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Birth Control Emergency Contraception Health Sexual Health

Missed Birth Control Pills: What To Do If You Forget Your Pills?

Credit: Illustration by Siena Health

Realising you missed your birth control pills can be a scary and stressful experience, and we know that. So here’s a step-by-step guide on what you can do to ease your worries! 

Perhaps you were running late and in a moment of panic, you couldn’t afford to indulge in your regular morning routine. Or you didn’t purchase your refills in time and realised it was way too late. 

Whichever’s the case, missing your birth control pills can most definitely leave you in a flurry, especially when you have devoted yourself to it. But alas, it happens so don’t beat yourself up about it! Thankfully, there are ways to manage this (mini) crisis. 

If you missed your pills, your next line of action should take into consideration:

  • Number of pills you have missed 
  • When you missed the pill (how far in are you with your pack)
  • Type of birth control pill you’re on (combined contraceptive pill or the progestogen-only pill)

The information leaflet that comes with your contraceptive pills should also have stated specific instructions on the steps you should take regarding the specific brand of birth control you are on. 

Symptoms you may notice if you missed your pills 

If you aren’t 100% sure, there are several symptoms that are pretty clear indicators you missed taking your birth control pills. The most common side effect is light bleeding or starting your period. You may experience menstrual cramps and nausea associated with it. 

Typically, there’s nothing to worry about and everything should return to normal once you’re back on the contraceptive pills regularly!

Combined contraceptive pill

The combined contraceptive pill contains both estrogen and progestin. There is a great variety of combined contraceptive pills you can choose from but some of the common combination pill brand names include Yaz, Yasmin, Microgynon 30, Liza, Mercilon and Drospera. A combination pill is considered “missed” if you don’t take it for 24 hours or more after you were supposed to. 

If you are late (less than 24 hours) or missed (24 to 48 hours) an active pill

You’re still protected against pregnancy if you missed 1 pill anywhere in the pack or started a new pack 1 day (24 hours) late. 

Follow these steps:

  1. Take the late or missed pill immediately
  2. Continue taking the remaining pills at the usual time (even if it means taking two pills on the same day)
  3. Take the 7-day pill-free break as prescribed or if you’re on an everyday pill, take the inactive pills 
  4. Emergency contraception is not usually needed but can be considered if hormonal pills were missed earlier in the cycle or in the last week of the previous cycle
  5. No additional contraceptive protection (e.g. condoms) needed

If you missed two or more active pills (48 hours or more)

When this happens, it greatly increases your chances of ovulation. In this case, when you missed 2 or more active pills anywhere in the pack or started a new pack only after 2 days (48 hours) or more, you may not be protected against pregnancy. 

What you should do:

  1. Take the last pill that you missed immediately even if it means taking 2 pills a day 
  2. Discard any earlier missed pills 
  3. If the missed pill is within: 
    • Week 1 (pills 1 to 7) or Week 2 (pills 8 to 14) of the pack:
      • Continue to take the active pills in your current pack daily
      • Take the inactive (sugar) pills or a 7-day break
      • Begin a new pack the next day
    • Week 3 of the pack (pills 15 to 21): 
      • Continue to take the active pills in your current pack daily
      • When you have finished taking all the active pills, discard the pack
      • Don’t take the inactive (sugar) pills or a 7-day break, begin a new pack the next day
  4. Consider taking emergency contraception if you missed 2 or more pills during the first week of a pack and/or had unprotected sex in the last 7 days
  5. Use extra contraception (i.e. condoms) or abstain from sex for the next 7 days 

If you missed inactive pills 

If you miss 1 or more inactive (sugar) pills, simply throw away the missed pills and take the next pill at the usual time. Remember, you also have to stay on track with your active pills as there should be no more than 7 consecutive active pill-free days between packs.  

Missed birth control pills: a brief overview

ScenarioRecommended ActionsEmergency ContraceptionBack-up Birth Control
Late or missed 1 active pill– Take the late or missed pill immediately
– Continue taking the remaining pills at the usual time (even if it means taking two pills on the same day).		Consider only if you missed the pill earlier in the pack or in the last week of your previous packNot required
Missed 2 or more active pills– Take the last pill that you missed immediately even if it means taking 2 pills a day
– Discard any earlier missed pills 

If you missed the pill within week 1 – 2 of the pack (pills 1 to 14):
– Continue to take the active pills in your current pack daily
– Take the inactive (sugar) pills or a 7-day break, begin a new pack the next day

If you missed the pill within week 3 of the pack (pills 15 to 21):
– Continue to take the active pills in your current pack daily
– Skip the inactive (sugar) pills or 7-day break, begin a new pack the next day		Consider only if you missed 2 or more pills during the first week of a pack and/or had unprotected sex in the last 7 days.Use extra contraception or abstain from sex for the next 7 days 
Missed 1 or more inactive pills– Discard missed pills and take the next pill at the usual timeNot requiredNot required

Progestogen-only pill or mini pill 

Unlike the combined contraceptive pill, progestogen-only pills (aka mini pills) contain progestin and not estrogen. They are taken continuously without any hormone-free breaks. 

If you missed a pill within the 3-hour (mini pills) or 12-hour window period (desogestrel pill)

You will still be protected against pregnancy if you are: 

  • Less than 3 hours late in taking a progestogen-only pill
  • Less than 12 hours late in taking a desogestrel pill

What you should do: 

  1. Take your missed pill as soon as you remember 
  2. Take your next pill at the usual time 
  3. There’s no need for an additional form of contraception or emergency contraception even if you’ve had unprotected sex

If you missed a pill for more than 3 hours (mini pills) or 12 hours (desogestrel pill)

Heads-up, according to the National Health Service, you’re likely unprotected against pregnancy! 

What you should do: 

  1. Take 1 pill as soon as you remember even if you have missed more than 1 pill
  2. Take your next pill at the usual time – this may mean taking 2 pills in a day (1 when you remember and the other at the usual time) which is totally okay to do so 
  3. Continue taking your remaining pills daily at the same time 
  4. You may need emergency contraception if you’ve had unprotected sex in the last 5 days
  5. Use back-up contraceptives for the next 2 days (48 hours) after taking the missed pills or simply refrain from having sex 

Useful tips to help you remember to take your pills on time

Whether or not you’re trying out a new routine to remind yourself to take the pill or ensuring you’re way more well-equipped after your first “missed birth control pill” scare, the following list of tips we’ve compiled will definitely help you.  

  • Opt for another birth control method such as the patch as it only needs to be changed once a week 
  • Set a recurring alarm or reminder on your phone 
  • Use a birth control pill reminder application 
  • Incorporate it into your daily routine 
  • Place the pills in an easily noticeable spot (e.g. bedside table, beside your toothbrush)
  • Get your partner to remind you

Seek help if you need to

We totally get that it can be real confusing knowing you missed your pill and the follow-up steps taken vary depending on what type of birth control pill you’re on. But hopefully, this condensed guide can be your saving grace in times of need (and that you won’t be referencing it anytime soon!).

Feel free to reach out to Siena’s doctors, if you are unsure which instructions pertain to your oral contraceptive pills or to discuss any other concerns you may have with your birth control method. 

References:

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Birth Control Health Period

Managing Migraines with Birth Control

Do you frequently experience migraines that frustrate the life out of you? Learn more about its causes and how birth control can help you cope.

Two types of headaches that are linked to your menstrual cycles

Tension headaches 

There are different types of headaches that vary in terms of their causes and nature of pain. But one of the most common forms of headache pain (aka tension headaches) may be linked to your menstrual cycle. The pain resulting from tension headaches tends to spread across both sides of the head and you’ll also experience slight pressure.

A study conducted among 165 female patients established menstrual tension-type headache as a real disorder that could represent a variant of migraine headaches. Thus, some women do experience tension headaches around the time of their period.

Menstrual migraines

Women who experience migraines reported that the attacks usually occur either right before or during their periods. This is also known as menstrual migraine. (Source: The Migraine Trust) 

A migraine is not merely a severe headache. Rather, migraine is a disabling neurological disease and headaches are only one symptom of migraines that can range in severity and length. It usually starts off as a one-sided throbbing headache, alongside other symptoms like nausea, dizziness, extreme fatigue, and increased sensitivity to light, sound or smells. 

More often than not, migraine attacks can be spontaneous as well. Thus, it is easier to detect the causes of headaches as migraines typically have several common triggers without a single cause. These triggers may vary depending on individuals:

  • Gender and hormonal shifts: Menstrual cycles and hormonal changes can cause menstrual migraines. In fact, migraine is three times more common among women than men and in the United States, it affects approximately 37% of women during their reproductive years. 
  • Allergies: Body irritation and inflammation as migraines are associated with the inflammation of blood vessels. 
  • Family history and genes: There’s often a hereditary link so you’re more likely to experience migraines if you have family members who suffer from the same problem.
  • The environment: This covers a wide range of factors from changes in weather, stress, lack of sleep and even food.

Why you may experience headaches or migraines around the time of your period

Hormonal imbalance

The cause of menstrual migraines is best explained by a drop in estrogen levels during your period whereby sensitivity toward such hormonal fluctuations makes you more vulnerable to migraines. It can also happen if you’re pregnant or going through menopause.

Low iron levels

Another reason why you may experience headaches after your period is because of low iron levels after shedding blood and tissue during your period. Especially for those who usually experience heavy period flow, greater loss of blood may cause iron deficiencies and thus trigger headaches.

Hormonal treatment to prevent migraines

Maintaining hormone levels during your period

Birth control like the combination pill, progestin-only pill, patch and even vaginal ring are forms of treatments that can help to relieve symptoms of migraine through hormonal balancing. Not only do they help to stabilise estrogen levels by regulating hormones throughout your menstrual cycle, but they also reduce uncomfortable period symptoms. Low-dose estrogen birth control pills are normally recommended to prevent migraines as you can avoid experiencing a sharp drop in hormone levels during your period.

Skipping periods

Otherwise, you may also choose to opt for a continuous dose of the pill to reduce the likelihood of migraines. This essentially means you continue taking active, low-dose estrogen pills instead of placebo pills during the seven inactive days. Thus, the steady dose of estrogen should prevent the drop in hormones that usually occurs once you stop taking active pills on inactive days. Altogether, this should help you reduce the severity and frequency of migraines while experiencing lesser withdrawal bleeding. 

If you’re on birth control that comes with the sugar (placebo) pills, simply skip them and start a new pack so that hormones are continuously released into your bloodstream. 

That’s right, birth control isn’t just for preventing pregnancy as skipping periods may even improve your quality of life because of certain benefits! Besides potentially preventing migraines and headaches, birth control can also reduce symptoms associated with premenstrual dysphoric disorder (PMDD) and symptoms of your periods like menstrual cramps, bloating and even acne.

Lifestyle changes to cope with migraines

Although there’s no single cure for migraine, lifestyle changes can help you counter the negative effects. This includes: 

  • Regular exercise 
  • Adopting a healthy diet to avoid trigger foods 
  • Improving sleep habits 
  • Practising relaxation techniques (e.g. yoga, meditation) 

Keeping a journal or record of your migraine episodes can also help you track patterns such as the duration and symptoms to identify potential causes. You’ll definitely be more well-equipped to deal with your migraines by recognising and avoiding triggers.

Need help?

If you do have a history of migraines, it’s best to consult a doctor before you begin a new birth control method. With Siena, you can even have your consults online and preferred birth control delivered straight to your doorstep for free!

References: 


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Birth Control Sexual Health

Birth Control Patch: 7 Facts You Should Know

Credit: Illustration by Siena Health

Don’t shy away from the birth control patch! Simple and convenient, it’s a seamless integration into your everyday routine and here are the reasons why.

With a variety of birth control to choose from, you may or may not have overlooked the birth control patch as another great alternative for your contraception needs. Or perhaps you’re unfamiliar with how the patch works and would rather stick to methods you’re used to. Nevertheless, the birth control patch is meant to be just as effective as birth control pills and may even be easier to use. 

A quick survey of the local landscape surrounding birth control based on a 2016 survey study: Singaporean women have low awareness and knowledge of hormonal intrauterine devices (IUD), the patch and the vaginal ring. This was the first survey study that assessed Singaporean women’s awareness and knowledge of contraception in Singapore. Thus, there were only a sparse few who actually used the patch. (Source: Singapore Medical Journal) 

Even though the patch may not be as popular as condoms or the pills, it works just the same in helping you prevent pregnancy. Especially if you dislike popping pills or if you’re afraid of going through with bigger commitments such as the implants and IUD, the patch is a perfect midway option. 

Read on as we cover how the birth control patch works, its benefits, and more!

1. The patch works by delivering hormones through your skin and into your bloodstream

Similar to birth control pills, the birth control patch contains two hormones estrogen and progesterone, which work together to prevent pregnancy by suppressing ovulation. When you wear the patch, it releases these hormones which your body subsequently absorbs through the skin.

The patch is able to stop ovulation while the hormones in the patch also thicken the cervical mucus, preventing sperm from entering the uterus. The hormones also thin the uterine lining which makes the implantation of a fertilised egg difficult.

Similar to birth control pills, the birth control patch is 99 percent effective in preventing pregnancy with perfect usage. But in real-life conditions, such as incorrect application or forgetting to replace the patch, they become about 91 percent effective. In comparison to the pill, however, the patch is a great alternative if you find daily pill-popping a hassle.

2. The patch is designed to be fun-sized and discreet 

Image credit: Siena Health

The birth control patch looks like a plaster, as it is a small and sticky square patch that is usually thin and beige in colour.

Worried about them being too obvious? You can apply them to the skin on your upper outer arm, abdomen, buttocks or upper torso. Take note: do not apply the birth control patch to your breasts or somewhere easily irritated by clothing.

3. You only need to think of the patch once a week

Application

The following steps are really important to ensure you use the patch accurately and effectively. 

Firstly, open the pouch containing the patch and remove the protective film. Apply the sticky side of the patch onto your skin by exerting slight pressure for at least 10 seconds to ensure it is properly attached before smoothing out any wrinkles. 

Thereafter, you can change your birth control patch each week over a period of three weeks and go without the patch during the fourth week. Similar to getting your period, you’ll experience withdrawal bleeding. After the fourth week has ended, start your next cycle with a new patch.

For first-time users of the patch 

Once the birth control patch has been prescribed to you, apply the first patch during the first 24 hours of your period. It becomes effective immediately after application within the first five days of your period. And yes, now you don’t have to worry about relying on any other back-up contraceptive methods! 

Alternatively, if you decide to use the first patch on the first Sunday after your period has started or you apply your first patch more than five days after your period started, the patch will not take effect immediately. Meanwhile, you should use an additional form of contraception (i.e. condoms) for the next seven days.  

Mark your calendars — note down the first day you apply the birth control patch and designate it as your next “patch-change” day! 

Each patch lasts for seven days so you’ll have to keep it on throughout and replace the patch exactly one week from the date you first applied it.

Extra tips:

  • Apply the patch on completely clean and dry skin
  • Avoid using lotion, oil, powder and makeup on the area you plan to apply the patch to
  • Try to store your unused birth control patches in a dry and room-temperature environment away from direct sunlight
  • Do not remove the patch from the pouch if you don’t intend to use it yet

4. Fuss-free removal process

Image credit: wikiHow

To remove the birth control patch, all you need to do is peel off the old one and replace it with a new one. It’s best to fold the adhesive sides of the old patch together before disposal so that it is not exposed. Do not flush the patch in the toilet as this may contaminate the water supply with hormones.

5. Do daily checks on your patch

This is an unlikely scenario as the birth control patch is designed to be firmly attached to your skin. You can safely shower, exercise and even swim with the patch. 

But in the event the patch does come loose or fall off, there are ways to get back on track! 

Prone to bad memory and sticking to a schedule? Don’t freak out because even if you really do forget to change your patch and it’s been less than two days (48 hours), just reapply a patch immediately and subsequently change your patch on the same day as the previous patch. If it’s only come loose, you can stick it back on and continue using it. 

However, if the patch has come off for more than two days or you’re unsure how long it has been since the patch fell off, reapply a new patch immediately and use another birth control method for at least a week. You’ll also have to begin a new four-week cycle and take note of the day you applied the replacement patch. The day on which you apply the new patch will be the new “first day” of the new application cycle. 

It’s uncommon for the birth control patch to fall off if you’ve followed the instructions closely. To prevent it from happening, try to cultivate a habit of checking your patch daily to ensure it’s still firmly attached to your skin. If the patch does not completely stick to your skin, immediately replace it with a new patch.

There is also a handy tool available online if you ever lose track of your birth control schedule and require help ASAP! 

6. The patch has other non-contraceptive benefits 

Similar to the benefits of other forms of hormonal birth control, the hormones in the patch can also help to lighten and regulate your periods while alleviating symptoms of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). It can even lower the risks of developing cysts in your breasts and ovaries. (Source: Planned Parenthood)

7. You can use your birth control patch to skip your period

A long-awaited holiday trip coming up? Attending a pool party in a couple of weeks? Or simply longing to head to the beach? With the birth control patch, you can be sure to leave all your period worries behind during times like these!

If you’d like to skip your period altogether, use the patch every week. This means starting a new pack of patches every three weeks without any break in between (i.e. continue using the patch during the fourth week). By doing this, the constant stream of hormones in your bloodstream eliminates your monthly withdrawal bleed.

What are you waiting for? 

Surely by now, you’re more familiar with the various upsides of the birth control patch and why it’s so convenient and easily reversible! Using the patch is definitely an effortless and painless process since it only needs to be applied once a week.

Feel free to check in with any of Siena’s female doctors before trying out or switching to a new birth control method. We’re most happy to help you find your most suitable, discreet and favoured birth control!

References:

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Birth Control Health

Does Birth Control Make You Gain Weight?

The truth about birth control and weight gain: it is largely due to water retention instead of actual increase in body fat! 

Are you reluctant to get birth control because you believe it may cause weight gain?

Weight gain is a common risk that most women are afraid of when it comes to birth control. And we do recognise why this may be a cause of concern. It’s one of those side effects you’re bound to constantly debate about with your girlfriends and still come to no clear conclusion at the end of the day.

But is this necessarily true? 

With a wide range of birth control options available now, it’s inevitable different individuals may react differently as well. Especially as birth control is more effective if you use it consistently, weight gain is also attributed to other factors such as lifestyle habits and routines or changes in metabolism as you age.

Most women don’t experience weight gain 

This may come as a form of reassurance but the majority of people on birth control do not actually experience weight gain. Any initial increase in weight is due to water retention rather than an increase in body fat and mass. As birth control may initially lead to water retention, you may feel a little bloated at the start. These effects are temporary and go away within a few weeks after starting birth control.

In fact, a 2008 study of 150 female athletes over two years found that oral contraceptives did not cause weight or fat mass gain. Similarly, a 2014 systematic review revealed that there was no significant causal relationship between weight gain and combination contraceptives as women taking birth control, compared with those in the placebo group, showed no substantial difference in weight.  

All in all, the hormones in birth control may trigger bodily changes but the idea that birth control leads to lasting weight gain is not a factual claim. 

Higher estrogen levels

Combined hormonal contraceptives such as birth control pills, patches and even the vaginal ring typically contain estrogen which prevents ovulation. This occurs as a compound (renin-angiotensin) created by the kidneys becomes stimulated because of the additional estrogen circulating throughout your body. This prompts your body to retain more fluid before your period. Essentially, higher estrogen levels may lead to a slightly higher level of water retention for those on the pill. However, there will usually be a decrease in weight after your period is over. 

Most birth control pills have approximately 30 to 35 micrograms of hormones but if you’re worried about the current dosage of estrogen in your pills, it’s best to consult your doctor and opt for a low-dose estrogen pill which will contain around 20 micrograms of estrogen.  

Higher doses of estrogen can potentially stimulate appetite, which may cause increased calorie intake in some women. 

Birth control implants and shots may be exceptions 

Hormonal implants, which are a form of long-term, reversible birth control may cause weight gain. This method works by inserting an implant into your arm, thereby releasing a synthetic hormone called etonogestrel into your bloodstream. Etonogestrel imitates progesterone by attempting to regulate your menstrual cycle alongside estrogen. 

Birth control shots can contribute to an increase in weight gain from water retention as its effects are meant to last for three months. Alternatively, you may want to opt for low-dose estrogen birth control pills instead. 

A final note

Always check with your doctor if you’re worried about the potential side effects or switching to a new type of birth control that fits your lifestyle. Other plausible causes for sudden weight gain may also be due to underlying health conditions such as thyroid disorders and diabetes. If you do experience bloating, keep in mind it is only temporary and there are other ways you can cope!

Here are some tips on how to reduce water retention: 

  • Lesser salt intake 
  • Staying well-hydrated 
  • Exercise consistently to move your muscles 
  • Wearing compression stockings during prolonged standing 

At Siena, we want to find the most effective and suitable birth control for you that also steers you away as much as possible from any unwanted side effects! Speak to any of our female doctors now from the comfort of your own home to explore your options.

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Birth Control Health Period

Period Pain and Birth Control: How Contraceptives Can Help You Alleviate Your Menstrual Cramps

Do you suffer from excruciating period pain every month knowing you just have to wait it out? Well, birth control is a solution you should definitely keep in mind!

What’s the science behind menstrual cramps?  

It’s pretty much a known fact that period pain is no fun at all and most women are bound to experience it every month. Even then, women can have varying encounters with period cramps. While some regularly face this problem, some are lucky enough to rarely experience it. Of course, most of us may have gotten used to this cycle since our teenage years and it’s just something we accept as part of female reproductive life. But have you ever wondered why this monthly inconvenience comes with its own set of unpleasant characteristics? 

Dysmenorrhea, also known as menstrual cramps, refers to the pain associated with your period. It is usually in the form of throbbing or cramp-like pains in the lower abdomen which occurs just before and during menstruation. There are two types of dysmenorrhea — primary and secondary. 

Primary Dysmenorrhea  

This is the most common type of period pain which most women experience and is not caused by another condition. Simply put, the pain is caused by the period itself. Approximately 50 to 90 percent of the female population suffer from primary dysmenorrhea and its effects are severe on 10 percent of women for one to three days a month. 

During your menstrual period, the contraction of the uterus allows it to shed its lining. Yes, this is necessary and yet often painful. The pain is actually caused by hormone-like substances (prostaglandins) that are produced by the uterine lining cells which then circulate into your bloodstream. This ultimately triggers the tightening and relaxing of the uterine muscle and it is these contractions that cause cramps. Typically, higher levels of prostaglandins tend to lead to more severe menstrual cramps.

Secondary Dysmenorrhea 

Apart from the common and tolerable pain most women suffer through during their period, some may have it worse due to certain medical conditions that intensify the pain. This usually starts later in life. 

  • Adenomyosis: a condition that causes the inner lining of the uterus to break into the uterus’ muscle walls 
  • Cervical stenosis: a smaller cervix opening can impede menstrual flow and lead to a painful increase of pressure within the uterus 
  • Endometriosis: the tissue lining the uterus grows outside the womb and on the fallopian tubes, ovaries or tissue lining the pelvis instead 
  • Pelvic inflammatory disease: sexually transmitted bacteria that infects the female reproductive organs 
  • Uterine fibroids: non-cancerous growths of the uterus

I’ve been thinking about going on the pill to help with the cramps.

If you’re already on birth control, you probably already know how fuss-free and effective it is in preventing pregnancy. But what about its other non-contraceptive benefits? 

Hormonal birth control is one treatment method used to ease menstrual cramps. Primarily, oral birth control pills contain hormones such as estrogen and progestin which deter ovulation and the production of prostaglandins, thus lowering the severity of period pain. 

A randomised controlled trial conducted in 2012 revealed the effectiveness of taking combination birth control pills cyclically (21 days with active pills followed by seven days of placebo) and those taken continually. The latter involves the continuous administration of active pills during all 28 days, without any placebo at all. As continuous OCP means that users only take the hormone pills and skip the inactive pills, they forgo the monthly bleeding altogether. Both methods were successful in treating primary dysmenorrhea. 

Alternatively, other birth control methods such as patches, the ring, intrauterine devices and implants are also able to alleviate cramps, and even cause periods to become lighter and more predictable.

By using these prescribed birth control methods, you can also safely skip your periods altogether. To postpone or skip your period, you should immediately start on a new pack of active pills right away without taking the sugar pills (inactive pills). 

It’s best to speak with a doctor before trying any new birth control methods or making major adjustments. 

But I’m worried, will there be any side effects?

For first-timers on the pill, don’t worry! It’s natural for your body to take time to adapt to the hormonal changes.

Some women may still temporarily experience discomfort and period-like symptoms at the start. Symptoms such as cramping and spotting may arise if you forget to take your birth control pill.

How we can help

There are different types of birth control for different requirements. If you’re looking to speak with a healthcare professional on coping with menstrual cramps or dysmenorrhea, feel free to talk to one of Siena’s female-only doctors now!

References:

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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
Emergency Contraception Sexual Health

What to do if the condom tore, broke or slipped?

In Singapore, the male condom remains one of the most popular contraceptive options, experts say.

Yes, it happens.

Condoms do not break or slip often. In fact, it most commonly only happens when couples do not follow the recommendations on proper condom use. 

Though infrequent, there is a chance that they might occur and being armed with the knowledge is crucial in the event you find yourself in such a situation. 

How can you tell if a condom tears or breaks?

Obvious breakage

Sometimes condoms break in the packaging or while they’re being put in place, so it’s a good idea to quickly inspect the condom before putting it on.

If the breakage happens when you’re in the moment, you’ll probably feel (immediate change in sensation for the one wearing it) or see the damage when you or your partner pull away.

However, many people don’t notice that a condom broke until after they’re done having sex. That’s why it’s important that you check the condom when you remove it for any obvious holes or leaks.

Microtear

Microtears are tiny tears not usually visible to the naked eye but can also allow viruses and sperm to pass through. This is rare, especially if you’re using and storing the condom correctly.

In some cases, microtears can be a manufacturer defect, though that’s extremely rare. Manufacturers put condoms through a series of tests to monitor for breaks and defects before selling them.

More often, user error causes microtears. Common mistakes that could lead to microtears include:

  • using an expired condom
  • opening condom wrappers with your teeth
  • putting a condom on the wrong way, then flipping it and reusing it
  • using a condom that was stored in an unsafe place, like a wallet
  • using a condom that was exposed to large temperature shifts, moisture, or direct sunlight
  • using a condom without lubrication, which results in friction that could make the condom break
  • using oil-based lubes, such as Vaseline, lotion, or coconut oil, which can break down the material the condom is made of (latex or polyisoprene condoms)

How to prevent pregnancy if a condom is torn, broke or slipped?

If you had sex within the last 5 days, you can take an emergency contraception (morning-after) pill, which delivers a high dose of hormones to delay ovulation and prevent a fertilized egg from implanting in your uterus.

The two common types of morning-after pills in Singapore are:

  • Ulipristal acetate (Ella®)
    • has to be taken within 120 hours (5 days) after unprotected sex
    • lowers your chances of getting pregnant by up to 98% throughout the entire five-day window; and
  • Levonorgestrel (Postinor®-2)
    • works up to 72 hours after unprotected sex but is generally not recommended after 24 hours
    • lowers your chances of getting pregnant by 95% if taken within the first 24 hours after unprotected intercourse but this declines to 85% if taken between 25 – 48 hours and 58% if taken between 48 – 72 hours after unprotected intercourse.

Generally, it’s important to remember that the EC pill works best the sooner you take it!

Where to get emergency contraception (morning-after) pills in Singapore?

In Singapore, emergency contraception is only available with a prescription.

With Siena, you can buy your emergency contraception online!

Consult one of our female doctors via a video call and have your emergency contraception pill delivered to your door.

No waiting time, free 4-hour discreet delivery.

How to prevent HIV if a condom is torn, broke or slipped?

If you believe that you or your partner are at risk of contracting HIV, speak to a doctor immediately to access your situation and suitability for Post Exposure Prophylaxis (PEP) treatment.

PEP is a 28-day course of anti-retroviral medication that can prevent HIV from infecting your body. PEP is only effective within 72 hours after exposure to HIV, but the earlier you begin treatment, the more likely it is to work in full effect.

After which, you will likely need to take HIV tests to ensure the medication has worked.

The bottom line

Condom breakage or slippage can be a stress-inducing accident, but they’re pretty rare, especially if you follow the recommendations on proper condom use.

More often than not, you’ll know if the condom broke — and that means you can quickly take measures to protect yourself.

Categories
Emergency Contraception

Morning-after Pill/Emergency Contraception in Singapore: What you need to know

Credit: Illustration by Yeji Kim

The morning-after pill, also known as emergency contraception (EC), is often an afterthought, something that comes to mind after accidents happen, or more colloquially “only when you need it”. Some couples though, do keep an extra pill at times because accidents do happen – condom broke during sex, you missed a birth control pill or no birth control was used.

If you’ve never taken emergency contraception before or have read up on it, it’s likely you’ll have lots of questions. What is it, how do you use it, are there any side effects (including fertility), how effective is it and how can I get it?

We understand it can get complicated, and we answer all these questions for you below.

What is the morning-after pill?

The morning-after pill is taken to prevent pregnancy for women who had sex without contraceptive protection  – either they didn’t use birth control, they missed a birth control pill, they were sexually assaulted or their primary birth control method failed (e.g. condom broke during sex).

The morning-after pill is available in two types: 

  1. Ulipristal acetate (sold as Ella®); and 
  2. Levonorgestrel (multiple brands – ​Postinor®-2, others.).

The pill works primarily by preventing or delaying the ovaries from releasing an egg (ovulation).

While the pill is an effective option for preventing pregnancy after unprotected sex, it is intended for backup contraception only, not as a primary method of birth control and offers no protection against sexually transmitted infections (STI).

Is the morning-after pill a form of abortion?

The morning-after pill doesn’t cause abortion or miscarriage. It is not the same as mifepristone or misoprostol, also known as the abortion pill. The abortion pill terminates an established pregnancy — one in which the fertilized egg has attached to the uterine wall and has begun to develop.

How do you use the morning-after pill and what can you expect?

The morning-after pill should be taken as soon as possible after unprotected intercourse. You can take morning-after pills anytime during your menstrual cycle. The contraceptive pill can be taken up to 5 days after unprotected sex, depending on the type of pill you take. 

The morning-after pill does not offer lasting protection from pregnancy, do not have sex until you start another method of birth control. Having unprotected intercourse in the period after taking the morning-after pill exposes you to the risk of becoming pregnant.

Your period may be delayed up to a week. If you don’t get your period within 3 to 4 weeks of taking the morning-after pill, take a pregnancy test as soon as possible (you can purchase any test kit at pharmacies like Guardian or Watsons). 

How effective is the morning-after pill?

The efficacy of the morning-after pill decreases the longer the period after unprotected sex and the time of taking the pill.

There are two main types of morning-after pills prescribed by doctors:

  • Ulipristal acetate (Ella®) has to be taken within 120 hours (5 days) after unprotected sex and it lowers your chances of getting pregnant by up to 98% throughout the entire five-day window; and
  • Levonorgestrel (Postinor®-2) works up to 72 hours after unprotected sex but is generally not recommended after 24 hours. Postinor lowers your chances of getting pregnant by 95% if taken within the first 24 hours after unprotected intercourse but this declines to 85% if taken between 25 – 48 hours and 58% if taken between 48 – 72 hours after unprotected intercourse.

What stops the morning-after pill from working?

If you vomit within 2-3 hours of taking the morning-after pill, it is likely not to work.

What are the side effects of the morning-after pill?

Please make sure you’re not pregnant before using ulipristal as the effects of ulipristal on a developing baby are unknown. If you’re breastfeeding, ulipristal isn’t recommended as the effect on newborns/infants has not been studied. 

The levonorgestrel emergency contraceptive pill is safe to take at any time after having a baby. It will not affect your breast milk.

If you notice spotting that lasts longer than a week or develop severe lower abdominal pain 3-5 weeks after taking the morning-after pill, speak to your doctor. These can indicate a miscarriage or that the fertilized egg has implanted outside the uterus, usually in a fallopian tube (ectopic pregnancy).

Side effects of the morning-after pill, which typically last only a few days, might include:

  • Nausea or vomiting
  • Dizziness
  • Fatigue
  • Headache
  • Breast tenderness
  • Bleeding between periods or heavier menstrual bleeding
  • Lower abdominal pain or cramps

Does the morning-after pill affect fertility?

Misinformation about the morning-after pill is often spread unwittingly. 

The 2020 Fact Not Fiction survey in the UK found that 51% of the respondents said they believed you shouldn’t take emergency contraception more than once in the same cycle and 40% of respondents believed the morning-after pill can make you infertile if you use it too many times (fiction). 

The reality is using emergency contraception will not affect your future fertility and won’t stop you from getting pregnant in the future.

How to get the morning-after pill in Singapore?

In Singapore, emergency contraception is only available with a prescription and any woman, regardless of age, can get the drug from a doctor or GP subject to a consultation.

At Siena, we provide online emergency contraception consultation with one of our female doctors so that you can get access to the care you need from the comfort and privacy of your home. If prescribed, we deliver your emergency contraception right to your doorstep in a discreet packaging, in 4 hours.

No more rushing to the clinic!