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Does birth control cause infertility?

Birth Control

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Women take birth control for a multitude of reasons, from preventing pregnancy to regulating the menstrual cycle and reducing acne. Taken correctly, the pill can prevent 99% of pregnancies. This has made birth control a staple for generations of women. However, some women may wonder, What happens if I stop taking the pill? One misconception about the pill is that taken for years, it can reduce the ability to have children. The possibility of future infertility would deter many women from considering birth control pills. So, let’s think twice about it.  

The combination pill works by supplying two hormones, estrogen and progesterone, that work together to stop the ovaries from releasing an egg each month during menstruation. Other pills provide only progesterone; progestin-only pills prevent pregnancy primarily by thickening the cervical mucus. When you stop taking the pill, the hormones it supplies leave your system in a matter of days, and your body reverts to its natural cycle. Additionally, your body begins to produce estrogen and progesterone again. Therefore, barring underlying health issues, women can become pregnant right away after stopping the pill. 

There are several reasons behind the misconception that birth control causes infertility. One is that taking birth control can conceal symptoms of conditions associated with infertility, such as endometriosis, PCOS, and uterine fibroids. Birth control is sometimes used to manage these conditions, so stopping birth control might mistakenly associated with infertility. Another reason for this misconception might be that historically, the side effects of the pill were not well-researched or disclosed to users, so it was not clear whether infertility was a risk. Women often felt dismissed by clinicians and pharmaceutical companies when they experienced side effects of the pill, even for conditions as serious as blood clots and strokes. In the 1960s, despite reports of deaths related to the pill, the FDA maintained that the pill was safe. Additionally, drug companies failed to inform healthcare providers of the pill’s more severe side effects. Since then, the dosage of hormones provided by the pill was adjusted to improve its safety, but mistrust of the pill persists and worries about infertility have continued to the present day.  

However, there is good evidence that birth control users need not worry about their fertility. A 2018 review of twenty-two birth control studies including over 14,000 women showed that 83% of women became pregnant within 12 months of discontinuing contraception. Furthermore, a 2013 study of 3,727 women found that although birth control use was associated with a short delay before conception, overall fertility was not impacted. Additionally, longer-term use of the pill was associated with higher fertility compared to short-term use (less than 2 years). Therefore, even long-term users of the pill should not be concerned. Overall, the evidence suggests that worries about infertility should not stop women from taking the pill.  


Is substance misuse a choice or a disease?

Various different types of pill capsules lay scattered on a wooden table.

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Some people talk as if substance misuse is a moral failing. Science suggests that substance misuse is a disease similar to many other health conditions that affect the brain’s reward pathway. When one performs enjoyable activities like running or eating a tasty meal, dopamine and endorphins are released, and an individual may feel some euphoria. Drug use increases similar chemicals in brain pathways at a much greater magnitude. Furthermore, some drugs alter these functions after a single use. With ongoing usage, the brain pathways are modified, making it difficult for people to feel happy without the drug. In other words, one may get little enjoyment from everyday activities, and drug-taking becomes the only source of pleasure. Tolerance also develops as the brain adjusts to drug use, so more is needed.

The choice to try a drug may occur in a moment of vulnerability. There may be peer pressure. Individuals may begin taking a drug as a coping method for stress or distress. 

As substance misuse develops, it causes a loss of control over behaviors that impair the individual. It’s not just a matter of willpower to stop taking the drug. Moreover, people with altered brain chemistry may experience withdrawal symptoms if they stop using the drug. Avoiding the drug may become as challenging as going without food or water. 

Substance use disorder, like heart disease, results from a combination of factors. Genetic factors, frequency, duration, type of drug, ease of availability, and feelings of worry or depression are all factors that may be associated with the potential to develop a substance misuse disorder.

By treating those struggling with substance use disorder with the same compassion we extend to patients with a chronic disease like diabetes or heart failure, we can help them overcome this challenge and restore their health.

Do Probiotics Promote Health?

Should you take a daily probiotic supplement? | MD Anderson Cancer Center

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Probiotics have increased in popularity in the past few years. According to a survey by the National Center for Complementary and Integrative Health, about 4 million US adults (1.6% of the population) used a probiotic or prebiotic supplement in the past 30 days1. From grocery store aisles devoted to probiotics to social media influencers, there are claims for probiotics, including improvement of everything from constipation to obesity to depression. What is the evidence that probiotics promote health?

Probiotics are gut microorganisms that are helpful in digesting food, producing vitamins, and fighting harmful pathogens. Probiotics are found in naturally fermented foods like yogurt, cheese, and kombucha.  The products we are addressing consist of similar bacteria, commercially manufactured and distributed. 

There is experimental evidence that probiotics can alleviate symptoms of Inflammatory Bowel Syndrome (IBS).  People taking a probiotic with the bacteria Bifidobacterium bifidum MIMBb75 experienced less discomfort, bloating, urgency, and digestive disorder compared to those who took a placebo2.

The evidence that probiotic use is helpful for restoring healthy gut flora after a course of antibiotics includes genetic sequencing of stool samples demonstrating increased diversity of gut bacteria and fewer antibiotic-resistant bacteria3.

There is some evidence of a connection between the gut microbiome and the brain. In one study, people with IBS taking the probiotic Bifidobacterium longum NCC3001 had fewer symptoms of depression relative to people taking a placebo4.  They also had reduced brain activity on fMRI in response to negative stimuli. More experimental evidence is needed to confirm these relationships. 

There are case reports of sepsis or fungemia from bacteria5 or yeast6 in probiotics in people with immune system deficiencies. However, the potential for harm is low, and no serious adverse events were reported in clinical trials. The most common side effect for the average healthy person is temporary bloating and constipation, which typically subsides after a few weeks of use7.

Think twice before consuming a probiotic pill. A healthy diet including natural sources of gut flora is probably just as good as any pill or drink. We need more experimental evidence before we can be certain of the relative potential benefits and harms of probiotics, natural or in pill form, for various illnesses.