Episode 24: Advice for Madison LeCroy & Why Do Elon Musk and Tik Tok Hate OCPs?

Dr. Klimczak and Dr. Reed give their advice to Madison LeCroy as she gets her IUD taken out. How long should you wait before trying to get pregnant after having had an IUD? And why do Elon Mush & Tik Tok hate birth control pills? Do you need a birth control pill detox? And should we all be taking Wild Yams?

Transcript

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Hi, I am Dr. Beverly Reed. And I'm Dr. Amber Klimczak. And we are Two Peaks in a Pod. Well, hi everybody. Welcome back. Um, how's your week been going for you so far? Okay, my week was a drag at the beginning. We've had, we've been plagued with the stomach virus at our family. Oh, yeah. I have survived it. Okay, good. I made it out unscathed. Yes. But it got a lot better today because someone, we did her transfer last week. I woke up to a positive pregnancy test, so much fun. Best phone calls to make. So I'm really on a high today. Yeah. You know, my kiddos have been a little sick this week too, but you know, I tell them, I'm like, guys, if you don't have a fever. And you are not vomiting, and you do not have diarrhea, you should be going to school. And, um, you know, I know not everybody agrees with that, but honestly, like, if they skip school for every sniffle, they would not, I mean, they wouldn't learn anything. They'd be gone all the time. Yeah. So, I'm like, you just gotta And school is the cesspool that they get it from. I'm like, go back there with all these people that have the same thing as you. Yes, exactly. Yep, yep. So, okay, well I wanted to show you a clip from one of my favorite shows. It's called Southern Charm. Have you heard of this show before? Okay, I rarely watch any reality shows as you knew. But one time, I was on a vacation. Like, I think it was conference or something by myself. And I like binge watched the show. It was probably like old seasons, but they're darling, the men with the accents, like right up my alley. Yes. It's very cute. Yes. And okay. I mean, this season has been. So good. Um, but one of the characters, Madison, then, I don't know if you're familiar with Madison, so she is in a stable relationship now. She's married, she's already had a kid before with her ex, but now that she's married, she has, we call NFL newfound love. Mm-Hmm. Okay. She, you know, she didn't think she was gonna have any more babies, but then when you. married and then you think, Oh, well, I want to give him a baby. And so, um, she goes to see her OBGYN. And so I just wanted to show you this little clip and I just wanted to know. If you were her doctor, how you would have answered this. So I'll kind of hold this up to the microphone here and show you. I recently just got married and obviously we're talking about children and things like that. But, um, I've had this IUD in for five years. So I'm just trying to think what I need to know and do beforehand. To get rid of all Okay. So this is a pretty common appointment that we would see as OBGYNs or even as fertility doctors. I feel like our patients are so educated these days and they come to see us for advice beforehand. So I just wanted to know as you know, if you were Madison's doctor, what kind of advice would you give her? Yeah. So she's with a new partner. Um, So probably I would do some preconception counseling on her, um, and with her partner if he wants to come to a visit. But usually I like to review their history, go over any medications that she's taking. It's really important because someone who has an IUD in place probably hasn't been thinking about all the medications that she's on and how they may affect a pregnancy. So I like to review their medication list. This is something really important. If you're thinking about getting pregnant, there are certain medications that can harm a baby in the first trimester while they're developing. So you want to make sure that all your medications that you're taking are safe. Counsel there her, her to start taking a prenatal vitamin with folic acid. You and I both like to supplement vitamin D. So get her started on a good regimen and go over her lifestyle habits. Make sure, you know, these reality stars, they like. To indulge. And that she did! That was part of the episode. Hurrah! Hurrah! Yeah. I'm not surprised. Before getting pregnant! I'm definitely not surprised. Uh, so we'll review things like that, alcohol use, smoking, vaping, drugs of any kind. caffeine use, things like that, that we know can affect fertility. Um, I always, we've talked about this a lot, but in case this is your first episode that you're listening to, I always recommend to my patients doing genetic carrier screening. That's where we screen both you and your partner to see if you carry certain Hidden genes that could come together in child and make a sick child, especially because this is a new partner and ask some questions about our partner. Hopefully he's pretty clean as well. Um, we always offer infectious disease testing ahead of time before they're thinking about getting pregnant. I think what she's probably asking her doctor is about getting her IUD out and how that's going to affect her chances of getting pregnant. Is that really what she's thinking about? Yeah, so, you know, a little bit later in the episode, one of the questions she asks is, Okay, when I get my IUD pulled, what are my next steps? Like, how long do I need to wait? How long is it going to take for my fertility to come back? So, you know, honestly, I've heard different answers and her doctor's answer was, As soon as you get it pulled. you're fertile. Um, and so, um, I just wanted to get some feedback from you. If you, if that's kind of what you advise people, I give a little bit of different advice, but I'm not saying there's right or wrong. I just like to hear what different. Yeah. So what do you say? Yeah. It's definitely a thought provoking question. I wanted to answer it with an explanation about how the IUD prevents pregnancy in general. This is something that a lot of you probably don't really quite grasp out there. You maybe you have an IUD. It's not necessarily preventing you from ovulating each month. So, um, you know, most women who have an IUD and they may ovulate, they may even have some bleeding, some cyclical bleeding, but really the number one way that it prevents you from getting pregnant is changing your cervical mucus. So that's really inhospitable and very difficult for you to get pregnant that way. And so if you're ovulating, this is kind of what we were discussing and you pull out an IUD, it's really going to depend on where you are in that. cycle, whether you can just boom, trying to have intercourse and get pregnant because it could be a little bit of a dysregulated cycle when you pull out that IED. So we were kind of discussing, it does seem maybe more reasonable to wait maybe one cycle, see if you get your period back, um, and make sure that your uterus can has time to recover and grow a nice lining, grow a nice follicle and time everything properly. It's going to be pretty hard to time it. I think until you get your first period, I don't really, you know, most of our patients want to know exactly when to have intercourse and I don't know what to tell them if they pull out their IUD randomly. Well, and I think there's a couple of factors to think about too. Of course, there's different types of IUDs. So some people may have a copper IUD, it doesn't have any hormone in it at all. In those cases, if you were, if you were already ovulating every month before. you know, using a copper IUD does not change that at all. So you probably have a better sense of your periods if you have a copper IUD. Um, but in those cases, kind of when I even think about pulling an IUD out and the little arms, I kind of wonder, could it? kind of scratch the lining a little bit. And I do think part of the mechanism of IUD is that it almost creates like an inflammatory environment too that just makes it harder for pregnancy to stick. So if your lining is feeling a little inflamed, that's why I kind of think it's better that you pull the IUD, you wait a period before you try, because when you have a period you're shedding off all that old lining anyways. and letting fresh new lining grow. And then the other popular type of IUD is one that has a progestin in it. And that's actually a really nice one because it usually thins your lining out so you either stop having periods or your periods are much lighter. In some women, they actually don't ovulate, um, because the progestin can actually inhibit ovulation. in other women, they may continue to ovulate. Um, but in that circumstance, I try to picture what could be going on. What if right as you have that IUD pulled, you're about to ovulate, but your lining is really thin from that IUD. To me, I would almost be worried. Well, one, you may just have a lower chance of getting pregnant anyways, but even if you did get pregnant, could you be at higher risk of having a miscarriage or something like that? Because that lining is. Thinner or maybe more inflamed than it should be. And so, um, I kind of think because of those things, I, I think it's best to wait one period before you try. But I should say the caveat to that is that is not proven by studies. Mm-Hmm. And you probably won't hear that from a lot of doctors. That's just me trying to use my experience and my logic to just kind of think through the possibilities and think. process. But to me, it's like, once you've had that period, you've shut off the old, you're ready for the new. And then it is okay, I think, to start trying right away. Yeah. I, there's always like certain topics in fertility that I feel a little bit indifferent about, you know, and the data's really mixed, but thin lining for me is such a. scary thing and that should be something that people really take into account because just like Dr. Reid is saying, thin lining can increase your chance of pregnancy loss. It can also affect your pregnancy later down the road and how your placenta actually grows into the wall of your uterus. So all those things are really important for the health of the pregnancy and the baby later on. So I'm very thoughtful about people's linings. We want to make sure that they develop a nice lining. Yes. Yeah. Um, okay. So we talked about IUDs but I thought it might be nice to talk about some other type of birth control options that people may be, um, kind of on or taking, um, and how that transition looks from when they stop their birth control to when they, um, start, um, trying. So should we delve into some other ones too? Yes. Well, I was like kind of laughing to myself because I have. I have so many patients now that come in and see me, maybe they're even for pre conception counseling. They're not even actively trying to get pregnant. And I ask them, They're using for contraception and they say, well, I stopped my birth control because of TikTok, right? Oh, yeah. And you guys know this, but Dr. Reed loves TikTok, but TikTok hates birth control. And I don't know what the vendetta is. I don't know. Is it China, right? That runs TikTok? Something about it. They're trying to feed this information to Americans. I have so many patients that are scared of birth control because of. Instagram and TikTok. And I really think that we should clear up some of this. Yes, yes, yes, I agree. But I have to say too, like to give China credit, if anyone knows contraception, it's China. Like, that's true. I mean, they've had laws for so long limiting how many kids women can have, so I don't think it's coming from them. But You know, I, I actually saw a tick tock the other day that I did really like, because they, um, they say really, probably we all need to learn how to adjust in the social media world because we are being flooded with new information at this point. And the information is often made in a way to kind of bait you into honestly. falling for a scam. Yes. And, um, so I saw some good tips of, okay, if you see some kind of recommendation that usually it'll kind of also start with like, does your doctor not care about you? You know, it's something like that. Um, and then, um, but they said, look, really the very first thing you should do when you see a video by somebody is check their credentials. Who is this person? Are they a physician? Honestly, a lot of times they are not a physician, right? This may be somebody with no degree, no medical background who has started an OCP cleanse course that they're selling to, right? So number one, check their credentials. Um, and number two, check their receipts. Okay, so they can come out and say anything, right? But, how can they back it up? Show me the study. Look it up on PubMed. Anybody can access PubMed. Is there a study confirming and proving what they are saying? And most of the time there is not. Very, very unlikely. Usually what they will give you is what's called an anecdotal story, a story of one person that tried this and then they felt better or something. And although I do love anecdotal stories and I have many myself, we don't want to base all of our medical decisions based on anecdotal stories alone. In order to truly understand the risk of something, sometimes you have to study that on both animals and humans. And you want to involve thousands of subjects in order to really be able to understand the risks and the benefits of a, of a certain treatment. Um, so I do love to talk and honestly, I'm on there and you should be on there too so that we can put out good, um, information because we have the credentials to be educating people and we have the receipts to show. So we, we do need to be out there. Um, but I think patients can be very vulnerable to all these different things. Not just birth control pills, they're always trying to, uh, sell wild yams on TikTok. They're always like, are you having trouble losing weight? Are your hormones not balanced? Use these wild yams, and whether you're a man or a woman, it can help either way. And I'm like, And like people are in the comments like Is it like like a yam that you eat like sweep tubes? I don't even know. Why are they wild? Aren't all vegetables wild? There's some old lady, she gets a whiteboard out, she starts writing a bunch of stuff, and I'm just like, no guys, she's not. endocrinologist. She doesn't know hormones. She's just trying to sell you wild yam or whatever it is. So, um, but, but, you know, um, I guess that kind of went off on a rant. No, but it is important to understand. Okay. So, you know, many of you out there are probably, maybe not in the phase of your life where you're completely ready to get pregnant and you need to use contraception and you want to know, okay. How is my choice of contraception going to affect me? What is the timing going to look like? And really, are there any risk to my health or my fertility later from using certain forms of contraception? So I think it really is important to understand. So we can start with the pill. I think probably, I don't know, I feel old because now people don't even really take birth control pills, I guess because of TikTok. But in my time, like All of my friends were on the pill, right? So like, birth control pills, what are they? Are you on the pill now, too? I love the pill. Never get off the pill. I'll be on the pill as long as possible. So, what are birth control pills? They're usually small doses, low doses of estrogen and progesterone. And I think something just really important to clear up is that your body naturally makes estrogen and progesterone. And so these chemicals that are in the pill are not something foreign, not something toxic, not something unrecognizable to your body. Because I think that's where a lot of this stems from, right? People get kind of paranoid that the pill contains something that is going to affect them, or maybe they feel a certain way when they're taking it, right? Yeah, and I think it's important to note too that the pill has really changed over the years. So You know, I guess this is not your mother's birth control, um, when they started off in the very beginning, honestly, they were using very high doses of these hormones. And over time we found out that birth control pills can get away with a much lower dose of hormone in order to still achieve an excellent contraceptive effect. However, sometimes it gets. so low that it may not be as helpful to patients as they may be wanting for some of their other symptoms. So of course we're talking about it for contraception, but birth control pills can help a number of other conditions, but sometimes you have to have a high enough dose to actually help. But I do love these days though, that you have so many different doses and formulations you can try. So let's say you try one on somebody they don't tolerate as well and you can say, okay, let's, what was our problem with it? Let's troubleshoot it a little bit so we can help you find one that works. better. Right. And I would say exactly what you're talking about is something I see in my patients, especially my young patients, spinning off of they're worried about the hormones. I don't want to be on too many, you know, too much hormone, right? So they start on a birth control pill that has a really, really low dose of estrogen. Um, estrogen, there's a couple of different formulations like, um, low estrogen, I think is probably the most common one that people take. And I asked them, well, why are you taking this one, right? And they say, well, I just didn't want to take too much estrogen, right? But the amount of estrogen in a full dose birth control pill is still very, very low. And what symptoms and side effects do my patients get from the low estrogen pill? A lot of times they're having spotting, unpredictable bleeding, and it's really bothering them. Or maybe they're taking birth control pills for other reasons, like they really wanted it to clear up their face, their acne, you know, things like that. And those low estrogen pills are not that great at fixing those things. And, you know, sometimes they're not getting the desired effect that they want. Um, and they're really only not taking it because they think this other pill has a super high dose of estrogen, so just like Dr. Reed said, they're not high doses, none of them are high doses anymore. Yeah, yeah. Um, another point too that I think is interesting to pick up on is, because I am one of the type of people, I like to be more natural, I don't like to take a lot of medication or anything, so people say, well you shouldn't take birth control pills because that's not your natural state. But y'all, we forgot what the natural state is, okay? The true natural state, when we were cave women, is we were pregnant all the time. That's true. We never had periods. Because we were always pregnant or we were always breastfeeding, okay? When you are pregnant, your hormones are so much higher than what you would take with a little birth control pill, okay? Um, and I do think that's kind of important too when we're talking about this, because this kind of tells us about one of the benefits of birth control pills. If you're ovulating every single month, although it's good, we like ovulation, is that almost even a problem in and of itself? Because that is not our natural state. We shouldn't be. We should either be pregnant or breastfeeding, according to cave women, right? But here's the thing. We know actually, if a woman takes birth control pills for at least five years during her lifetime, she will actually lower her chance of getting ovarian cancer. 15%. And that is very impressive, especially because ovarian cancer is a very difficult cancer to detect. If we don't have, you know, great screening methods like we do for breast cancer or cervical cancer and to when it is detected, it is a very deadly cancer too. And so to be able to lower your risk so significantly of a cancer like that, I think is worth talking about too. And, but why do we have that drop? I think it's because you're not ovulating all the time. Right. And, um, so I think when people try to bring up that natural point, it's a good counterpoint to think about when we're not in our true natural state. Right. Oh my gosh. And talk about having the receipts to back something up. Yeah. That is a really, those are really important studies that have now been around and are proven. It's really important for you to know, is your birth control pill hurting you? No. And in fact, it could be helping you and your overall health later. Um, not to mention preventing you from getting pregnant if you don't want to get pregnant, right? Oh, exactly. And, um, may lower chance of, um, getting endometrial cancer or not me. It does. It lowers your chance of getting endometrial cancer. Um, may lower your chance of getting colon cancer. Um, I do think probably the tricky one is breast cancer. So I think we should come in touch on this because this gets brought up. And so, um, you know, really the takeaway on breast cancer is that there was in the studies maybe a higher risk of seeing breast cancer, but they don't think that the pill causes breast cancer, but that maybe it could have caused the breast cancer to appear sooner if it was a hormonally sensitive breast cancer. Um, I think that's an important distinction to make too, because breast cancer is the most, you know, one of the most common cancers, um, for women. And so I think that would be an important factor to think about or, or to bring up. But again, it does not appear that birth control pills. cause breast cancer, right? Yes. Definitely important to delineate. Um, okay. So I do think we should talk about how birth control pills can affect fertility. So sometimes people will say, okay, well, if I'm taking birth control pills, how long do I need to wait after stopping birth control pills in order to get pregnant? It's kind of interesting because if we think about my point with the IUD, I say you'd like to wait one period. Well, with birth control pills, the way they work when you stop them, right? You have a period. That's how birth control pills work. So there you go, you have your period. So really, I'd say right away, what do you say? Yeah, I do not make my patients wait after stopping their birth control pills. And sometimes, which will happen with women, is you may not get a period right after stopping birth control pills. And that's okay. It may take a couple cycles for your body to regulate. But if after several months you're not getting periods after stopping your birth control pill, you need to come see us because something else may not be. may be going wrong. You know, that's not necessarily related to the birth control pills. Something important to know. Yeah. Um, another thing I think that is important to think, uh, to think about is a lot of times we're offering our patients fertility testing with a blood test that is called a m h, which stands for anti malaria and hormone. And this is a test for us to really look at somebody's ovarian reserve to tell us Are we running low on eggs? Do we have plenty of eggs? It really gives us a rough idea of that. Initially when this test came out, because I remember I've been working for that long, they told us you can check this test whenever you want, anytime of month, it doesn't matter if patients are on pills or not. And technically that is true, but in more recent years what we found out is if you have this level checked, and your egg count number came back low. It could be that the birth control pill may be causing temporary suppression of that level and that it could be reasonable to stop your birth control pills for a couple months, let them wear off and recheck your AMH levels so that you can understand, was that a true AMH level or was it just temporary suppression from your birth control pills? But I do want to make this distinction of birth control pills are not lowering your eggs at all. Also, it's not saving your eggs. Some people say, well, if I'm not ovulating, does that mean I'm saving up more eggs? No. So it really just doesn't affect your egg counts at all either way, but it just may affect the test we use to check your egg counts. And so that's kind of just an important thing to factor in because if you happen to get a low test while you're on birth control pills, I always tell my patients, Hey, like, don't panic. Don't worry. We can stop your pills, recheck, and just kind of get a better assessment of the situation. Absolutely. I think they. biggest takeaway is when you stop birth control pills, your fertility really should go back to its baseline state. They haven't done anything to affect your fertility. And so one thing that I think kind of comes up fairly frequently is that people get on birth control pills pretty young now, you know, maybe even in their teenage years. Well, Most teenagers weren't really tracking their cycles perfectly. Even, you know, in your early 20s, you probably weren't using your app like you are now, and you know, following everything perfectly. So people get on birth control pills, and maybe you're on it for 10 years, and then all of a sudden you want to get pregnant, and you stop. Then you're really tracking your cycles, and you're like, my cycles are irregular. Birth control made my cycles irregular. Chances are, your cycles were irregular before you got on birth control pills and your body's going back to its baseline state, but you didn't pay attention to it or pick up on it until now, because now you really care about them. Right. Absolutely. Yeah. Yeah. So, I mean, I think overall, when you really look at it, we are very supportive of birth control pills, but we also understand, too, if you've tried it and it's just not for you and you don't really want to troubleshoot different things, of course, that's okay. My biggest thing is, again, when you're watching these TikTok videos, you've got to look for their bias, okay? Why are they telling you you to sign up for their course or whatever. If th to sell you something, th flags need to really come what? Don't fall for it. and just see your, um, se provider. Um, that is cred for them to be able to guide you towards a better option. You know, your provider is not going to force you to do birth control pills. If you don't want to do birth control pills, that's totally fine. There's plenty of different options available, but we just don't want people to be scared to potentially use a really good option. Right. And going off of the cleanse and what we discussed before, it should also be said that birth control pills do not linger in your, your system after you stop taking them. So you do not need a cleanse to get them out of your body, even if it takes your body a couple cycles to really wake up. It's not. Actually because the birth control pill is circulating around and still leaving these, you know, metabolites in your body causing destruction. That's not what happened. What's happening is just that your brain has been asleep for so long it feels like it doesn't need to wake up yet. So really be thoughtful. Do not buy any cleanse products. You don't need an extra supplement to get rid of birth control pills or anything like that. Yeah. Yeah. Um, do we wanna touch on any of the other types of birth control? So for example, Depo-Provera. I do think that one can just be a harder one. Sometimes that lasts in the system for quite some time, huh? Yes. Mm-Hmm. So Depo-Provera is a progesterone injection that you can get and you get it every three months, I think, typically. And because it is a depoed shot, it. can linger and have effects for a longer because that's actually how it works. And so if you're thinking about maybe in the next few months about getting pregnant and you've been on Depo Provera, it may be a good idea to actually switch to a different form of contraception that you can stop more immediately when you're ready to get pregnant so that you don't have to wait that interval of time. Yeah. And then what about the next? I used to place these before I was a fertility doctor. Did you ever place Nexplanon? I did, but I can tell you that I cut out a lot more than I put in. Okay, but a lot of people don't like them, right? They don't like them. People do not like them. I don't have any bias against them. I get, I've never had one myself, but I can tell you my patients had a lot of abnormal bleeding, unpredictable bleeding, and women just really don't like that. Yeah. You gotta live your life. And so, I'm gonna be trying to get them out a lot. Yes. Yeah. Well, and I think it just goes to show you too that, Maybe what's important to you could be different. I agree. It's, it, I would get a lot of complaints about just not being able to predict when you were going to have bleeding and that was very disruptive, but it's also very reliable too. You don't have to remember to take anything. And some women, you know, may not want to have like an actual IUD placed or something. So sometimes I would see it, um, being used in teenagers. It is very effective. It's effective. It is really effective. Yes. If I could implant them in my teenage daughters at some point, I would be happy about it. It's, it's nearly the effectiveness of getting your tubes tied, which is incredible that we have a medication that can do that. Um, and it doesn't require a pelvic exam, you know, to get it in. You know, IUDs make people really anxious, especially young women. And so it is nice because it's implanted into your arm. So it is a really nice, effective option. As long as that's not something that's going to bother you. Yeah. Um, I did, I kind of just made, brought to mind. I wanted to update you too on, um, actually there have been a number of clinics now who have, um, purchased the machine to use nitrous gas, laughing gas, like we do kind of all over the United States. Everybody knows this is a big goal for Dr. K and I, we are taking the fear out of fertility testing and treatment by making sure women everywhere have access to comfort measures and not even just for fertility testing and treatment, really just for women's health in general. So we've been talking to OBGYNs, we've been talking to fertility doctors everywhere, and just really sharing our experience. experience with how helpful and comforting this has been, um, for our patients and for women. Um, I had multiple HST procedures I did this week and every single one of them afterwards said that's it? Yes. That was it? I read online, And I said, you know what? You should listen to them. It is terrible. That's the thing. It really is. And people didn't listen when they should have. And that's what we're really trying to change and turn around. And, and we're doing it. And so I'm just so glad that all over people are getting access, um, to, to better care. Yeah, and it's interesting. I know you've recommended it to a lot of, um, OBGYN offices. And one of the ones that I just did it with, the doctor was so hesitant about it, right? Like, well, how do you keep it safe? And you know, how, like, how can they drive themselves home afterwards? Like all of these questions. And then just recently she messaged me and was like, Oh my gosh, our patients love it. We love it because their procedures are so much easier. Patients are so much more comfortable. It really benefits everyone for your patients to have good pain control. Right. It is win win. We want our patients to be happy and stress free and relaxed. and everything. So the biggest problem right now I've been seeing is just all those bad stories are still up there. So I'm like, guys, if y'all had a good story, y'all need to start posting it on the internet to provide comfort to people who have to go get these procedures done to just say, look, if your doctor has nitrous, it's not going to be bad. It's going to be okay. So, right. Yeah. Yeah. Well, thank you guys so much for listening. Um, if you have the time, we would definitely appreciate if you gave us a good review on the podcast, that definitely helps us a lot. And we appreciate y'all listening and hope you have a great rest of your week. Bye