, perform an exam, and possibly even refer you for or perform bladder testing called Urodynamics. This will reveal whether pelvic floor physical therapy, temporary medication, or surgery are your best option. A Pessary may also be an option for certain populations.

My take home points are as follows:

    1. Urine leakage is not uncommon. You are not alone.
    2. You don’t have to live with untreated incontinence. It can often be improved
    3. Don’t be ashamed. Speak up
    4. After you’ve done all you can, sing about it….

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Check out my record-breaking birth plan post by clicking on this image