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IUDs

What is an Intrauterine device?

An intrauterine device (IUD) is a type of birth control. It is a small, plastic T-shaped device that your doctor inserts into your uterus during an office visit.

An IUD is one of the safest, most effective methods for preventing pregnancy. It is an excellent choice for women or teens who do not want to get pregnant for at least 1 year.

What are the types of IUD’s?

There are 2 types of IUDs available in the United States. Non-hormonal and hormonal. The hormonal IUDs release progesterone in steady small doses to the uterus.

The non-hormonal IUD is called Paragard®. It is a copper IUD.  It can stay in your uterus for up to 10 years to prevent pregnancy. Some women who use it get heavier or longer periods. Paragard can also make your periods more painful. It is an excellent choice for women who need an effective non-hormonal birth control.

The hormonal IUDs offered in my office are Mirena®, Kyleena® and Skyla®.

Mirena and Kyleena can both stay in your uterus for up to 5 years to prevent pregnancy. Mirena is slightly larger than Kyleena and contains a higher dose of progesterone. Mirena has an FDA indication to treat heavy periods. Kyleena can be inserted in a woman who has never had a baby.

Skyla contains the lowest dose of progesterone and can stay in place for up to 3 years. It is the same size as Kyleena (slightly smaller than Mirena). It is also recommended for a woman who has never had a baby.

Most women who use a progestin-releasing IUDs will have lighter, less painful periods than they had before getting the IUD. Some women stop getting a period but this is not harmful and does not need to be treated.  Regular periods return when the device is taken out.

How does the IUD work to prevent pregnancy?

Hormonal IUD’s- The hormones in the IUD make the mucus in your cervix thicker and blocks the sperm from getting into the uterus. It also thins the lining inside the uterus (the endometrium) making it unfavorable for pregnancy.

Copper IUD- Paragard- The copper in the IUD produces an inflammatory reaction that is toxic to the sperm and egg.

What are the benefits of using an IUD?

  • IUDs are very effective. Fewer than 1 in 100 women who use an IUD get pregnant during the first year of using them. That is as effective as a tubal ligation!
  • IUDs have few side effects. They do not contain estrogen, a hormone that some women can't or don't want to take.
  • If you decide you want to get pregnant, you can have the IUD taken out at any time.
  • If you use an IUD for several years, it costs less overall than many other types of birth control. That's because there are no costs after you have it inserted and we find most insurances cover the cost of the device and insertion. (Each insurance is different so we always recommend checking with your individual plan).
  • There is evidence that using an IUD lowers your risk of getting cervical cancer.

What are the downsides of an IUD?

  • IUDs do not protect you against sexually transmitted diseases. You and your partner can use a condom to prevent spreading infections.
  • You may have unpredictable spotting after insertion. Spotting usually improves after the first 3 months of use for progesterone IUDs. The copper IUD can make your period heavier, longer and more painful.
  • There is a small chance the IUD will come out during your period. If this happens, you will need a new IUD. If you see your IUD in your underwear, on your pad, or in the toilet, call your doctor and use a back up method of birth control.

Is insertion painful?

You will likely feel some discomfort and slight cramping during and after insertion of your IUD. The cramps generally go away within a day. Over-the-counter pain medicines like ibuprofen  (Advil, Motrin) or naproxen (Aleve) can decrease the cramping.

After the IUD is in place, you should not be able to feel it. You will be able to feel the strings at the top of your vagina. This is normal and recommended you check for them after each period.

Nexplanon®

What is Nexplanon?

NEXPLANON is a small, thin, and flexible progestin only contraception rod that is placed under the skin of your inner, upper arm by Dr Hanna. She is a certified provider for Nexplanon. Nexplanon lasts for up to 3 years and is over 99% effective to prevent pregnancy. NEXPLANON must be removed by the end of the third year and can be replaced by a new implant at the time of removal.

How does Nexplanon work?

Nexplanon releases the hormone progestin at a steady small dose. Progestin prevents ovulation and thickens the cervical mucus to help stop the sperm from swimming thru the cervix. Progestin also thins the lining of the uterus (endometrium), which makes your periods lighter.

What are the benefits of Nexplanon?

  • It is more than 99% effective.
  • It is convenient and private. - Once your Nexplanon is in your arm, it works until it expires or you have it removed. You can’t see it under your skin so no one knows it is there unless you tell them.
  • It can decrease your period cramps. It also makes your period lighter. 1 in 3 people with Nexplanon stop getting their period after a year of use.
  • Nexplanon is reversible. If you decide you want to get pregnant, you can get it removed at any time. It won’t affect your fertility or make it harder to get pregnant in the future.

What are the side effects of Nexplanon?

  • The most common side effect is irregular bleeding and spotting. This is most common in the first 6-12 months. For most people, their periods are lighter.
  • Less common side effects include irregular periods, mood swings, weight gain, headache, acne and depressed mood.

How is Nexplanon inserted and removed?

Insertion: Your skin cleaned and then numbed in the area of insertion. An insertion applicator is then used to guide the NEXPLANON under the skin of your arm. This minor surgical procedure is done in the office and takes less than 5 minutes.

Immediately after the insertion, you and your health care provider will feel for NEXPLANON to ensure that it has been placed correctly. Following the insertion, you’ll wear a pressure bandage for 24 hours and a small bandage (steri-strip) for 3 to 5 days.

The timing of insertion is important. A pregnancy test will be performed before insertion of Nexplanon. If you are not on your period during insertion, an additional method of birth control such as a condom is recommended for 7 days after insertion. You will also be asked to return for a second pregnancy test in one week after insertion. Your arm will also be examined at that time for confirmation your Nexplanon did not move under the skin.

Removal: a trained provider can remove NEXPLANON at any time during the 3-year period. Removal of NEXPLANON involves a minor surgical procedure in which a small incision is made in your arm where NEXPLANON is located. The Nexplanon is then grasped, removed and the skin covered with a bandage. If you are having a new Nexplanon placed, it can be done at the same time as removal thru the same small incision.

Depo-Provera®: (The birth control shot, Depo, DMPA)

What is Depo-Provera?

An injection you get every 3 months to prevent pregnancy. It is a great option for women who do not want to take a birth control pill every day or need to avoid using estrogen. It is also used for women who Have health problems such as anemia, seizures, sickle cell disease, endometriosis or uterine fibroids.

The shot is 94% effective because sometimes people for get to get their shots on time. The better you are about getting your shot on time, the close to 99% effective the shot will become.

How does Depo work?

Depo-Provera contains the hormone progestin. The dose of progestin in the injection prevents ovulation. It also make the cervical mucus thicker so sperm can’t get thru to the uterus.

What are the benefits of Depo-Provera?

Most women using the birth control shot won’t have any problems at all.

Depo-Provera doesn't require daily action, eliminates the need to interrupt sex for contraception, decreases menstrual cramps and pain, lessens menstrual blood flow, in some cases stops menstruation, decreases the risk of endometrial cancer, decrease incidence ovarian cysts, decrease risk of ovarian cancer.

What are the Risks of Depo-Provera?

After stopping Depo-Provera, it might take 10 months or more before you begin ovulating again. Depo-Provera doesn't protect against sexually transmitted infections.  Research has suggested that Depo-Provera might cause a loss of bone mineral density. It's not clear whether this loss is reversible. The most common complaints of Depo users in my practice are acne, weight gain and irregular spotting.

Other side effects of Depo-Provera usually decrease or stop within the first few months. They might include: Abdominal pain, bloating, decreased interest in sex, depression, and dizziness.

Birth Control Pills


What are Combination Birth Control Pills (The Pill)?

Combination Birth Control Pills are a medicine that contains estrogen and progestin. The Combination Pill is 91% effective. 9 out of 100 women who use Combination Pills to prevent pregnancy will get pregnant.

What is the Mini Pill?

Progestin only pills are called the Mini pill. The Mini pill is usually only recommended to women who are breastfeeding but desire to prevent pregnancy. The Mini Pill is not as effective as Combination Pills to prevent pregnancy. The Mini Pill must be taken within a 3-hour window each day to prevent pregnancy in a woman who is not breast-feeding. It is an excellent option for a young, non-sexually active woman who desires to decrease her period flow and cramps.

How does the Combination pill work?

The Combination Pill is taken daily to prevent ovulation (release of an egg from the ovary), which prevents pregnancy. The hormones in the Combination Pill also make the cervical mucus thicker to prevent sperm from swimming into the uterus. Vomiting or having diarrhea for more than 48 hours can decrease how well the pill works. The Combination Pill does not work as well for women who are very overweight. Some medications can decrease how well the Combination Pill works. Be sure to tell the office staff all your medications including herbs so Dr. Hanna can review them and guide you accordingly.

What are the benefits of the Combination Pill?

The Combination Pill is a safe, simple and convenient way to prevent pregnancy. It has been around for more than 50 years! It can improve acne, make your periods lighter and improve period cramps. The Combination Pill can also can improve/prevent PMS (premenstrual syndrome), acne, prevent endometrial and ovarian cancer, ovarian cysts, anemia and bone thinning. The Combination Pill can also be used to help symptoms of other medical conditions like endometriosis.

What are the risks of the Combination Pill?

The Combination Pill is very safe but using any form of birth control that contains estrogen can slightly increase your risk for heart attack, stroke, blood clots and liver tumors. The chance of having any of these problems is very low for most people, lower than pregnancy itself.

The Combination Pill may cause side effects at first but they usually go away after 2-3 months. These can include: headaches, nausea, sore breasts, spotting. Your period may be lighter and sometimes you may not get a period at all. This is normal. You may also experience decreased sexual drive. This is a normal side effect of the pill but can be bothersome in some women. I recommend making an appointment to discuss other birth control options if your sex drive is an issue in your relationship.

If you are over 35 and a smoker, you shouldn’t use any birth control that contains estrogen.

How do I take the Combination Pill?

You can begin your Combination Pill on any day. In my practice, I usually recommend beginning on a Sunday as the pill packages are designed for a Sunday start. If you are not within 5 days of your period and begin the Combination Pill, it will not be effective for pregnancy prevention for 7 days. I recommend condoms to prevent pregnancy during that time. You will take one pill daily. You do not have to take the Combination Pill at the same time each day but it is a good habit. Combination Pills come in 21 day, 28 day and 91-day packs.

If you are using 91-day packs, you will get a period once every 3 months. Some women who are using 21 or 28-day packs prefer to skip their period. This is easy to do by skipping the hormone free pills and start taking the active hormone pills of a new pack at the beginning.

Women who skip their period while using the Combination Pill may have irregular bleeding or spotting. This is more common in the first 6 months of use. In most cases this is normal but I advise you to call the office to let us know. There is nothing harmful about using the Combination Pill to skip your period.

Birth Control Ring (NuvaRing®, Annovera®)

What is the birth control ring?

The birth control ring is a small, flexible ring you wear inside your vagina that secretes both the hormones estrogen and progestin (the same type of hormones in birth control pills). The ring is 91% effective. 9 out of 100 users will get pregnant each year. There are 2 types of rings available in the United States, Nuvaring and Annovera. Each Nuvaring is designed to be worn in the vagina for 3 weeks each cycle. Annovera is worn for one year.

How does the Birth Control Ring work?

The hormones in the ring are absorbed though your vaginal tissue. Theses hormones then prevent your ovary from releasing an egg called ovulation. The hormones also thicken the cervical mucus blocking the sperm from entering the uterus.

Some medications make the ring less effective. You should discuss your medications with Dr Hanna if you choose this option.

What are the benefits of the ring?

The ring is a safe, simple and convenient way to prevent pregnancy. It can improve acne, make your periods lighter and improve period cramps. The ring can also can improve/prevent PMS (premenstrual syndrome), prevent endometrial and ovarian cancer, ovarian cysts, anemia and bone thinning. The ring can also be used to help symptoms of other medical conditions like endometriosis.

What are the risks of the ring?

  • The ring is very safe but using any form of birth control that contains estrogen can slightly increase your risk for heart attack, stroke, blood clots and liver tumors. The chance of having any of these problems is very low for most people, lower than pregnancy itself.
  • The ring may cause side effects at first but they usually go away after 2-3 months. These can include: headaches, nausea, sore breasts, spotting. Your period may be lighter and sometimes you may not get a period at all. This is normal.
  • You may also experience decreased sexual drive. This is a normal side effect of the pill but can be bothersome in some women. I recommend making an appointment to discuss other birth control options if your sex drive is an issue in your relationship.
  • If you are over 35 and a smoker, you shouldn’t use any birth control that contains estrogen.

Do I have to take the birth control ring out during sex?

No. The ring is designed to be worn during sex. If it bothers you or your partner and you decide to take it out, rinse it in cool water and put it back in when you are done. If you leave the ring out for more than 2 days (48 hours), you won’t be protected from pregnancy.

Birth Control Patch


What is the Birth Control Patch?

The transdermal contraceptive patch is a device you wear on you body to prevent pregnancy. The patch is 91% effective. 9 out of 100 patch uses will get pregnant each year.

How does the Birth Control Patch work?

The patch releases hormones (estuarial and progestin) through your skin to prevent ovulation. These hormones are similar to the hormones in oral birth control pills. If you do not ovulate, there is no egg for a sperm to fertilize. The patch also thickens your cervical mucus to prevent the sperm from entering the uterus.

You wear each patch on your belly, upper arm, buttocks or back. Some medications make the patch less effective. Dr. Hanna will review your medication list at the time she prescribes the patch.

How do I use the patch?

Wear each patch for 1 week (7 days), then take if off and plan a new one. Change your patch once weekly for 3 weeks straight. Be sure to begin a new patch on the same day every week. Do not wear the same patch for longer than one week. You can wear your patch while swimming, exercising, in a Jacuzzi, bathtub or sauna. Check your patch each day to ensure it is sticking. Do not flush the patch down the toilet. Store your patches at room temperature away from sunlight. Keep each pouch sealed until you use it.

What do I do if the patch falls off?

If the patch has come loose or falls off and it has been less than 2 days, put a new patch on right away. Your change day will remain the same.

If the patch got loose or fell off and it has been more than 2 days, start a new 4-week cycle by putting on a new patch right away. This is your new patch change day. We are condom for the next 7 days to prevent pregnancy.

What do I do if I forget to change my patch on time?

Put on a new patch immediately. This now becomes your new change day. Wear a condom for the next 7 days to prevent pregnancy.

What are the benefits of the patch?

The patch is a safe, simple and convenient way to prevent pregnancy. It can improve acne, make your periods lighter and improve period cramps. The patch can also can improve/prevent PMS (premenstrual syndrome), prevent endometrial and ovarian cancer, ovarian cysts, anemia and bone thinning. The patch can also be used to help symptoms of other medical conditions like endometriosis.

What are the risks of the patch?

  • The patch does not protect from getting sexually transmitted diseases. The patch is very safe but using any form of birth control that contains estrogen can slightly increase your risk for heart attack, stroke, blood clots and liver tumors. The chance of having any of these problems is very low for most people, lower than pregnancy itself.
  • The patch may cause side effects at first but they usually go away after 2-3 months. These can include: headaches, nausea, sore breasts, spotting. Your period may be lighter and sometimes you may not get a period at all. This is normal. The patch may also cause a skin irritation from the glue that holds it on the skin.
  • You may also experience decreased sexual drive. This is a normal side effect of the pill but can be bothersome in some women. I recommend making an appointment to discuss other birth control options if your sex drive is an issue in your relationship.
  • If you are over 35 and a smoker, you shouldn’t use any birth control that contains estrogen.

The content is meant for educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment.
Please seek the advice of your physician with any questions you may have regarding a medical condition.

Barbra S. Hanna, DO, FACOG, NCMP
1604 North Main Street  •  Wheaton, Illinois 60187  •  630-260-1818