Podcast 38 - Para-gard Contraceptive

Transcription

Dr. Chad Edwards: This is Dr. Chad Edwards and you’re listening to podcast 38 of Against the Grain.

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Welcome to Against the Grain podcast with Dr. Chad Edwards where he challenges the status quo when it comes to medicine. We get into hot topics in the medical field with real stories from real patients, to help you on your way to a healthy lifestyle. Get ready because we’re about to go Against the Grain.

Marshall Morris: Hello, this is the super tall Marshall Morris and I am joined today by Dr. Chad Edwards who believes that 80% of medical recommendations are crap technically speaking here. Dr. Chad Edwards, he is the author of Revolutionize Your Health with Customized Supplements, he served in the US Army for 23 years. He is a board certified, part certified, family physician and he is the founder of revolutionhealth.org and Against the Grain podcast. Dr. Edwards what is up how are you doing?

Dr. Edwards: I am just excited to be here. I love doing podcast, I love talking about all the crap that’s out there, and all the good stuff that’s out there, so I’m ready to hit it.

Marshall: All right, let’s get into it what is the hot topic for today?

Dr. Edwards: We are talking about The ParaGard.

Marshall: The ParaGard. ParaGard. Am I saying it correctly?

Dr. Edwards: Obviously the question for many people is going to be what is ParaGard. ParaGard is that brand name for a type of birth control intra-uterine device. That’s my big term for the day, intra-uterine device IUD, is the big word. So I’m going to reference people back to episode 16.

Our podcast number 16 of Against the Grain podcast where we talk about bad birth control. And the issue there is probably one of the most common forms of birth control that we see are oral contraceptive pills or OCPs. And in episode or podcast number 16 we talk about why those may not be a good idea.

In the last podcast we talked a little bit about bio-identical hormones, we talked about them in other podcasts, and they are synthetic hormones, they are not natural or native to your body. They are metabolized differently, they behave differently in your body.

Some women tolerate it well, some women have serious severe problems. So not a big fan of birth control pills. There’s a lot of risks that can go with them, especially if you are getting a little bit older in age and smoke you got an increased risk of blood clots, pulmonary embolism things like that. You got to take those little suckers every day.

You can’t miss because you could get pregnant in the middle of this thing. So when our patients come to us, and they say, “I feel bad” and we do this work up and we say, ”Well your hormones may be causing a big problem,” we got to have a solution for them.

For a long time, I recommended IUDs, intrauterine devices. This is a little T-shaped device. They’re usually about a centimeter by a centimeter and a half, and it’s a very simple procedure. Come into the office, and it’s kind of like getting a pap smear for women.

You get up into the stirrups, and I know everybody loves doing that, so it’s basically like getting a pap smear, but we’ll insert the intrauterine device in the middle of this procedure. Takes just a couple of minutes, I will say that my caveat, the procedure itself, one of my recommendations, and if you’ve listened to the podcast about Tulsa Prolotherapy and things like that I strongly advise avoiding anti-inflammatory medications such as Motrin, naproxen, ibuprofen those kinds of things for most things.

This is one time there are a couple of others where I recommend that medication so something like Motrin, naproxen, ibuprofen those kinds of things. I strongly recommend taking those medications a couple hours before you come in, because it can really help with the cramping that you may get during the procedure.

We’ll often grab onto the uterus or the cervix with a device called a Tenaculum. We measure the uterus so that we know how deep this intrauterine device is supposed to go, and that it’s always, that it’s absolutely up inside there. We place the intrauterine device and then pull the little insertion thing out and then we clip the strings.

Now when I was doing the research for this particular podcast, I was looking up– I remember when I grew up, I remember intrauterine device is having a real bad name, and it was those things kill people and you get infections and stuff like that. Let me see if I wrote down the name, I can’t remember the name of the thing.

It’s not a decoder, there’s a name for the thing. It was used back in the ’70s, and it resulted in 300,000 lawsuits. It was the largest medical malpractice or the largest [inaudible 00:05:52] case, I can’t remember after asbestos. It was a big deal and the company ended up going bankrupt so they quit using this intrauterine device.

Well one of the problems was that the string that they had attached to the thing, you want a string because you put it up in the uterus, you want to be able to get that back out sometime. The string that they have tied to it that sticks out of your cervix not out of your vagina just out of the cervix so it’s not visible.

That that string was not a mono filament meaning that it was kind of woven and bacteria could get in the string, and it was a source of infection and bacteria could kind of wake up inside the uterus and cause pelvic inflammatory disease and all of these kinds of problems. There were a couple of concerns that it may have caused some deaths Tulsa Prolotherapy.

I don’t really know if it did or not, but that sounds like a bad thing. We quit using those, and all intrauterine devices got a bad name because of that. These strings that we use today are mono filaments, kind of like fishing lure, but it’s a real flexible soft string.

And the other thing is make sure if you’re listening and you’re not coming into our clinic to get your IUD or intrauterine device, tell them to cut the strings kind of long. If you think about men or women, if you don’t shave your face or your legs for a couple few days the whiskers are spiky, and that’s because they’re a little short and they’re stiff and and bristly.

But if you let everything grow out then the hair on your head is soft not spiky. Well the intrauterine device if you cut that string too short, it’s spiky that doesn’t matter for the woman, but it might matter for the man and nobody wants to get poked with a little thing during intercourse.

Make sure they cut that string sufficiently long and I usually go a good couple three centimeters in length because it makes it much softer and not poky. So these intrauterine devices are placed inside the uterus, and they are an effective form of birth control.

I used to recommend the marina and the mirena has I think it’s norgestrel. It’s a hormone that works, they say locally in the uterus, but there is some systemic effect, and I’ve seen a lot of problems with a lot of patients when they had mirena because of the hormones.

Not every woman does, but I’ve seen a lot of them, so I recommend avoiding the hormones if at all possible. So the ParaGard uses copper, it’s this little plastic device again one to one and a half centimeters, and it’s got copper wrapped around them. That copper induces some localized inflammation and it makes the environment hospitable to sperm Tulsa Prolotherapy.

When there’s semen in the area the sperm are killed off because of that inflammation associated with the copper. So a very, very effective form of contraception. In fact when you look at birth control pills, the oral contraceptive pills OCPs are between 91 and 94% effective depending on what study you look at, and that is based on perfect use.

That means you take it at the same time of day every day and they work by suppressing the hormones from the brain, so the FSHLH and the the estrogens. When we suppress that stuff and you don’t get this spike then you don’t have ovulation, so you can’t get pregnant.

The intrauterine devices work by creating an inhospitable environment in the uterus, but when you take those oral contraceptive pills and you miss a day, then the hormone levels now drop, and it can stimulate ovulation. They lose their effectiveness if you are not consistent and reliable in how you take those birth control pills. That’s probably a bad thing.

Marshall: That’s kind of like the core difference between the IUDs and the oral contraceptives.

Dr. Edwards: I’d say there’s two core reasons.

Interviewer: Okay, so what are the two?

Dr. Edwards: One is, one is using hormones, and synthetic hormones at that. The other one is a pill you got to take every day. There’s a lot of risks associated with oral estrogens, and we talked about this a little bit in the past, but your increased risk of blood clots, you get what’s called first pass metabolism in the liver Tulsa Prolotherapy.

I would argue that there’s a higher level of estrone: it’s one of the bad estrogens we talked a little bit about in the last podcast. Estrone which can cause some problems, there may be some increased risk of birth breast cancer and things like that associated with that, so we want to be very careful.

I just see too many problems with oral birth control pills versus the IUD, which is just this little plastic device, stimulates some inflammation inside the uterus and makes the environment inhospitable to the sperm.

Interviewer: Real quick question for you. In your experience, and I understand there might be some, not intentional bias, but you see all these patients taking oral contraceptives. How many in your mind do you feel confident are taking it perfectly?

Dr. Edwards: Taking it perfectly?

Interviewer: Yes. Same time, every day, same time, every day.

Dr. Edwards: 5% to 10%.

Interviewer: 5% to 10%.

Dr. Edwards: I just don’t see that many now. Of course I don’t see that many failures either, but there’s a window in there, but to maintain that optimal effectiveness of that 91% to 94% it needs to be taken consistently.

Interviewer: Okay. Just educating me here, does that 91– Is that like a 91 or a 0%, or is that a 91 down to like 70% or 60% as you fail to take it appropriately?

Dr. Edwards: Well, I think it is scaled.

Interviewer: It’s scaled?

Dr. Edwards: Yes. I can’t tell you what the perfect use number is because if you’re the one that didn’t use it correctly and you got pregnant, then yours went down to zero. That’s a good question. Across the board I don’t know Tulsa Prolotherapy.

Interviewer: Sure. Okay. So, let’s take a quick break and we’ll come back and wrap it up.

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Interviewer: We’re back and we’re here joined by Dr. Chad Edwards and we’re talking about contraceptives, specifically IUDs and oral contraceptives; the differences between the two. We just talked about the effectiveness of oral contraceptives. Now let’s get into the IUD side, and what is the effect of the effectiveness of these?

Dr. Edwards: I’m going to sideline for just one second, talk about the effectiveness of other forms of birth control. The oral contraceptives are 91% to 94% effective. Other birth control methods like condoms, the withdrawal method, diaphragms, the rhythm method which– You know what we call people that use the rhythm method for birth control?

Interviewer: I’ve never heard of it.

Dr. Edwards: Parents. I would not recommend that. Anyway, and using spermicides. These different forms of contraceptives range from between 72 and 88%. So the oral birth control pills are much more effective than those methods. Now, with the intrauterine device, we are greater than 99% percent effective.

You don’t have to worry about a perfect use because you implant it. You place it inside the uterus and it stays there. There’s nothing to think about, there’s nothing to do, you don’t have to interrupt sex, you just go do your thing, it’s just there and it’s doing its job all the time.

And some studies will suggest that it’s between 99.2 and 99.4% effective in preventing birth control. Now that is approaching the effectiveness of sterilization, like having your tubes tied without having surgery. The ParaGard is, you can put it in and it stays there for up to 10 years.

So if you’re considering a long-term form of birth control, and I don’t want to say permanent, but if you’re looking long term form of birth control, at least a year in duration, if you’re thinking six months, then do something else because it’s too much procedure, too much cost. It’s not cost-effective do that or you could. But it’s not cost-effective at that point.

Interviewer: That’s a long term birth control.

Dr. Edwards: And whether or not you want to have kids after that, it doesn’t really matter, you put the IUD and leave it in there, and the flip side of that is that you are almost as effective as having your tubes tied. So I’m a big fan. We used it in my family, we’ve seen good results with our patients, most patients are very satisfied, and so we’re a big fan of the of the ParaGard.

Interviewer: What are some of the benefits and some of the risks?

Dr. Edwards: Yes. First there’s no hormones. That’s a big thing. Some of the hormone issues that we see what the other things and of course we like to replicate nature, although having a device inside your uterus isn’t replicating nature, but replicating nature to that extreme means that you’re going to get pregnant when you have sex so it’s a trade-off.

Definitely we don’t have to worry about the hormones and the effect of the hormones. When you place an intrauterine device and you decide that you’re done with it and you want to pull it out, there is a quick return to fertility. Some would argue that you can get pregnant that night.

You don’t have to worry for your hormones to adjust and all of those kinds of things. You pull the thing out, you flip the switch, you could conceive fairly very quickly and we’ve seen that before. It can be a very rapid return to fertility. Some studies would show a decreased risk in endometrial cancer associated with the ParaGard intrauterine device.

There is an increased risk of what we call an ectopic pregnancy. Normally the egg, when it’s released from the ovary, goes down what’s called the fallopian tube, and then it will actually be fertilized by the sperm in the fallopian tube, but then it travels down and implants into the uterus.

An ectopic pregnancy is a pregnancy– or when that fertilization occurs, and the egg implants anywhere else other than the uterus, it’s called an ectopic pregnancy. And those have to be managed, they have to be taken care of. You can’t have a pregnancy grow inside your fallopian tube. It won’t be a viable pregnancy and it could potentially kill you if you don’t address that.

There’s an increased risk of ectopic pregnancies associated with the intrauterine device. The interesting really important thing to think about here is that, the intrauterine device does not cause ectopic pregnancies. Across the board, if the risk of ectopic pregnancy– I’m making this number up, but say it’s 10% of all pregnancies, 10% of them are ectopic.

If you have an intrauterine device, your risk of ectopic pregnancy may be higher; it may be like 15% but, the overall risk of pregnancy is much lower than it would be. So it’s a relative risk. It does not make you more likely to have an ectopic pregnancy. It’s just that if you get pregnant, it’s more likely to be ectopic than if you didn’t have the intrauterine device.

It doesn’t make that absolute risk of ectopic pregnancy go up. Other risks would be; during the procedure you could have what’s called a uterine perforation, very, very low risk and that’s– We work very diligently to make sure that the procedure is very easy and well tolerated.

I am not aware of any myself. I’ve never seen one with it in any of my procedures and I’ve never seen one with it in my colleagues as far as putting them in, but it’s just something that we watch for. Those are some of the risks.

Also if you are either in a monogamous relationship or not monogamous, but there is a risk of infection – sexually transmitted diseases, we don’t recommend a ParaGard in those patients because there would be an increased risk of infection associated with that sexually transmitted disease, so those patients wouldn’t be a good candidate either.

Interviewer: Benefits, Risks. We have compared it to some of the other contraceptives. What am I missing here?

Dr. Edwards: The last piece is in young women. The American College of Obstetrics and Gynecology, ACOG, has actually released a statement that said they actually recommend an intrauterine device for birth control in young women that have never had a kid before; they’re what we called nulliparous.

They recommend the IUD. At least they say it’s safe for that population. I think they’ve strengthened it and said that they recommended it, I can’t remember, but because of the effectiveness and its safety, IUD is a great way to go, and you have to worry about that perfect use of birth control pills – forgetting a pill, or missing one or whatever, but it will not protect you against sexually transmitted diseases like a condom would.

Interviewer: To learn more about this, where do any of our listeners go?

Dr. Edwards: As always, revolutionhealth.org. Visit our website, give us a call at 918-935-3636 and schedule your appointment.

Interviewer: Boom. Dr. Edwards thank you so much.

Dr. Edwards: Always a pleasure. Have a great day.

Interviewer: Boom.

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Announcer: Thanks for listening to this week’s podcast with Dr. Chad Edwards. Tune in next week; where we’ll be going Against the Grain.

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