Category: Birth Control

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Birth Control Health Period

Premenstrual Dysphoric Disorder (PMDD): Symptoms and How Hormonal Birth Control Can Help

This extreme version of PMS can be both life-changing and life-threatening. How can birth control help in alleviating symptoms of PMDD?

Premenstrual Dysphoric Disorder (PMDD) is more than just Premenstrual Syndrome (PMS)

For starters, PMDD is not a hormonal imbalance nor is it merely behavioural changes during that excruciating time of the month!

PMDD is commonly defined as an endocrine disorder and is also known to be a more severe form of PMS. They are both similar in terms of experiencing hormone-related symptoms in physical and emotional forms. This typically happens during the premenstrual phase about seven to 10 days before your period starts, and persists for the first few days of your period. 

While this may sound familiar to most women (and significant others or partners who have to bear the brunt of PMS every month), there is a huge difference between PMS and PMDD. In fact, PMDD can be so extreme that sudden shifts in mood can disrupt daily life and even negatively affect relationships. In some cases, besides facing challenges in interpersonal functioning and maintaining social relations, PMDD can also cause occupational impairment. This may refer to frequent outbursts towards loved ones or the inability to cope with the distressing symptoms at work, ultimately requiring one to take medical leave. 

How serious is PMDD?

PMDD affects about 5 percent of women of reproductive age and those who have underlying depression and anxiety are more likely to suffer from it. While there is no clear cause for this disorder, possible causes include genetics, thyroid and detrimental factors such as alcohol and substance abuse. 

According to the manual for assessment and diagnosis of mental disorders DSM-5, PMDD is also defined as a depressive disorder that requires prescription medication, unlike PMS. As its effects on women’s mental health are consistent and yet intermittent, PMDD tends to be underdiagnosed and undertreated. Thus, although PMDD may be uncommon compared to PMS, it is important to render conscientious attention and treatment as symptoms may worsen over time especially upon entering into menopause. As such, those with PMDD may harbour suicidal thoughts and behaviour which can be life-threatening. 

What are the symptoms of PMDD?

Similar to PMS, PMDD also causes bloating, breast tenderness, fatigue and changes in diet and sleeping habits. But the display of at least one of the below emotional and behavioural traits differentiates PMDD from PMS: 

  • Feeling sad or hopeless 
  • Severe moodiness 
  • Anxiety or tension 
  • Easily irritable or angry 

If you experience either one of the symptoms alongside other common symptoms* which occur before your menstrual flow that significantly disrupts your ability to function in everyday life, there is a chance you may be suffering from PMDD. 

Emotional SymptomsPhysical Symptoms 
– Agitation or nervousness
– Irritability
– Feeling overwhelmed and out of control
– Crying spells
– Anger, sadness
– Suicidal thoughts
– Panic attacks, paranoia
– Moodiness
– Forgetfulness
– Loss of interest in activities and relationships		– Acne
– Back, joint or muscle pain
– Bloating
– Breast swelling and tenderness
– Constipation, diarrhoea, nausea, vomiting
– Cramps
– Dizziness, headaches
– Appetite changes
– Reduced sex drive
– Lethargy or fatigue
– Sleep disturbance 
Common symptoms of Premenstrual Dysphoric Disorder (PMDD)

If you feel you check most of these boxes, you can first take a self-screening test online. As PMDD symptoms may overlap with features of other medical conditions that mimic PMDD, it is strongly advised to seek professional help and speak with a healthcare provider for a diagnosis thereafter. 

How can birth control help with PMDD? 

Yes, birth control does more than helping you prevent pregnancy!

Hormonal interventions utilising oral contraceptives is one useful method in treating both PMS and PMDD. PMDD symptoms tend to arise once ovulation begins. Thus, as birth control pills prevent ovulation, they can regulate hormone levels in order to suppress ovulation and its related hormone changes, thereby avoiding premenstrual symptoms.

Most birth control pills are usually prescribed such that there are 21 active pills followed by seven days of placebo pills containing only sugar. This creates a hormone-free interval where the transition from taking active pills to sugar pills causes a sudden decrease in hormones.

Currently, Yaz is the only FDA-approved hormonal birth control pill used to treat PMDD. It implements a 24-day dosing regimen with active pills, followed by four inactive sugar pills. Similarly, other birth control options such as contraceptive patches and rings can also help to treat PMDD. 

Nonetheless, these benefits are also accompanied by certain risks for some individuals. Some may be more sensitive toward the sudden fluctuations in hormone levels and instead experience even more severe mood swings. Unsuitable candidates for treating PMDD with hormonal medications also include: 

  • Those with a past medical history of blood clots, stroke or migraine 
  • Smokers, especially those over 35 years of age 

What are other treatment options or alternatives? 

More often than not, a combination of solutions is needed in order to treat PMDD. 

Other ways to prevent or minimise PMDD symptoms:

  • Selective serotonin reuptake inhibitors (SSRIs) — commonly prescribed antidepressants 
  • Nutritional supplements rich in calcium
  • Over-the-counter pain relievers such as ibuprofen and aspirin to relieve physical symptoms 
  • Stress management

What’s next? Well, taking charge of your own health and wellness is also extremely important in treating PMDD. Firstly, you can start with small steps such as having frequent meals lower in salt but high in nutrients from fruits, vegetables and whole grains. Next, have sufficient hours of sleep or try out various relaxation techniques like meditation and yoga.

Exercising five days a week for at least half an hour a day and cultivating healthy sleep habits will also aid in reducing premenstrual symptoms. And if you’re a coffee addict or frequent bar-goer every TGIF, perhaps it’s time to cut down on both the caffeine and alcohol as they will also help to ease symptoms. 

Remember, you can take charge!

Ultimately, it is always important to get the right diagnosis if you feel like you have PMDD. So here’s an important tip: A tracking journal will be most useful for you to start tracking and recording your symptoms before you decide to visit the doctor. Different remedies may work differently for every individual but if you do decide to opt for birth control as a solution, don’t hesitate to find out more about your options with Siena!

References: 

Categories
Birth Control Sexual Health

Birth Control Before The Pill: How Women Prevented Pregnancy Throughout History

Discover a brief history of contraception before the invention of the birth control pill. You’ll be surprised to know about various bizarre and ancient methods!

Birth control options are now more than ever readily accessible in both physical and online spaces. But have you ever wondered how it was like for women in the past when technology wasn’t a thing yet? Read on and I imagine you will count yourselves lucky to be living in the 21st century. Now, you can even get your birth control online and delivered right to your doorstep.

Ancient birth control methods, no thanks!

Commonly used traditional methods comprise largely home-made techniques, some of which may (or may not) surprise you. In the ancient era, women relied on disturbing ingredients like crocodile dung, and bizarre concoctions of edibles such as honey and acacia. Condoms were made from animal membranes and there was a common practice of washing and soaking one’s genitals with ingredients like lemon and olive oil. Lastly, a deadly-sounding method even includes ingesting lead and mercury. Otherwise, before the discovery of chemical and hormonal contraception, the traditional withdrawal (pull-out) method was just as common back then. 

British artist William Blake’s depiction of King Minos. Image credit: National Gallery of Victoria

What about the trusty “wetsuit”? The first known documentation of the use of condoms was by King Minos of Crete in about 3000 B.C. Apparently, his semen contained “serpents and scorpions” which killed his mistresses after intercourse. Back then, condoms were subjected to primitive ideals and definitely did not come in the clean, rubber form we are now accustomed to. Thus, as a form of protection, a goat’s bladder was inserted in the vagina of King Minos’ wife to act as a sheath. Essentially, animal bladders were primarily employed to prevent the contraction of venereal diseases rather than to prevent pregnancy. Resourceful or downright nasty? You decide. 

Finally (and thankfully), rubber was introduced in the manufacturing of condoms which brought about real technological advances. By the 1860s, there was a rise in the large-scale production and popular use of latex condoms, altogether replacing skin condoms made from animal intestines or bladder. 

The battle for birth control

Despite being normally associated with family planning, birth control faced resistance in the 1800s. Many perceived contraception as immoral and akin to encouraging prostitution. (Source: Stanford Medicine)

In fact, under the Comstock Act of 1873 in the United States, even medically prescribed writings or materials regarding contraception and abortion were made illegal as they were seen as obscene and indecent. As a result, the enforcement of the sale and distribution of materials concerning birth control eventually prompted social reformers to advocate the repealing of the federal law. Before the birth control movement became closely tied to the feminist movement, worry-free and safe sex were pretty out of reach for women in those days.

From the 1940s to 1950s, activists Margaret Sanger and Katharine McCormick embarked on a vigorous scientific research in search for the pill that could potentially control fertility. Oh boy did this cause a shift in the previously uneven level playing field for women to take charge of their sexual health. The first invented pill was both effective and simple to use, thus attracting millions of women to partake the first of oral contraceptives. (Source: Planned Parenthood Federation of America) 

Implants such as the intrauterine device (IUD) also made their mark in history since 1909. IUDs were first experimented using a ring made of silkworm gut with two protruding ends of the cervical os. Subsequently, other physicians such as Ernest Graefenberg (FYI: the G-spot was named after him), developed similar versions that proved more effective with the use of a mixture of metals including copper. Ultimately, it was only in the 1980s did the FDA-approved Copper-T gain more significant traction as one of the most effective and safest forms of contraception. 

Revolutionary effects

Needless to say, birth control has improved drastically and we should all be grateful for today’s plethora of reliable birth control methods to choose from. Beyond mere access to birth control pills, other forms of birth control such as patches and emergency contraception have likewise allowed women all around the world to be empowered, educated and take charge of their own health.

References:
Armitage, H. (2018). Contraception: An evolution and history. Stanford Medicine. https://scopeblog.stanford.edu/2018/05/16/contraception-evolving-the-options/

Burnette, B.R. (2009). Comstock Act of 1873 (1873). The First Amendment Encyclopedia. https://www.mtsu.edu/first-amendment/article/1038/comstock-act-of-1873#:~:text=%2C%20public%20domain

Khan, F., Mukhtar, S., Sriprasad, S., & Dickinson, I. K. (2013). The story of the condom. Indian Journal of Urology, 29(1), 12-15. https://doi.org/10.4103/0970-1591.109976

Margulies, L. (1975). History of intrauterine devices. Bulletin of the New York Academy of Medicine, 51(5), 662-667. https://pubmed.ncbi.nlm.nih.gov/1093589/

Marhol, A. (2021). Ancient Birth Control Methods: How Did Women Prevent Pregnancy Throughout the Ages? Flo. flo.health/menstrual-cycle/sex/birth-control/ancient-birth-control-methods

Planned Parenthood Federation of America. (2015). Birth Control – History of the Pill. https://www.plannedparenthood.org/files/1514/3518/7100/Pill_History_FactSheet.pdf

Categories
Birth Control Health Period Skin

Hormonal Acne Breakouts: How can I prevent it?

Do you find yourself breaking out 1-2 weeks before your period every month?

It is likely to be hormonal acne, a flare-up of blemishes every month due to a fluctuation in hormonal levels in the body. These may present as large, painful, cystic acne around the chin and jawline.

Less commonly, hormonal acne may be due to an underlying medication condition such as Polycystic Ovarian Syndrome (PCOS).

Why does hormonal acne flare up before my period?

About 2 weeks before your period, the hormones estrogen and progesterone drop dramatically, while you will also experience a slight increase in testosterone.

The drop in estrogen and progesterone can trigger your sebaceous glands to secrete more sebum – an oily substance that lubricates your skin. This oil provides the perfect breeding ground for bacteria, and thus causes clogged pores, pimples and cystic acne (those somewhat painful bumps just under the skin) – usually around the chin and jawline.

While testosterone is thought of as the ‘male’ sex hormone, it exists in slightly differing amounts in everyone. The increase in testosterone can trigger acne by over-stimulating oil glands, which ultimately creates a fertile breeding ground for bacteria on the skin – resulting in clogged pores and period acne. They can also change the skin cells that line hair follicles, making them sticky and more likely to clog pores.

So what can you do about hormonal acne?

For acne that is related to your period, intervention treatment needs to be hormonal as well to work.

Birth control pills or patch

Hormonal birth control – including birth control pills and patches raise estrogen levels and reduce the effects of testosterone on women. Lower levels of testosterone reduce sebum levels, directly reducing breakouts and possible acne due to less oil and bacteria growth.

According to WebMD, hormonal birth control increase a protein known as “sex-hormone binding globulin” (SHBG) in the blood. In turn, SHBG acts like a testosterone sponge soaking up testosterone in your blood. In simple words, lesser testosterone equals lesser sebum which results in less acne.

Be patient when you first start hormonal birth control to control acne. Some women may experience increased breakouts for the first few months. However, this normally goes away as your body adjusts to the change in hormones.

Some birth control pills and patches are specifically useful for controlling acne, including Yaz and Evra Patch. Speak with your doctor before deciding if this is right for you!

Exercise and eat well (Non-hormonal)

Drink more water as the drop in estrogen and increase in testosterone can leave your skin dehydrated and thus susceptible to sebum build-up and clogged pores. Studies have shown dairy products and high glycemic (GI) foods can trigger acne as well, so stay off milk related products and processed foods to keep your skin healthy.

Categories
Birth Control

Guide to Birth Control Methods in Singapore

What is Birth Control?

Birth control, also known as contraception, anti-conception, and fertility control, is a method or device used to prevent pregnancy. Although birth control has been used since ancient times, effective and safe contraception methods only became available in the 20th century.

Birth Control in Singapore

One of the most commonly practised birth control methods in Singapore is the rhythm method (sex only while you’re not ovulating) and withdrawal (pull out) method, which is not super effective. After all, sperm can be extremely tricky – they can live inside the vagina and the rest of the reproductive tract for up to around six days.

Another common method is male condoms. Condoms can be readily bought at any convenience store or supermarket and offer protection against sexually transmitted infections (STIs). However, they are only about 85 percent effective in preventing pregnancies (one of the lowest). The effectiveness of condoms depends on when and how it is put on and there is also a risk of condoms tearing during sex.

There are other birth control methods that have higher success rates – but they can cost more money, take more discipline to use or require more commitment. All require a doctor’s prescription after a thorough consultation.

Types of Birth Control Methods

These contraception options can be split into 2 major categories – Temporary and Permanent.

ContraceptionTemporary (Reversible)Permanent
MethodHormonal birth control (Short-acting)
– Birth control pill
– Birth control patch
– Contraception injection

Intrauterine device (Long-acting)		Tubal ligation

To help you along, we discuss the common contraceptive methods in Singapore, their mode of action, effectiveness, pros and cons. Here’s what every responsible man and woman should know.

1. Birth control pill 

What are the best birth control pill brands?
Birth control pill

What is birth control pill?

Birth control pills are medications you take by mouth to prevent pregnancy. Hormones in the pills prevent pregnancy by:

  • stopping or reducing ovulation (the release of an egg from an ovary)
  • thickening cervical mucus to keep sperm from entering the uterus
  • thinning the lining of the uterus so that a fertilized egg is less likely to attach

Effectiveness:

Used perfectly, most birth control pills are 99 percent effective at preventing pregnancy. In “real life” conditions (e.g. occasional missed or late dose), the birth control pills are about 91 percent effective. 

Pros:

  • you don’t need to use the pill every time you have sex in order to stay protected, unlike condoms
  • fertility returns immediately when you stop taking it
  • lower risk of ovarian and endometrial cancer
  • non-contraceptive benefits such as:
    • helping to regulate the menstrual cycle;
    • manage acne; and
    • improve PMS symptoms.

Cons:

  • not for those who hate popping pills
  • have to take the pill every day for it to work properly
  • not suitable for women with certain existing health problems, or medications

2. Birth control patch 

Contraceptive patches
Birth control / contraceptive patch

What is birth control patch?

The birth control patch is a thin skin patch that is worn anywhere on the abdomen, thigh, buttocks or arm and changed weekly. The patch releases a daily dose of hormones (estrogen and progestin) through the skin into the bloodstream to prevent the ovaries from releasing eggs each month (ovulation). It also thickens the cervical mucus, which keeps sperm from getting to the egg. (Source: MayoClinic)

Effectiveness: 

Used perfectly, most birth control patches are 99 percent effective at preventing pregnancy. In “real life” conditions (e.g. forget to replace the patch or patch is not stuck properly), the birth control patches are about 91 percent effective. 

Pros:

  • good alternative for people who find pill-popping a hassle

Cons:

  • the patch is not transparent
  • might be uncomfortable due to Singapore’s hot and humid weather
  • some women get insecure because they are unsure if it will fall off

3. Contraceptive injection 

Understanding Combined Contraceptive Injections
Contraceptive injection

What is contraceptive injection?

The contraceptive injection is a shot of hormones given by your GP or gynae to prevent ovulation and has to be repeated every 90 days.

Effectiveness:

Used perfectly, most contraceptive shots are more than 99 percent effective at preventing pregnancy. In “real life” conditions (e.g. missed or late shots), the contraceptive shots are about 94 percent effective. 

Pros:

  • good alternative for people who find pill-popping or changing patches a hassle
  • suitable for breastfeeding mums
  • light or possibly no periods after a year

Cons:

  • weight gain and irregular bleeding in the first three months are possible as your body adjusts
  • takes 6 to 12 months to regain fertility after you stop the injections

4. Intrauterine device (IUD) 

Caucasian woman holding IUD in hand
Intrauterine device (IUD)

What is IUD?

An IUD, or the coil, is a small T-shaped device that is inserted and left in your uterus to prevent pregnancy. Some IUD types work by releasing small amounts of hormones, while others use copper to trigger your immune system to prevent pregnancy.

Effectiveness:

More than 99 percent effective at preventing pregnancy

Pros:

  • can be left in the womb for up to five years
  • fertility returns immediately once you remove it

Cons:

  • may cause irregular bleeding or spotting
  • usually not recommended as the first choice for anaemic women or those who have heavy periods
  • there is a small risk that the IUD may fall out and cause an infection during the insertion (in rare instances)
  • difficulty in removing the device.

5. Tubal ligation

Tubal ligation

What is Tubal Ligation?

During a tubal ligation (female sterilization), the fallopian tubes are cut, tied or blocked to permanently prevent pregnancy. Tubal ligation prevents an egg from travelling from the ovaries through the fallopian tubes and blocks sperm from travelling up the fallopian tubes to the egg. (Source: Mayo Clinic)

Effectiveness:

More than 99 percent effective at preventing pregnancy

Pros:

  • a good option for women who are certain that they no longer want more children
  • does not affect your hormone levels and you’ll still have periods

Cons:

  • irreversible
  • small risk of complications as with any surgery, such as internal bleeding, infection or damage to other organs

Which Birth Control Method Is Right for Me

When it comes to birth control, you have options and there are no bad options.

What suits you will depend on factors such as your age, frequency of sexual activity, family history regarding certain illnesses, comfort level when using a particular method, and level of desire to be pregnant in the future.

And remember, you don’t have to figure it out all on your own. Before settling on any option, do your own research or speak with your doctor to figure out which contraceptive will work best for you.

At Siena, you can speak to one of our female doctors in the privacy and comfort of your home, order your contraceptives online and get them delivered to your door in discreet packaging. Feel free to reach out!