The Antisocial Doctors Podcast
Join Dr. Rebecca Berens & Dr. Sonia Singh as they unpack viral health trends with curiosity, nuance, and compassion. No snark, no shame —just thoughtful conversations about what’s true, what’s hype, why we're drawn to it and how to find calm and clarity in the chaos of social media and online health advice.
The Antisocial Doctors Podcast
Episode 2: Are Birth Control Pills Really Bad for You?
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A viral narrative suggests birth control pills are used as a band-aid and cause long-term harm. In this episode, we unpack where that belief comes from and what the evidence actually shows about risks, benefits, and informed decision-making.
What we cover:
• Why distrust around birth control is growing
• Evidence-based uses beyond contraception
• Real vs exaggerated risks
• Fertility, mood, weight, and cancer context
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You are listening to the Antisocial Doctors Podcast, hosted by me, Sonia Singh, a board certified internal medicine physician with a Master's in nutrition and a special interest in health anxiety
Rebecca Berens MDand me, Rebecca Barons, a board certified family medicine physician with a special interest in disordered eating.
Sonia Singh MDWe're also a millennial women anxious moms and curious humans navigating social media. We've seen firsthand how these platforms can be powerful tools for education and connection, but can also make us unwell.
Rebecca Berens MDThis podcast is meant to be the antidote to your doom. Scrolling, a solve for the anxiety, stress, guilt, shame, and confusion. That comes from social media's messaging around health. In each episode, we discuss a health related talk trending on social media with curiosity, nuance, evidence, humility, and compassion.
Sonia Singh MDThis is not your average debunking podcast. We wanna explore not just what is trending on social media, but why, why are so many people drawn to this? What is the nugget of truth here? What are the facts? What can we learn from this as patients and doctors? No shame. No blame, no snark.
Rebecca Berens MDWe're so glad you're here.
Sonia Singh MDOkay. Hi Rebecca. Hi Sonia. So today we're actually rerecording an episode that we already recorded. But we had more ideas on it, so yeah. It's, we had to go back and talk about it again, because there's just too much to cover.
Rebecca Berens MDIt is a huge topic, and I feel like we're probably eventually gonna do another episode. Yeah. Or a few on this topic. It's
Sonia Singh MDprobably gonna need a part two and a part three, but we'll try to do it some better justice today. So, tell us the story that inspired this episode topic.
Rebecca Berens MDYeah, so this is a story that I see over and over again. So this is not just one patient. But I see this a lot. So I'll see a patient that comes in that either has or has not been diagnosed with PCOS, but has PCOS. And, they'll come in and they'll tell me, oh yeah, I've had a regular period since I was a teenager. I've had these other issues. They always just prescribe me birth control. Mm-hmm. And never really with a full explanation of, what was causing the irregular periods. Mm-hmm. What's causing these other symptoms and the implications of that diagnosis beyond just the irregular periods to where it's just oh, just take birth control now your periods irregular problem solved. And feeling that dissatisfaction with that answer. And I think you found an excellent tweet that kind of encapsulates the problem that we all see with
Speaker 3that.
Sonia Singh MDYeah. So I'm sure a lot of you who are listening to this have had, have seen this tweet at some point, I think maybe two or three years ago. A lot of people I knew were resharing it and posting it. So basically the tweet says, an entire generation of women was prescribed birth control from the age of 14 for acne and irregular periods. And now that same generation is dealing with PCOS, hormonal imbalances, depression and infertility. So that is the claim that birth control pills are slapped on or given to people as a bandaid, and then they cause all these problems down the road. So we're gonna delve into that a little bit. I have some ideas about this, but you tell me why do you think this tweet was so viral and why do you think this whole, antibi birth control movement has been so big in the last few
Rebecca Berens MDyears? So there's so many reasons for this, but I think one of the big overarching ones that I know you and I have both seen is women in general feel very dismissed and unheard when they go to the doctor. Particularly if it's A-A-G-Y-N related concern, but really any concern, I think women are feeling unheard. And so, especially when they go in and they're having a problem and they're told, oh, just take birth control. Yeah, the problem's fixed, but then the question is always why am I having this problem? Yes. And this is not necessarily a bandaid forever. And I think, the implication from this tweet is, oh, you gave me birth control and now I have all these problems. When in actuality it's probably like there was a problem that was causing the symptoms you had to begin with. And rather than figuring out the cause of that problem and explaining it and understanding what that is and what other ways there may be to manage it mm-hmm. Or what other, screenings or testing may need to be done, it's just like, here's a bandaid prescription. Yeah. Yeah. Get outta my office is kind of the implication. Right. And so then later if a woman is having symptoms, maybe they've stopped birth control 'cause they wanna start trying to conceive and they're struggling to conceive. Mm. Or they stop the birth control and their symptoms are coming back. They're like, was this caused by me taking birth control all these years? Mm-hmm. And they're not really, they don't really have the answers that they were looking for. Yeah.
Sonia Singh MDYeah, I can totally see that. Can talk about this a little later too, but this concept of like birth control masking something I think is very popular. Like this idea that oh, I was just taking this and it just masked all these symptoms. And I think it's interesting to think about what's the distinction between taking the birth control and having it masked something versus it actually being an evidence-based treatment for that condition. And I, and I think a lot of people, it boils down to, well, is it treating the root cause, which is you mentioned. And I think, as we're probably gonna discuss for a lot of these conditions, we may not know the root cause, which I think leads to a lot of uncertainty and uneasiness and leads people to seek answers in other places. So
Rebecca Berens MDyeah, and I think that implication comes a lot from. As we know, women's health conditions in particular have been understudied. Their research is not well funded for these conditions, and then has not as a result then been taught mm-hmm. In an evidence-based fashion in medical schools in the same way that some other conditions have been, just because there is a larger gap there in the research. And so sometimes when we're talking about evidence-based treatments, well, to have evidence you have to have the studies to provide you with the evidence. And historically speaking, women were not included in studies necessarily, or these issues were not considered important enough to be funded. And so yeah, we are lacking evidence in some areas because we don't have the research to back it up. And so that can just contributes further to this sort of conspiracy theory idea. Mm-hmm. Which is not entirely false, right. That there really is a lack of evidence in some of these areas. Yeah. Yeah.
Sonia Singh MDAnd this is a recurring theme. I think in a lot of the topics we'll discuss, especially women's health topics, is that whole, trend of not enough funding for research, not enough research, not taught in medical school as well, not enough guidelines and data to make clinical decisions on. So even though you go to your doctor and they may actually be telling you what is the best available evidence about a certain thing, the answer may still be, we don't know the exact cause and we don't know a natural way to treat this. And, we don't know exactly why this happened to you and not your sister or whatever. And so I think that's where a lot of times, like you said, like false information and, conspiracy theories and sort of alternative stuff gets flourishes. Yeah.
Rebecca Berens MDAnd then coming into the conspiracy idea too, this is something I think a lot, a lot is Up until recently there was no option for birth control for women, it was not something that we, that we had up until we very recently. Right. Yeah. And recently there have been increasing, attacks on the availability of various reproductive health options for women. Mm-hmm. And I think there is sort of, there's some usage in social media of pushing agendas one way or the other. And I think that also stokes some of the fear-based. Content that you're seeing mm-hmm. To kind of, rather than just saying we don't want you to have this. Mm-hmm. It's oh, this is not safe for you. Mm-hmm. And we're protecting you from this. And so that's maybe my conspiracy theory. Yeah. Mind going that place. But I do think it contributes some to, to this issue as well.
Sonia Singh MDNo, I think you're absolutely right. And I did some research on sort of clean living as a concept and clean living movements. And I, I didn't realize this at all, but you know, that's not really a new thing. Those happen actually in cycles, often in society. And often it's, it follows like some other big societal shift, you know? So for instance, maybe you see women's liberation and, reproductive rights being expanded and then there's kind of this reactionary. Backlash to that and having, things move in the other direction and people maybe advocating for natural family planning or, having more babies or, various other, uh, um, things that are basically, a response to that initial movement. So it's, I think it's really interesting to think about these things in that kind of societal, historical context and think about why they're appealing at this moment. And I think this makes a lot of sense in the context that we're in. Okay. So Rebecca, what is the nugget of truth here? What do you think underlies the spirit of the tweet? That is true.
Rebecca Berens MDYeah. So as we said, Women often do feel rightfully dismissed by the healthcare system. And often when, like you said, if birth control is maybe the best option that we have evidence-based for a certain condition, and that's what's recommended. The time constraints that we have in a typical healthcare system visit, you know, typically it's what, like 10 minutes that you get with the doctor don't really allow for a very in-depth discussion. Mm-hmm. About, the risks and benefits and potential side effects, and understanding the why of why I'm recommending this, that's maybe not happening. Mm-hmm. And so it, it maybe is, the. Guideline based correct recommendation, but maybe you're not getting a full understanding or the opportunity to be fully informed about all of the Yeah. Potential risks and benefits. And so that is certainly true. And there are some side effects to birth control pills. Mm-hmm. Yeah. It's not as if there are no side effects, any medication is gonna have a potential risk or potential side effect. And and if that's not being fully explained or, or understood, that could definitely lead to some suspicion later. Mm-hmm. When maybe that's discovered or or someone does have a side effect. Why was this pushed on me? Why was a, mm-hmm. Why was I not given another choice?
Sonia Singh MDYeah, even in situations where you make the correct clinical decision, if the patient does not feel on board with it and they don't understand why they're doing it and they haven't been fully informed, that is always gonna feel like the wrong decision. And so, like you said, I think it's really challenging to get to that place in traditional healthcare because there's just so little time to do all of that. So anyway. Yeah. And the other thing you mentioned how there's very real, side effects to birth control. My perception just as somebody passively consuming social media content is the things that I see people worried about, about birth control on social media are usually not the actual risks to the birth control that I counsel patients on and, I, I'm aware of and talk about and I'm actually genuinely concerned about, so anyway, we can dive into that discrepancy a little bit later. So tell us a little, a little bit more about the facts in terms of birth control pills. What are the actual risks? What are they, valid treatment options for tell us more.
Rebecca Berens MDYeah. Okay. So for the sake of time in this episode, I'm going to focus just on combination oral contraceptives, which means, the contraceptives that contain both an estrogen and progestin because. There's so many different types of birth control and they all have different, potential side effect and risk profiles. And I think what most people are referring to when they refer to birth control is these combination oral contraceptives. Mm-hmm. I, as I said, we'll probably have future episodes about some of these other options. Yeah. And we can get more into that. So that's what these risks and side effects are, that focusing on here that I'm gonna be talking about. So first of all, what are they actually like factually used for and recommended for? So most commonly they can be used to treat dysmenorrhea or painful periods. Mm-hmm. Which is common. For people who have endometriosis or fibroids, they can be used in that context. They're also very effective for treatment of acne and hersom or excessive like male, typically male pattern hair growth. In patients with PCOS. Yeah. They can be used to treat hypogonadism or premature ovarian failure, which, these are more rare conditions that some, women are experiencing. And they also can reduce cancer risk in women who are at risk of endometrial or ovarian cancer. Mm-hmm. Who have certain risk factors for those. They also improve bone health and hot flashes for women in perimenopause who also need effective birth control. Mm-hmm. Perimenopause is a topic for another episode, but obviously like perimenopause is hot right now. Yeah. And, women in perimenopause can get pregnant. Yeah. And so, menopause hormone therapy does not provide effective birth control. Yeah. And so if you need effective birth control and management of some perimenopause syndrome, a birth control pill might be a great option for you. Mm-hmm. Depending on your other risk factors. So that's, some real, real uses that, that they can be used for that have evidence-based. So then I'll just talk about the common side effects that we truly do see. Most common side effects that are typically milder are nausea, breast tenderness, bloating. These are typically mild and short-lived. It's sort of an adjustment period to the pill. Unscheduled bleeding is another common one, particularly in the first few cycles because, we are taking over your normal hormone cycling right cycle. Yep. So there may be some unscheduled bleeding that happens in the process of that adjustment. And that can also happen later in the course of taking a pill if, say you miss a pill or you're, delayed on taking a dose or whatever, you may get some unscheduled bleeding as a result of that as well. And then
Sonia Singh MDcan you talk a little bit about weight gain, because I feel like that's one of the popular, side effects that people come to me concerned about.
Rebecca Berens MDYeah, absolutely. So weight gain is a really common concern that people have with birth control. And it's been studied a lot. Mm-hmm. And there, there has not borne out in meta-analyses that weight gain is a side effect of birth control on the whole on average. But of course, with anything individual experience may vary. And this is really tricky because a lot of times the people that are starting birth control pills are often in a phase of their life where weight gain might be happening. Anyway. Mm-hmm. Naturally. Mm-hmm. In adolescence, late adolescence, moving into your early twenties, like part of puberty,
Sonia Singh MDstarting a new relationship. Yeah.
Rebecca Berens MDLike you're gaining weight at that time. That's a normal thing that's happening. Yeah. Um, your body is changing and developing into an adult body. I think people have this perception that you hate 18 and now you're an adult. No, you continue to mm-hmm. Develop into an adult, into your early to mid twenties. Mm-hmm. And your body does continue to change Yeah. In that process. It's not supposed to be your 18-year-old body forever. Right. Um, and so yeah, there's weight gain that happens there and it's really hard to tease out in some cases, is this weight gain because you are growing and changing and going through, you know, development into an adult? Or is this weight gain because you started college and your habits are different and your routines are different, you eating differently and your Yeah. Mm-hmm. Yeah. Mm-hmm. Or is this weight gain because you started birth control pill or is it all of these things? Right. But like I said, in med analysis, it has not borne out that there is a significant impact of birth control pills on weight gain. But that said, individual experience is valid. Yeah. Some people do experience weight gain. Yeah. And if that's been the case for you, that is a true experience that you had. Yeah. But that does not mean that we should use an individual experience of an anecdotal case to provide recommendations for an entire population of people.
Sonia Singh MDExactly. So, is there a chance you may gain weight on a birth control pill? Yes. There is a chance you may lose weight on a birth control pill. All we can say is that the best available data tells us that on the whole, it doesn't seem like it's likely to make you. Gain a significant amount of weight.
Rebecca Berens MDExactly. You may. Yeah. Another common one that we talked about that's been recently reevaluated as well is, mood changes. Mm-hmm. So, there's been a lot of studies on mood changes affected by birth control pills and some have reported an increase in moodiness or, depressive symptoms. Some have reported a decrease. There is some evidence that, someone with a preexisting mood disorder has an increased risk of discontinuation. Mm-hmm. And that might affect studies results as well. Mm-hmm. Like you're actually more likely to discontinue the pill if you have a preexisting mood disorder. And is that maybe it was exacerbated by the pill. Mm-hmm. But then also, it's an evidenced-based treatment for premenstrual dysphoric disorder. Right. And it clearly improves mood symptoms in those patients. So again, this can be individualized. There was a, a study that you found, in 2023, it was a population based cohort study for over 250,000 women in the uk. And that did suggest that in the first two years of using an oral contraceptive, there may be an increased risk of depression, or that using it in adolescence might increase the risk of depression later in life. But again, this was. One study and then there's been other studies saying the opposite. So again, this is one of those situations where there may be individual cases in which it's an issue, but there also may be cases in which it could be beneficial. Yeah. And so it's an individualized decision at that point.
Sonia Singh MDYeah. I wanted, I wanted us to mention this study specifically. 'cause it was recent. I feel like it, it probably made a lot of headlines at the time where people were just like, oh yeah, CIO, I knew it. Birth control, makes you depressed. It makes you feel, and it's just one of these cases where, yeah, you can cherry pick a study and then there's, there may be 10 other studies that don't show any effect, you know? Or there's some, like you said, some situations in which it shows beneficial effect on mood. And so, you really have to put things in the greater context and, be kind of wary when you hear those headlines. Okay. Can you talk a little bit about desire and libido, with respect to birth control?
Rebecca Berens MDYeah, so this one's been big recently, I think, on social media. So, again, most studies, show no change in, sexual function, oral libido. There have been both an increase in libido or or a decrease in libido reported or some increase in sexual function issues or decrease reported. But some of the things that I think have been reported a lot recently in social media, there's been a lot of discussion about it affecting your partner selection. Are you more likely to choose a more or less masculine appearing partner mm-hmm. If you're taking birth control? And there was some evidence actually that said yes, but it was a very low sample size. And then there was a study with a much larger sample size that said, no, it does not affect. Partner selection. And then there was, another discussion I've seen recently, a lot on social media and on some podcasts about it affecting your pre preference for major histo compatibility, complex dissimilarity. And so, mhc, these are, markers of our, immune system function that are sort of genetically determined. So this is essentially a way of selecting for, someone who's more genetically different than you.
Sonia Singh MDYeah. So it's like evolutionarily beneficial to find someone dissimilar to you. In
Rebecca Berens MDorder to have a
Sonia Singh MDbetter mix of genes
Rebecca Berens MDExactly. Less. And so, there was a very small study, again, it was like 193 women that said yes, it, it affects our preference and makes us choose people more similar to us. Mm-hmm. But again, this is a super small study and really. How relevant is this to our evolutionary context in this day and age? There's so many things we're doing right now that, are not what evolution would have selected for necessarily. And so, how much of an impact does this truly have? Is it really relevant? Yeah, I mean,
Sonia Singh MDfrom talking to my friends who are still single, it seems like finding and choosing a mate is already really hard. So if you're also introducing into that, well, could my birth control possibly be making me choose like an evolutionary less? Evolutionarily less fit partner. I mean, I don't know that, and it just, it's another example of just kind of reducing something that is so complex, like female desire into being like, oh, it's the birth control. You know, it's like, oh no. It's a lot of other things. But okay. And then another thing that I've heard people talk a lot about is when they'll say oh, I'm thinking about trying to conceive, so I gotta stop my birth control and reset my system for a year. And what, what is the data on returning to be becoming fertile after using?
Rebecca Berens MDYeah, so this is one that I hear a lot actually is that it affects future fertility. Mm-hmm. Not just in the short term, but in the long term. Mm-hmm. And there's really no evidence of long term changes in fertility after using birth control. I think a lot of that comes from, again, if someone is prescribed birth control for irregular periods. There's probably something underlying that affected the irregularity of periods that is maybe also affecting fertility. Mm-hmm. Like for example, PCOS. And so then when you come off the birth control and you've been like, well it was regulating my periods, but it made me infertile. It probably didn't, you probably had something affecting your fertility Right. Outright that was causing the irregular periods. Right. That, if we wanna say it was masked by the birth control. Yeah. The birth, the birth control was treating the irregularity of your periods Right. But it was not addressing the underlying issue that is contributing to infertility. But all that to say, there is no evidence of long-term changes in fertility from the usage of birth control. Mm-hmm. Now there is gonna be, again, in a couple months adjustment period, so you're not maybe immediately going to go back into a normal fertile cycle mm-hmm. Immediately after stopping the birth control. 'cause again, your pituitary gland has to reset its cycling after we've suppressed it. Right. And so yes, there is going to be, a short term, slight delay potentially of a couple of cycles. Mm-hmm. But again, you've, there's lots of stories of people getting pregnant on birth control who just missed a couple of pills. Yeah. Or, or getting pregnant right away when they stop it. So it's not to say that it's necessarily gonna be a guarantee. And that's also important 'cause I have had people. Think that they couldn't get pregnant yet. Mm-hmm. And stop their birth control early and get pregnant earlier than they were intending. And so I think it's really important to be accurate about the risk there. Yeah. The other thing too is if you use birth control for a prolonged period of time because you are not ready to conceive yet, and then you are later in your life when you do start trying to conceive mm-hmm. Obviously there is a natural decline in fertility mm-hmm. With age. Mm-hmm. And so depending on the age you are when you discontinue the birth control, that may have an impact on your fertility as well. Right. So it's just important to keep in mind again, if, if fertility is something that's important to you it is something that needs to be considered and planned. Mm-hmm. And and we can't necessarily just blame it on the birth control. Right. If it takes longer.
Sonia Singh MDOkay. So now talk a little bit more about the serious side effects of birth control pills. 'cause I think we as physicians know these, we think about them, we've seen them but they don't feel like the ones that people talk about the most on social media.
Rebecca Berens MDYeah. All the ones we just talked about that are not actually that big of a deal are the ones that are all over social media and these ones are the actual important ones to consider. I
Sonia Singh MDmean, not to minimize, for some people the effect it may have had on their mood or the effect it may had on their weight or, whatever it is, may have been profound. But on the whole, those are not life threatening where this is the ones that we're trying to talk about now are life threatening.
Rebecca Berens MDAbsolutely, yes. So, The serious risks of, the combined oral contraceptives are the, combined birth control pills. So the first one that I think is, the one that we are really conscious of as physicians, to be assessing for risk is the increased risk of ven venous thromboembolism or blood clots. Mm-hmm. So these can be blood clots, deep venous thrombosis in the legs, or they can travel to the lung and cause a pulmonary embolism. So these can be very serious and can be fatal. Yeah. So there is a three to five times increased relative risk of, vte, which is ven thromboembolism with combined oral contraceptives. And that is based both on the dose of the estrogen and the type of progestin used in the pill. Mm-hmm. So there is a change, in that risk depending on the type of pro progestin and the dosage which you choose.
Speaker 3Mm-hmm.
Rebecca Berens MDHowever, the absolute risk is still low. So the baseline risk for a non-pregnant woman is one to five out of 10,000 women years. Mm-hmm. So then if you increase that by three to five times, that's three to five per 10,000 women years. Mm-hmm. It is, or three to 25. Oh, yes. Mm-hmm. Sorry. Thank you. Whereas the relative risk is still half as much as the relative risk increase while you're pregnant or postpartum. Mm-hmm. So I think this is the other key thing to think about, and that I think is often not discussed when we're talking about the risks of birth control pills.
Sonia Singh MDYeah.
Rebecca Berens MDThere are true risks to pregnancy. Mm-hmm. Pregnancy is a risky situation Yeah. For a woman. Yeah. And so if you're comparing the risk of unintended pregnancy to baseline versus the risk of birth control to baseline, it really diminishes how risky birth control is looking. Yeah. Yeah. And so I just think that's an important thing to consider. Yeah. We're talking about risk here, but you have to also consider what is the risk of not taking birth control for that person.
Sonia Singh MD'Cause if you are terrified of having a blood clot and for that reason you avoid the birth control, but you increase your risk of an unintended pregnancy, you're signing up for a much, much, much higher risk, basically.
Rebecca Berens MDYeah. Much higher risk of blood clot and a lot of other things. Yeah. It's one of the most dangerous things that, that can happen to a woman. Right? Yes. And, and it, there's a lifelong impact right. Of of pregnancy. So, so this is just important to, to consider. Now there are underlying risk factors that increase someone's baseline risk of, a blood clot. And so if you, have a hereditary thrombophilia, like some sort of genetic disorder, clotting disorder which can come from just like a genetic clotting disorder or other autoimmune conditions, there's a variety of things that can increase your risk of blood clots. Smoking, if you're also taking a, NSAID like ibuprofen on a regular basis or some other nsaid or have a, an illness for, so example COVID. So COVID Slightly increases your risk of blood clots. And so the combination of those two things. The other thing is like in the postoperative period, say you've had an orthopedic surgery mm-hmm. Where you're bed bound Yeah. And you're not moving. Yeah. And you just had surgery that greatly increases your clotting risk. And so that combination of two risk factors can increase the risk more significantly. And so that's something that, a physician is taking into account before prescribing someone a birth control. Yeah. And we may consider a different option Yeah. For birth control in that person.
Sonia Singh MDYeah, and this is another situation in which I think having a physician who can spend time with you and who knows you and knows your history can be so helpful in informing a decision like this. And the other thing that you didn't mention here, I think was, patients with migraine with aura. Mm-hmm. So it, that's incredibly common that I have seen patients who were started on birth control at some time in their life, and later they developed migraines and no one has ever talked to them about. Well, do you have an aura? And are you aware that, patients with migraine, with aura actually have a higher risk of stroke or clotting on birth control? And, it's amazing how often they say no. No one's ever talked to me about that. And I really think it's, again, that's a function of so many different problems in our healthcare system. It's partially a function of time. It's fragmentation, maybe they're getting that from their OB and then the PCP doesn't know that they're on a birth control pill and maybe they went to an urgent care for their migraine. And so no one is kind of looking at the entire picture. But yeah, these are all things that I think, the decisions should be so, individualized and should be made together, with the patient.
Rebecca Berens MDYeah. And to, to that point, like you said, a common thing that I notice is that people do not report birth control when they are As a medication. Yeah. As a medication. Mm-hmm. You ask what are the medications you're taking? Mm-hmm. It just. It seems like it's separate in people's mind. It goes in a different bucket. That's not a thing, right? Yeah. Yeah. So sometimes you may go, you said to an er, urgent care with a severe migraine and they ask you your list of medications and you just, in your mind it's in a separate place. You're just like, that's not a medication. I think 'cause
Sonia Singh MDpeople think I'm not taking it to treat a disease, so they don't think of it like it's my blood pressure medicine, or it's my cholesterol medicine. They just think oh yeah, no, that's, oh yeah, I take that, but like I don't have any problem.
Rebecca Berens MDYeah. And so, that's why it is so important again to make sure you are getting, Giving a thorough history. Yeah. But also that people are asking the questions. 'cause I always specifically separately ask about birth control because I've noticed that habit that people have. Mm-hmm. But again, it's just, it's hard to do in a time limited fashion. And the other thing, as you mentioned with the fragmentation, like increasingly I'm seeing people getting their birth control prescribed asynchronously on the internet.
Speaker 3Yeah. Mm-hmm. They like not even talking to anyone. Yeah.
Rebecca Berens MDThey click a few boxes and, and, I don't know, take a picture of their driver's license, I guess, and send it to someone on the internet and then it shows up at their door. So yeah. There's really no discussion of that happening.
Sonia Singh MDYeah, yeah. In those cases, and in those cases, you might say no to some of these things that you just don't even know what they are, you know, no one's actually explained to you what that thing is and you're like, oh, that headache, that that's what that is. Or Oh yeah. Even just knowing what. What different words for clotting. Yeah. Like you may know somebody in your family had a PE or had a clot in their leg or whatever, but the way it may be phrased, you know Yeah. The hereditary
Rebecca Berens MDthrombophilia checkbox is not, not triggering in your mind. Right, right. So yeah, it's just important to, be aware of, of that. And, and again, it's just the importance of having that conversation.
Sonia Singh MDYeah. Talk a little bit more about cardiovascular risk. That kind of relates to clotting as well.
Rebecca Berens MDYeah. So there, there is, this concern around an increased risk for cardiovascular disease and like you mentioned with migraine with aura, for example, increased risk of stroke in those patients. The other, risk can be with increased risk of myocardial infarction or a heart attack. Mm-hmm. So there are, potentially increased risk of cardiovascular disease that actually has substantially reduced with newer birth control pills. Mm-hmm. That have lower estrogen doses. Yeah. And so, and there is not according to the data that I found any long-term increased risk in heart attack or stroke with a history of use. It's just while you're actively taking it. Mm-hmm. Mm-hmm. Um, and so again, we can kind of take into account what is your. Active risk at this moment, assessing you as a patient as a whole. Yeah. And then continually reassess that while you're taking the pill and, and decide at some point is the risk increasing based on your other risk factors as to where this may not may no longer make sense. Mm-hmm. And so, and again, as with the venous thrombo or blood clot, the absolute risk of heart attack and stroke is lower with the birth control pills compared to pregnancy or the postpartum period. So, again, important to,. Mitigate that risk there point the risk of not doing it. Yeah. Yeah. There is also, some data that shows there may be a slight increase in triglycerides and an effect on insulin resistance. With combined oral contraceptives. Again, while you're taking them there, this is usually not in a clinically significant way. But again, you have to weigh the risk and benefits for an individual patient. And this may play into why some people maybe are experiencing weight gain with birth control pills while others aren't. If there is an effect on your insulin sensitivity mm-hmm. Maybe you're more apt to gain some weight and that isn't necessarily gonna happen to everyone. 'cause there's a lot of genetic predisposition that goes into that. Right. And so again, it's a very individualized thing where we monitor for that individual patient Yeah. Assess their total risk and continually reassess, not just hit auto refill on the internet every three months. Right, right.
Sonia Singh MDOkay. What about, cancer? You briefly mentioned that birth control can actually lower certain cancer risks for certain patients. So talk a little bit more about cancer risks.
Rebecca Berens MDYeah, so, there is no evidence that oral contraceptives or combined oral contraceptives increase overall risk of cancer. And there's been, long-term studies on this that have showed that and as you said, and as we talked about earlier, there is actually evidence of protection from specific cancers including ovarian, endometrial, and colorectal cancers. With use of combined oral contraceptives, there is a temporary increase. Risk in breast and cervical cancer associated with current or recent use of combined oral contraceptives. But this disappears within two to five years of stopping the pill. And therefore it's outweighed by the other interesting protective effects. And I think the other thing to think about with this is, so one, is it causative of breast cancer or is it, there's, they're interacting with the health system at the time. Well, and also like with the, with breast cancer, if you have an estrogen or progestin progesterone sensitive breast cancer mm-hmm. And then you're taking additional hormone, it may be more apt to grow. Yeah. Which again is why it's important to have your annual checkup. Right. Be familiar with any changes in your body, those sorts of things. Yeah. And then and then also in the time of life when we are on birth control presumably you're on birth control because you are having unprotected sex. And so that is going to increase your cervical cancer risk. Right. Because that is how we contract cervical cancer is with exposure to the HPV virus. Yeah. With unprotected sex. Right. And so, there's other factors there. Yeah. That might be contributing to that. But long term overall, there is no increased risk of cancer with birth control pills.
Sonia Singh MDOkay. That's reassuring. And then, I think you already mentioned some of these, there are certain conditions in which birth control pills are actually considered too risky, basically, and so they're contraindicated. You mentioned some of them already, but yeah, I'll just kind of run through them just
Rebecca Berens MDto again, like these are things that we should be taking into account. So we talked about the inherited thrombophilias or, blood clot disorders, autoimmune disease that increases, blood clotting risk, preexisting cardiovascular disease, like you had a prior heart attack or you have known blockages or something like that. Mm-hmm. The other ones that we didn't really talk about, hepatic adenoma. So if you have a, this is a, a type of growth in the liver that's typically benign but can grow with. Oral contraceptive use, as we said, migraine with aura, or if you're, older than the age of 35, that does increase stroke risk. Yeah. So there needs to be, concern there. And then this is an important one, post bariatric surgery or, If you're using a GLP one, there is actually a concern about absorption of the birth control pill, which might impact its effectiveness. And so it may not be the best option for birth control in that patient. And I think that's something that is also not well known by the general public and is important again, to discuss with your doctor. I've, I've definitely had the experience of having a patient. Take a GLP one compounded from some place that I was not aware of and they did not tell me about. And that's very relevant for your physician to know. 'cause it, it's really not the best option. There may be an absorption issue that could make it less effective for you.
Sonia Singh MDYeah. Honestly, you taught me that. I didn't realize that that was a thing. And I don't feel like the GLP one companies are making a big enough effort to put those warnings on these products because, like you said, I sadly, I think there's a lot of shame too around using these products. So a lot of patients get them through like med spas and weight loss clinics and they don't even disclose to their ob gyn or their doctor that they're using the drugs. And they are, not considered or they're not known to be safe in pregnancy. And so, this could potentially be very bad if you end up with an unintended pregnancy and you've been taking these medications. So
Rebecca Berens MDyeah, it's, it's really important to, and again, Another thing where people might not consider it a medication. Yeah. Because it's not being prescribed. Maybe they're getting it from a med spa or they bought it online from a compounding place. It's not a pill that they're taking. Yeah. And so, I think it's, it's just important to be aware. And then the last one, if you're over 35 and smoking, that is a much increased risk of clotting and cardiovascular disease. And so that's just an important thing to be, always reassessing risk. Yeah. Again, no auto refilling on the internet if we can avoid it.
Sonia Singh MDWell, and you know, in the same way that certain things about your history can make you, have an elevated risk beyond what we know from the studies, things in your history can also make you have a lower risk than what we see in the studies. So if you have already been pregnant before, you have tested your body with a very high dose of estrogen. And so if you have been through some of these kind of pro clotting prothrombotic states already, and you have not had an issue with clotting, then that's reassuring that that may be a lower risk for you. So anyway, this is also individualized and, requires a lot of, Patient, doctor, history taking and understanding and discussion. So, I, a couple of years ago fell down this rabbit hole of reading about post birth control syndrome. I know there's an influencer out there who has made a career on this and has an entire book about it. And I had a couple of patients ask me oh, do, do you think I have post birth control syndrome? So what is that and is it a thing? Does it exist?
Rebecca Berens MDYeah. So there's no credible evidence for a post birth control syndrome. But there were some studies dating back to the 1970s and I looked these up and I actually couldn't find anything recent text of the studies because they were so old. Um, and I couldn't find a whole lot recently about it. But, but there are maybe some decreased micronutrient levels with use of oral birth control pills which I imagine is probably somewhat similar to like in pregnancy. Mm-hmm. Obviously pregnancy is a very different situation in terms of the amount of increased nutritional need. Yeah. But maybe there's some correlation there. 'cause it's a lot of the same vitamins, that, that we see that, that can become more easily depleted in pregnancy. Interesting. And it was mostly subclinical levels, but it could be more significant if you are someone who already has a poor nutritional status at baseline. Like maybe you've been chronically dieting or you have some sort of malabsorption issue issue, have celiac or some other GI issue. Yeah. And there's a particular concern around this with folic acid. If you become ly shortly after. Taking a birth control pill. Mm-hmm. Because obviously pregnancy requires a higher folic acid intake. Yeah. And, in the early stages of pregnancy, before you realize you're pregnant is the most critical time period. Mm-hmm. And so if you're somewhat sub clinically deficient and you're not taking in a whole lot and then you get pregnant, maybe there's some risk. But I think the point here is if you are someone of reproductive age who could become pregnant, you should be taking a prenatal vitamin with adequate folic acid. Yeah. And I think that's something that, Is important to take into account. And then I just think it's, it's more, again, adequate nutrition is really important and there's in an age where we're so obsessed with dieting and thinness and restriction, maybe we're contributing to some of these deficiencies. Mm-hmm. And I think it's just important as always to be vigilant about our nutrition status.
Sonia Singh MDWell, it's interesting though that the one study that you did find, was talking about subclinical changes in these things. So when people talk about this post birth control syndrome, they're really talking about symptoms and what I've read about it to me sounds like what we discussed earlier is maybe just manifestations of whatever the underlying condition was that the person was put on birth control for, and now they've taken it away and those symptoms have returned.
Rebecca Berens MDYeah. And I think that, the symptoms that you would have from like actually clinical deficiencies of these vitamins. Like it's, for example, folic acid, vitamins B two, B six, B12, vitamin C and E, magnesium, selenium, zinc. That's not necessarily causing the same symptoms that people are attributing to their birth control. Right? Right. But there's all these vague symptoms that people experience. Mm-hmm. Like fatigue. Mm-hmm. Fatigue is such a non-specific syndrome. Yeah. You can be fatigued for any number of reasons and could it be a nutritional deficiency? Yeah, sure. Yeah. But it could also be just living in 2025 is, is exhausting. Right. And so there's a lot of things that could be contributing to that. And I think the other thing is there's a lot of interest. In the functional medicine space about well there's, the clinical levels and then there's the optimal levels, right? And then there's the intracellular levels, right. And, you know, and some of these things it's so hard to actually know How much of that it has any true evidence behind it that's actually Yeah. Clinically relevant to a patient. Right. And and some of it is yeah, okay, I took the supplement and now I feel better. Well, is it because you took the supplement or was it a placebo effect? Or there's so many other factors that could contribute, especially when you're talking about these really non-specific symptoms. But I think that the key thing is a syndrome of long-term health effects of birth control pills. Yeah. Does not exist in any credibly evident way. Yeah. I think when we talk about a purse birth control syndrome, and you see that on social media very often. There is a clear conflict of interest of the person talking about it in that they're probably selling you something. Right. Right. That cures your post birth control syndrome. Right. Like a supplement or a course or a diet plan or something. Right. And so we always have to take what we're seeing with a grain of salt and if someone is selling you something Yeah. To treat the condition they're telling you that you have, that your doctor doesn't think is a thing. Yeah. It might just need to have some more evidence behind it before you consider, Yeah. Shelling out your money for that.
Sonia Singh MDYeah. I mean, it's kind of a classic marketing tactic that I think you see over and over is you create fear or anxiety around something or you, you tell a person about a need that they didn't know they had and then you offer them the solution. And I think that's what we see a lot in this. Yeah. In this space. I can tell you that every time I stop birth control, I get terrible acne and I have to shave my legs more often and my period also becomes irreg. And so I could easily, interpret that as oh, this is like some. Wash out of birth control syndrome, but I, I know based on my own medical training, that that's actually probably what my underlying baseline state is. And that really was, what it was like as a teenager. And the birth control for me is a treatment for that. Yeah. And so, there's nothing wrong with, I think people get a little bit stuck on this idea of if you need to stay on it for it to treat that thing, then it's not really treating it, it's just masking it. You have to keep taking it forever. If you wanna keep having that effect. And to me it's like, I mean, yeah, but I wear glasses and I do, I do lots of things that I have to continue to do. I make healthy choices. Like all of these things you choose to do because they serve a purpose and they are effective for serving that purpose. So, that's how I view birth control. But I think it's a very easy to interpret it. In this other way that's it's done something to me and now I'm like this.
Rebecca Berens MDYeah. You know? Yeah. And especially when there's a condition that there is maybe no clear cause treatment for. Mm-hmm. Right. For example, PC os, it's such a complicated condition. Yeah. And it's very unlikely that we're gonna find a miraculous cure. Yeah. That doesn't involve taking something long term or making specific changes long term. Right, right. It's, it's an underlying condition that people have and so it's very, it's very unfair to those patients to say well, you shouldn't be just taking something, you should be treating the root cause. Like how? Yeah. Yeah. How do you expect them to do that? We have not advanced that far, scientifically. I don't know if we ever really will. Yeah. Without something that's maybe a long term treatment.
Sonia Singh MDYeah. Yeah. And I have like personal empathy for that, population that deals with PCOS. I was told that I might have PCOS when I was maybe 17 or 18 years old. And I remember going home and punching it into Alta Vista or whatever the search engine was on my, gargantuan desktop. And I remember reading about it and seeing, people struggled with infertility. I remember I looked at a picture of polycystic ovaries, which were just looked very disturbing. Alien, and I was just like, oh my God, my insides look like that. I had this whole kinda mental spiral about it. And now, all these years later, truth, I don't meet criteria for PCOS. I actually don't, probably it was just some ethnic variation and I'm probably somewhere on the spectrum of normal. But I think throwing those words around to people and not explaining them and, and then also even when somebody does explain them, the fact that there's so much uncertainty around them, we don't know. I, I can deeply empathize with that feeling of uncertainty and uneasiness and well, what am I supposed to do about this? You know? So yeah, I think it's it's completely understandable why people are looking for answers and why it feels as though, they're just being given a bandaid.
Rebecca Berens MDYeah. And then I think the other thing that we talked about that, we haven't really explored yet is, I think patients get frustrated again with the. The lack of options that they're given. Yeah. They're just told this is your option, this is it. Yeah. And without being explained, in depth the risks, the benefits, the alternatives. Mm-hmm. I think that's the clear thing with informed consent. Yes. You have to know risks, you have to know benefits, you have to know alternatives. Mm-hmm. And I think alternatives to birth control pills or birth control in general is sort of frowned upon or, or looked down on by doctors. Mm-hmm. And I think patients that for maybe a religious or cultural reason, do not want to use a form of birth control. They're being provided with, these are your options. If you don't take it, you're non-compliant. Yeah. Or, you're crazy or whatever. They're just, they just feel like I have nothing to offer you. Mm-hmm. Um, and one thing that I was really grateful for when I was in my residency training, I trained at Georgetown and so it's a Catholic university and so there actually is a lot of research on, fertility awareness based methods mm-hmm. Of Family planning that do not involve. Artificial birth control. Mm-hmm. And I think if you go to the doctor and you tell them oh, I don't wanna use birth control, I don't believe in that. They're just like good luck. Rather than, hey, here are some ways you can maybe, choose to space your family or choose to manage your fertility. Yeah. That doesn't involve taking something. So I did wanna talk a little bit about the fact that yes, there are truly evidence-based mm-hmm. Fertility awareness-based methods of contraception or. Family planning available. And just talk about the effectiveness of those. 'cause I think they're very much downplayed by physicians. So for example, there's a variety of methods and we'll include in the show notes, a little handout summary of the, the evidence-based methods that are out there. I think people think of the rhythm method from like a million years ago. That, that's literally what I learned. Yeah, that's
Sonia Singh MDwhat I think. I, that's what I learned. And I remember the chart in the book, the textbook that would show the effectiveness rates and I just remember the rhythm method being not good. Yeah. And then I think after that point, I just, in my mind it was like, oh, I can't counsel a patient to do that. It's so much less effective than the other things. And honestly, I also don't think I could trust myself to adequately teach them in a way that would make me feel confident that they understood and were gonna be able to, implement, a fertility, awareness based method on their own.
Rebecca Berens MDYeah, absolutely. And, and you shouldn't have to, right? That shouldn't be your job. Mm-hmm. To teach them the method. But it is important to be able to say Hey. This is the evidence for the methods that are available. Yeah. These are the names of the methods and resources that you could look at and some resources to direct you to someone who can teach you. Mm-hmm. Rather than just saying well, good luck. And who would, who would that be? I don't know the answer. Yeah. So, so I'll tell you, there's a variety of methods and, most of the Catholic churches near you will know all the teachers locally because it's part of marriage prep. I can tell you that. You have to learn fertility awareness based, oh, this is like a
Sonia Singh MDtotally new world to me. Okay. I'm so, so I
Rebecca Berens MDam, I am Catholic by marriage, and so this is part of Catholic marriage prep is you have to learn about fertility, awareness based methods of family planning. You do not have to necessarily sign off any very formal thing. It's, it is very parish specific, but, but I mean, there is at least education about it that's required. And so, the handout that will include in the show notes does list the names of all of the various methods. But I'll just tell you like with perfect use, their effectiveness rates are between 95 to 99.5%. That's pretty good. Okay. So just for, for reference, Condom effect effectiveness rates with perfect use is 98% and the combined birth control pill with perfect use is over 99%. Now the key thing there is perfect use. Right. No one is perfect, right? Yes. We know. So when we're looking at effectiveness rates of birth control yeah. We look at typical use. Yeah. Not perfect use. 'cause no one is perfect and we have to assume that we're gonna make a mistake. And it's particularly easy to not perfectly use a fertility wear awareness based method. Yeah. Because it is an active choice every single day. Mm-hmm. To not only track the things you need to track mm-hmm. To be able to, predict where you are in your cycle and whether you're fertile that day, but also to choose to have or not have sex that day. Mm-hmm. And, you can see how that could go awry. Right. And so with, typical use, the rates, depending on the method is anywhere from 83 to 98%. Okay. So still pretty good condoms. Typical use rate is 87%. Okay. And typical use for birth control pills is 93%. Yeah. And so, again, there is there are these methods that have like decently good typical use rates. Mm-hmm. Not perfect, but decently good. And of course it depends a lot on the, the individual using them and their motivation and their, adherence to the method where they're gonna be on that, on that typical use. But, what I will say is something I learned when I was learning about the studies of these methods is it is difficult in the studies to capture the people whose intentions changed. So for example, if you one month where maybe. Trying to avoid pregnancy, and then the next month decided oh, well maybe we could, it's okay. I'm not worried. That's hard to capture. Yeah. Because again, it's a daily choice. And so, I, I bring this up just to say I think it's important as physicians for us to not be dismissive of people who chooses methods or just say I have nothing to offer you. Right. You don't have to go all the way as to teaching them, but you could at least not be dismissive or mean about it. Yeah. And then just provide 'em like, Hey, you know what? I don't know any of these methods. I'm not very familiar with them, but here's a handout I can give you Yeah. To learn more about them. Yeah. And so I think it's, reasonably, It's a reasonable expectation for a physician to at least have that level of familiarity when they're talking about birth control options.
Sonia Singh MDNo, and I think, like you said presenting the alternatives is part of informed choice, and I think what a lot of people feel is that they're getting thrown a pharmaceutical for everything. And so I think it would go a long way in terms of just. Patient trust, and regaining people's faith in doctors, to feel as though the only option presented was not a pharmaceutical. And even if are clear about, well, the effectiveness is gonna vary depending on, how closely you're following the, the protocol. As long as you've explained that to them and presented it as an option, even if people don't take it, I, I really think that there's therapeutic value in just having that part of the conversation. And I, I will fully admit, I just, I didn't have much knowledge about these. I never was, educated beyond the rhythm method, which was a, small box in the textbook that was like a don't do this. You know?
Rebecca Berens MDYeah. And I mean it's, if you're not taught, like, how can you know? Yeah. And I think, I think it's a fair expectation for patients to have of us to like. Be curious and look into these other things and Yeah. And even if you don't offer them term, 'cause you don't know, just not being judgment about it, about it if they
Sonia Singh MDstay Yeah. Judgment and, the decision that's right. For a woman who's in a stable, long-term relationship and could or could not have a ch you know, doesn't want one right now, but would be okay with it in heaven. That's a very different situation than a 16-year-old who is trying to prevent pregnancy, you know? Right.
Rebecca Berens MDOr someone who's experienced a severely high risk pregnancy mm-hmm. And has an actual, real life threatening risk if they become pregnant again. Yeah. That is, they need to have the autonomy different to make the right choice for them, and they're gonna maybe make a different choice. Yeah. But they need to have the autonomy of all options being presented.
Sonia Singh MDI wanna touch a little bit too on putting the claim in a little bit more of a cultural and political context. Because when I first read that tweet that we shared at the opening, the first feeling that I had was just this is kind of painting birth control generally as something that's just been thoughtlessly or maliciously given to women to just shut them up and control them. And now it's having all of these,, negative impacts and. To me that just totally ignores, the actual historical and political context and what birth control has meant for women's rights and reproductive rights generally. I mean, I think the fact that we think of it that way sometimes is just evidence of how our generation has never had to experience a world in which this wasn't an option. You know, to think that just a few generations ago, women didn't have any control over when their period came or not. The fact that we can control our menstrual cycles, let alone, fertility or anything is that's a big advancement, you know? And then beyond that to be able to control when you do and do not conceive or whether or not you do without any input or, participation from your partner. Is huge, and so I think to I'm sure there are women who remember it becoming an option who would probably be like, man, you guys don't realize like what it was like to not have this, you know?
Rebecca Berens MDYeah.
Sonia Singh MDSo anyway, I was curious about your thoughts too on just sort of the putting this can kind of like the political context.
Rebecca Berens MDYeah, absolutely. I mean, and that, we kinda alluded to that beginning, I think there is a concerted effort on the part of some people on social media with a certain agenda to. Sway people against the use of mm-hmm. Artificial forms of birth control. And, there's this whole like trad wife movement Yeah. On social media and like idealizing this mm-hmm. Life. And, and I think, like you said, historically, women fought very hard to have the choice not to do that. And if that is your choice Yeah. That is wonderful. But the choice is the important part of it. And I think like when there is not a choice in removing that choice from people, it is just, it's, it could be really devastating from the progress that's been made for women mm-hmm. In the last several generations. And birth control is a big part of that choice. Right. Because, especially even with the fertility awareness based methods, when you are teaching a person, it is not just the woman. The partner has to be a part of that conversation. Yes. And actively, they're actively also participating in that choice.
Speaker 3And,
Rebecca Berens MDWe know that domestic violence is rampant. Yeah. You know, rape in marriage is a thing that happens routinely. And so if you are a woman in a situation like that, you have to, the only way out for that person is to have some choice and some control over the situation. Mm-hmm. And so, I think it's just really important to keep that in mind. And, and you said, I think that's sort of ignored when we focus so much on these, these negatives. It's well yes, there are some side effects and it's, it should be an individualized decision. Mm-hmm. And we should be talking to people about all of their options. But also we have to consider that we wanna keep this option available for people who need it. Right. And I feel like that's being targeted right now.
Sonia Singh MDYeah. I mean, my feeling is just that the overall movement on social media has created a lot of fear and sometimes even guilt. I have patients who will say, oh my God, I was on birth control for 15 years. I just didn't know how bad it was. You know? And it takes a while to undo that for them and be like, it's okay. You are fine. Whatever is wrong right now is probably not because of the birth control. But I think there's so many women walking around that feel that way, that feel like they have done something harmful, to themselves by being on this because of what they're seeing. So, yeah. Anyway, there's another piece of context that I think was important to mention. So, all right. So what are the take homes here? What do you, what do you think, you take from this kind of, as a doctor in terms of what we can learn?
Rebecca Berens MDSo I think from, as we talked about with, with doctors, we need to acknowledge the gaps Yeah. And the sexism that's inherent in medical research of Yeah. How we, why we have those gaps. And we need to advocate for funding so we can address those gaps because we want to address them in an evidence-based way. Yeah. And we wanna make sure that we are not just leaving this to the influencers of the internet to take over. Right. And it is very important for us to be very thoughtful in how we're communicating with patients. Yeah. And again, the, the tenants have informed consent. Risks, benefits, alternatives. Yeah. We need to have all of those when we're talking. And it needs to be a shared decision. And if a patient makes a decision, that's not the decision that you would make. Yeah. As long as you have clearly communicated all of the options to them that is their and it's not fair to be judgmental to them about that. And we wanna make sure that we are sharing all the options. And actually, I put a note here that we didn't mention, but a vasectomy is also an option. Yeah. So I think we also sometimes are so focused on what can the woman do? Yes. Yes. For birth control, vasectomies are great birth control options. So we wanna make sure that we're taking into account, but we also to recognize that we know there isn't always time. Yeah. For doctors in the traditional, we know well volume-based healthcare system. Mm-hmm. You and I are very lucky in our practices. Yeah. We have lots of time, but that, that's not really the reality for other doctors. And so, doing what you can to summarize that, whether it's a handout, whether it's something just to make the patient understand that, I really do wanna give you all the information. This is how much time we have today. Yeah. This, it doesn't have to be a decision today. We can come back to this, but here's some resources for you to, to read.
Sonia Singh MDYeah.
Rebecca Berens MDYeah. And
Sonia Singh MDI think just taking into account as a physician, that when a patient comes to you with a bunch of information that they found on social media, just taking a beat and, reflecting on the fact that this is a buildup of decades of, all the things we've talked about, like feeling unheard and misunderstood and underrepresented and having their concerns not fully addressed, that is leading to this. And, to just take a moment before immediately dismissing that or becoming judgmental and for a moment try to picture things from their perspective and, give them. The explanations and, the evidence-based information in a empathetic, compassionate, non-judgmental kind of way. Yeah.
Rebecca Berens MDAnd I do just wanna acknowledge, like I know how burnout inducing it is Yeah. For the physicians in the system to deal with this. 'cause when I left, like the traditional system practice was in 2020.
Sonia Singh MDYeah.
Rebecca Berens MDI cannot even imagine
Sonia Singh MDYeah.
Rebecca Berens MDHow things have escalated in the last five years. But When they come and they're coming in with this sort of immediate it's me versus you. Right. It's this
Sonia Singh MDthere's already a distrust. Yeah. There's distrust, you know, and
Rebecca Berens MDit's it's so hard to overcome that and hold yourself together, visit after visit, after visit, after visit. But I think for us to rebuild that trust, that is so important. And so again, leaning on any resources that you can to say here's a list of all of the resources. And you're welcome to come back and we can talk about them in more depth, but just having something to give to so that they feel that you actually truly have considered all the options for them. Yeah. And that's something you can put together and then use it over and over again. Well,
Sonia Singh MDhopefully this podcast can be one of those resources, we're doing this because we have the time and bandwidth and I think like 99% of physicians do not have the time and bandwidth to do this level of discussion. And we just talked for who knows how long, an hour or something on this topic and, you get, the average of 11 minutes or something with your healthcare provider. So, I can understand why so many doctors. Fall short here, because it feels like a losing game, and especially when, they hear your voice for those 11 minutes and then, their social media feed is telling them all day, every day, something completely different. It's, it feels like you're never gonna win. Yeah. So, hopefully we can be a resource in that respect. Okay. And then as patients, what do you think people should take home from this?
Rebecca Berens MDYeah, so I hope that this kind of review has given people some one context Yeah. For this discussion. And then also some more balanced information Yeah. Than what you're seeing. On social media. Yeah. Yes, there are true real risks and side effects to birth control pills, but there's also a lot of benefits and in the right patient they can be a great option. Yeah. And so it's, it really should be a shared decision and hopefully this is, more information for you to be able to help make an informed decision for yourself. And we'll include some resources in the show notes too for where patients can go to learn about. All of the various birth control options and compare them and then, we'll probably do some more, more birth control content in the future. 'cause it's a big topic. Okay. And then how do you talk to your patients about birth control? Yeah, so first I think with me, I'm seeing a lot of patients with PCOS, it's a super common thing that I see. And so when someone comes in, well, first of all, I'm always asking a menstrual history. For any patient that menstruates, how old were you when it started? What was it like when it started? What is it like now? Yeah. What birth control have you used in the past? And then what concerns do you have about it? Often they're coming in mm-hmm. With a menstrual concern. And so it's just hearing what is your cycle like, how long has it lasting? What's the bleeding like? What's pain like, getting a full understanding of the symptoms that they're experiencing and doing an evaluation. Of where that could be coming from, rather than just saying okay, let's treat it right and then we'll figure it out later. It's more of a discussion of we are gonna figure out what caused this, but in the interim mm-hmm. Here are some options that could help you manage the bleeding. Yeah. Because I'm sure you've seen this as well, there's so many patients who become severely anemic from heavy menstrual bleeding. Mm-hmm. There are patients who are, just completely unable to do the social activities that they would like to do. Yeah. Because of the pain, the bleeding is either it's so either so painful or it's so irregular and unpredictable. Yeah. They're like, I don't wanna swim, I don't wanna go to the beach. You know? Right. And so, we can manage their symptoms now
Speaker 3but
Rebecca Berens MDwe can also figure out what's causing it. Mm-hmm. And help get as best of an understanding as we can. And so I think that it's that It's both. It's not just treating, it's also evaluating. Yeah.
Sonia Singh MDYeah. Okay. So that brings us to the end of the episode. We're gonna put some resources and references in the show notes, also some Instagram, social media handles that you can follow for evidence-based information to balance out maybe some of the other things you're seeing. And that brings us to the end of the episode. All right, thanks. Thanks. Hey guys, last but not least, we have a very important disclaimer. This podcast is intended for educational and entertainment purposes only. The content shared on this podcast, including but not limited to opinions, research discussions, case examples, and commentary, is not medical advice and should not be considered a substitute for professional medical evaluation, diagnosis, or treatment. Listening to this podcast does not establish a physician-patient relationship between you and the hosts. We are doctors, but not your doctors. Any medical topics discussed are presented for general informational purposes and may not apply to your individual circumstances. Always seek the advice of your own qualified healthcare professional regarding any questions you have about your health. Medical conditions or treatment options, never disregard or delay medical advice because of something you've heard on this podcast. While the hosts are licensed physicians, the views and opinions expressed are our own and do not represent those of our employers, institutions, organizations, or professional societies with which we are affiliated, although we do our best to stay up to date. Please note that this podcast includes discussion of emerging research, evolving medical concepts, and differing professional opinions. Medicine is not static and information may change over time. We, the hosts make no guarantees about the accuracy, completeness, or applicability of this content, and we disclaim any liability for actions taken or not taken based on the information provided in this podcast by listening to the Antisocial Doctors Podcast, you have agreed to these terms. Thanks again for joining us.