Over 90 Percent of What Planned Parenthood Does, Part 8: Hormonal Option without Pelvic Exam (HOPE)

Welcome to the latest installment of “Over 90 Percent of What Planned Parenthood Does,” a series on Planned Parenthood Advocates of Arizona’s blog that highlights Planned Parenthood’s diverse array of services — the ones Jon Kyl doesn’t know about.


I remember sitting in the exam room, fidgeting with my paper gown and nervously explaining to the doctor that my boyfriend and I had come very close to having sex already, and I would please like to be on birth control pills when it actually happened.

“Sure,” he said, swinging open the stirrups. “Just as soon a we do a pelvic exam.”

I didn’t want one. I really didn’t want one.


While it’s common for health care providers in the United States to require or routinely perform a pelvic examination — with or without a Pap test — prior to prescribing hormonal birth control, several health organizations state that a pelvic exam isn’t necessary in order to be safely prescribed hormonal contraceptive pills, patches, shots, or rings. For instance, the American College of Obstetricians and Gynecologists advises, “A pelvic exam is not needed to get most forms of birth control from a health care provider except for the intrauterine device (IUD), diaphragm, and cervical cap.” In such cases, HOPE (Hormonal Option without Pelvic Exam) may be an appropriate alternative. Continue reading

Let’s Talk Contraception: The Mini-Pill or Progestin-Only Pill

Birth control pills usually contain progestin and estrogen, which are both sex hormones. Progestin-only birth control pills (POPs) are sometimes called the mini-pill because they don’t contain estrogen. If you are concerned about taking estrogens because you have high blood pressure, migraines, heart disease, or a history of blood clots, but still would like to take an oral contraceptive, this may be an option for you. It is also a good choice if you are a new mother and breastfeeding.


Progestin-only pills don’t contain estrogen, making them a good option for some people.


POPs are used in the same way as other birth control pills. They come in packs of 28 pills. You take one pill at the same time each day and after the last pill in the pack is taken, you start a new pack the next day; there is no skipping days. Because there is a slightly greater risk of becoming pregnant on progestin-only pills, you must be very careful to take each pill at the same time each day and never miss a day. If your period is late and you missed one or more pills or took them late, you may need to take a pregnancy test.

The effects of POPs are easily reversible and after stopping these pills your chances of getting pregnant should not be delayed. Continue reading

Keeping Medications and Contraceptives Safe through the Summer

Highs in the triple digits are common in Arizona during the summer months. As the mercury rises, we’re often reminded about the things we need to do to stay healthy in hot weather, like avoiding dehydration, heat exhaustion, and sunburn. Those tips are important — and can even be potentially life-saving — but what’s often missing from summertime health advice is information about using medications and contraceptives safely and effectively when a hot environment can quickly diminish their integrity. That’s a serious omission when Americans buy about 5 billion over-the-counter drug products annually and nearly half of all Americans use one or more prescription drugs.


Heat can alter the molecular structure of oral contraceptives or shorten a condom’s shelf life.


Extreme heat and cold can cause medications to change physically, and those changes can make medications less potent — and for some medications, unsafe to use. Oral contraceptives and other medications that contain hormones are especially susceptible, since the proteins they contain can change their properties during heat exposure.

The labels on medications, whether over-the-counter or prescription, typically recommend storing them in a cool, dry place and keeping them away from excessive heat and humidity, or might give a specific temperature range, commonly 68 to 77 degrees Fahrenheit (20 to 25 degrees Celsius). That’s an ideal range, but most medications are still usable after storage in temperatures as low as 32 to 58 degrees Fahrenheit (zero to 14 degrees Celsius) and as high as 80 to 86 degrees Fahrenheit (27 to 30 degrees Celsius). Advice varies, so it’s always best to consult a physician or pharmacist when less-than-ideal storage has already happened or is anticipated. Help is also available at Planned Parenthood health centers, where staff can answer questions about general health care and about using contraceptives safely and effectively. Continue reading

Let’s Talk Contraception: What’s the Difference Between Generic and Brand-Name Birth Control?

Oral contraceptives (birth control pills) have been around for decades, and many are now available as generics. In general, generics cost less than brand-name medications. Despite saving money, some users question whether generic birth control pills are as “good” as brand-name pills. To confuse the situation, new brand-name birth control pills have been developed that specifically claim other benefits in addition to protection from pregnancy, such as treatment of acne. The cost of these brand-name pills is much higher. To understand the generic vs. brand-name debate, it is first important to understand how drugs are developed.


Clinical evidence doesn’t support the idea that generic birth control pills have different failure rates or side effects than their name-brand counterparts.


When a drug is first discovered and developed it goes through a drug review process. This involves many steps: chemistry experiments to discover the active chemical structure of the drug, manufacturing and testing the chemical drug product, inspections of the manufacturing process, and many other developmental studies. Then there are animal studies to check safety and efficacy — and if the drug works without major side effects. Finally, clinical studies are conducted in people; these studies test to assure bioavailability (the amount of time it takes for the body to absorb the drug). These last tests, in animals and people, show bioequivalence. Bioequivalence means the drug must enter the body, be absorbed in the same time frame, and work in the body the same way consistently.

When a new drug is finally approved by the FDA, it has met strict standards regarding its strength, purity, quality, potency, safety, and clinical effectiveness. New drugs are awarded patents for 20 years, but by the time they come to market, much of that time has run out due to all of the testing requirements. Generics are usually less expensive — manufacturers do not need to repeat discovering the drug, nor must they redo animal and human studies to assure the drug is safe and works as intended. The generic companies also do not need to spend as much money on advertising, marketing, and promotion. Continue reading

This Week, Say Goodbye to Birth Control and Religious Freedom

The political assault on women’s health care that has overwhelmed America in recent weeks is reaching a climax in Arizona THIS week.

No less than six bills that will make it harder or even impossible to get various women’s health care services are being voted on in committee hearings in these five days.

Every one of these bills is poised to become law if we don’t fight back NOW and LOUDLY. Continue reading

Let’s Talk Contraception: Taking Birth Control Pills Properly

Failure to take birth control pills properly can cause a lot of anxiety, and even lead to pregnancy. For best results, follow the manufacturer’s directions.

Oral contraceptives (also known as birth control pills or BCPs) are used to prevent pregnancy. Taken properly, they are about 99 percent effective in preventing pregnancy. They are even more effective when used in combination with other birth-control methods, such as condoms.

There are many different brands of birth control pills. Most contain a combination of the two female hormones estrogen and progesterone, but there are some BCPs that only contain progesterone. These different brands may need to be taken in slightly different ways and may have different benefits and risks, but whichever type you use, it’s very important to take them properly to get the most benefit.


You cannot take a birth control pill only when you remember to or just after you’ve had a sexual encounter — they must be taken daily.


First of all, it’s important to know which oral contraceptive you are taking. These pills usually come in packs of 21, 28, or 91 tablets and need to be taken daily.

  • Packs of 21: Take one pill each day until all 21 are gone, then don’t take a pill for seven days — this is when you should have your period. After seven days off, start a new pack of 21 pills.
  • Packs of 28: Take one pill each day, and when you finish with the pack start a new pack the next day. Sometimes these packs have pills with different colors that contain different doses of the hormones or inactive ingredients, vitamins, or minerals. They must be taken in order.
  • Packs of 91: The 91-tablet pack is larger and may contain three trays — take one pill each day until all 91 pills have been taken and then start the new pack of 91 pills the next day. Continue reading

Pro-Choice Book Club: Histories of Oral Contraceptives

Hormonal birth control has an incredible history that stretches back almost a century, when Margaret Sanger wrote of her dream of a “magic pill” in 1912. In the ensuing decades, scientists were busy piecing together the complex system of the body’s “chemical messengers,” hormones, and when they learned how to synthesize them in the ’40s, Sanger’s dream was but a few steps away from being fulfilled. Three engaging accounts of the Pill’s development — The Pill: A Biography of the Drug That Changed the World by Bernard Asbell (1995), America and the Pill: A History of Promise, Peril, and Liberation by Elaine Tyler May (2010), and Jungle Laboratories: Mexican Peasants, National Projects, and the Making of the Pill by Gabriela Soto Laveaga (2009) — contain some overlap, while offering different perspectives.

Each author tells the inspiring story of Russell Marker, the chemist who first finagled progesterone from a wild-growing Mexican yam. Despite a near lack of support from pharmaceutical companies and the scientific community, he traveled to rural Mexico on a hunch — and ended up co-founding a laboratory that became the world’s top hormone supplier for the next few decades. Before Marker formulated a way to synthesize hormones in abundance, they were derived from slaughterhouse byproducts and were prohibitively expensive. Marker’s experiments enabled further medical research in hormones, and progesterone was soon used not only in oral contraceptives, but as a precursor for other medications such as cortisone.

While Carl Djerassi is often credited as the “father of the Pill,” both Asbell and May tip their hats to Margaret Sanger and Katharine McCormick, the Pill’s “mothers.” These two women also have fascinating biographies. As a nurse in the early twentieth century, Sanger was acquainted with the horrors that arose when women did not have control over their fertility. Many of her patients became infected or even died as the result of illegal or self-induced abortions, which motivated Sanger to become an activist for contraception’s legalization — an avocation that saw her illegally smuggling diaphragms into the country and serving time in jail after opening a family-planning clinic in Brooklyn. Continue reading