Combination Hormonal and Mechanical—Mirena®, Skyla® and Liletta™
The Mirena IUD was first the first hormone-releasing IUD approved by the FDA in 2000. It is a small, T-shaped plastic device that secretes a small amount of a synthetic progestin called levonorgestrel. Since there is no estrogen released by the Mirena it is perfect for women who are concerned about the side effects of estrogen—women with clotting disorders or have medical conditions such as hypertension, obesity, cardiovascular disease and diabetes. The Mirena IUD does not generally stop ovulation. Instead it works by altering the cervical mucus so that it becomes almost impenetrable by sperm. It also causes the uterine lining (endometrium) to become thin further decreasing the survival of sperm.
The Mirena IUD is an example of long-acting-reversible contraceptive (LARC). It provides contraception for up to 5 years. A second example of a hormone releasing IUD is the Skyla® which was approved by the FDA in 2013. The Skyla® emits a smaller amount of progestin for 3 years and may be better suited for adolescents who have a slightly smaller uterus than a woman who has already carried a pregnancy to term. In mid-2015 the Liletta IUD was approved by the FDA. Liletta is another hormone releasing IUD similar to the Mirena and Skyla. Continue reading “Birth Control in 2015: Making the Right Choice (Part 3)”→
I’ve enjoyed many years in practice. The best part of it has always been meeting some unbelievably kind women, men and couples who are my “quiet heroes.” They don’t write books or give television interviews. They’re not likely to make it onto 60 Minutes or the evening news but they are a gift to their families, friends and communities. Let me tell you about a few of them.
Yesterday I had the good fortune to meet a truly amazing mother of four—two adopted and two biological children. Nina (not her real name) works in a government-funded position and lives a modest lifestyle. One of Nina’s children—a pre-adolescent—carries an assortment of mental health diagnoses; serious ones. And whatever the specifics the fact remains that Nina’s child is violent, has tried to attack her and other members of the family and even attempted an arson attack at the family home. By all accounts Nina’s child will soon require chronic care. And yet this mother soldiers between her job and three other children all while attending to the special needs of her troubled child. While Nina keeps moving forward with no “light” at the end of this tunnel I remain awestruck by her quiet determination and selflessness.
There are two types of spontaneous mechanical contraception available today that do not contain any type of hormone. The first is the Paragard IUD which is embedded with copper and is approved by the FDA for up to 10 years of use. The second—the Essure® device—is a permanent plug that can be placed into the openings of the fallopian tube. The technique for inserting it is called hysteroscopic tubal occlusions (HTO).
October is Breast Cancer Awareness month and as a physician who’s cared for women for over 30 years the simple fact remains that scarcely a month goes by when someone I’ve known for many years becomes newly diagnosed.
While breast cancer is the second leading cause of cancer death among women there is still much that can be done to detect this disease in its earliest stages and survive this cancer.
In 2015 it is expected that 230 thousand new cases of invasive breast cancer will be diagnosed in the U.S. Another60 thousand women will be diagnosed with an early non-invasive form of the disease. Unfortunately 40,000 women will succumb to this disease.
Most women in the Rochester area (and United States for that matter!) will end up having 2 children but will spend most of their reproductive lives—about 35 years—trying to avoid an unintended pregnancy. Unfortunately, about half of all pregnancies today are unintended and affect mostly younger women—teenagers and twenty-somethings.
For some women, it seems like there’s no “perfect” contraceptive yet there have never been as many high quality methods available as there are today. This series of articles will review today’s available methods and may provide some insight about how you can make a good choice for yourself. We will also share not just the science, but our personal experience in proving these methods of birth control (contraception) over the past few decades.