Women’s Health: What Every Woman Should Know About Contraceptives and Weight

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Valerie Tarico

Author, ‘Trusting Doubt’ and ‘Deas and Other Imaginings’; Founder, WisdomCommons.org

Our ancestors struggled to get enough calories just to stay alive. Now, as we try to keep our weight in a healthy range, we look at all kinds of factors: diet, exercise, sleep, supplements, meditation, hypnosis, psychotherapy, prayer, or even surgery that might help us tip the scales a little less.

For many women, one question that comes up every so often is whether contraception is making weight management harder. Anxiety is contagious, which makes scary stories particularly viral. As a woman trying to figure out what is best for your body, it can be challenging to sort out reality from hype or haze.

What’s real?

For starters, it is important to keep this in mind: No matter what beauty ideals we may absorb from Hollywood and glamour, normal healthy women gain weight during the fertile years with or without contraception. At age 13, many girls are menstruating and some have reached their adult height, but the average weight is 100 pounds. By age 20, most have filled out, and American females weigh on average 125-130 pounds. By age 55, the norm is closer to 165 before average weight then starts declining. (Even long-distance runners and other highly active women tend to gain over time.)

The net-net is that any time a woman is contracepting is a time she is also likely to be gaining weight, regardless of any effects from contraception. Consequently, in all trials of contraceptives, some women complain of weight gain, and so virtually all contraceptives list it as a possible side effect. Only after the fact, as data accumulate, are researchers able to tease apart normal gain from possible effects of contraceptive hormones.

Pregnancy and childbearing have such huge effects on our bodies that (barring certain medical conditions) the most significant health question related to any contraceptive is — how well does it work? On the pill, 1 in 12 women gets pregnant each year; relying on condoms alone, that rate is 1 in 8.[1] (For no contraception, the annual rate is 85 percent, and abstinence commitments may cut that 85 percent by about half.) With a long-acting method like an implant or IUD, the pregnancy rate drops to 1 in 500 or less. If you are trying to managing weight for health or lifestyle reasons, efficacy should be a primary consideration in choosing among contraceptive options.

Efficacy aside, the best research available suggests that most contraceptives have little effect on weight — with a few very important exceptions. Here is the lay of the land.

IUDs — The copper IUD is in the top tier for efficacy (99-plus percent) and at the same time is completely non-hormonal. This means that, despite some challenges in insertion and adjustment, it is the gold standard for women who want no artificial hormones. Its only effect on weight is through reducing unintended pregnancies. Hormone IUDs boost contraceptive effectiveness and may decrease menstrual symptoms. When it comes to weight, though, the difference appears small and inconsistent. One widely-publicized study found modest weight loss for women on both kinds of IUD but the effects were minimal, so don’t assume either IUD will prevent normal weight changes.

Implants — Like IUDs, implants are top-tier (99-plus percent effective).[1] Unfortunately, information about implants and weight is lacking controlled research. In clinical trials and an online side-effect summary (not controlled research) five percent of women complained of weight gain, which is right around the rate found when a contraceptive has no significant effect on weight.

 Depo/Shot — Depo-Provera, also known as the shot, (94 percent effective) is where things get complicated when it comes to contraceptives and weight.[1] When compared to IUD users, women using Depo-Provera gained an extra pound a year on average. But some women’s bodies react quite differently, with weight gain that over time is unhealthy.  It now appears that any woman who gains 5 percent of her body weight in the first six months on the shot is at risk for ongoing, contraception-related weight gain and should consider another method.

Patch, Ring, Pill — It is widely believed by women and doctors alike that the pill and related combination contraceptives (all around 91 percent effective) cause weight gain.[1] But guess what? The best controlled studies, taken together, find that the effect of today’s pill, patch or ring is usually negligible and that women who respond by putting on pounds are roughly equaled by those who respond by dropping pounds.

Barrier Methods — For a barrier method like condoms or a diaphragm (82-88 percent effective), the primary weight question is going to be unintended pregnancy.[1] With an annual failure rate of 1 in 8, a woman using a barrier method needs to be prepared for the eventuality of either an abortion or an unplanned child.

Natural Family Planning/Abstinence — Like barrier methods, the primary weight question related to NFP (76 percent) or abstinence commitment is the likelihood of an unintended pregnancy — only more so.[1] Proponents like to say that abstinence is 100 percent effective. So are diets. In reality, abstinence education and virginity pledges have little measureable effect on STD or pregnancy rates. Plan B or ella can reduce pregnancy risk when an abstinence commitment fails, and has no effect on weight.

Women’s bodies respond differently to hormones, as we all know. Some of us have horrid periods and pregnancies. Some of us breeze through. Some of us barely gain a few pounds while incubating a baby; others gain a third or even half of our body weight. It is reasonable to assume that there are differences in how we respond to hormonal contraceptives as well, and every woman needs to listen to her own mind and body. All the same, it helps at times to remind ourselves of what is known — and to update our knowledge, since technology and research are constantly moving forward.

So, the bad news about contraception is this: Mostly it isn’t the explanation for those frustrating extra pounds. You are likely to gain some weight over the next decade regardless. So am I. Throwing the pill pack in the garbage or getting the IUD or implant pulled isn’t likely to be a magic bullet. The great news about contraception is this: Mostly it isn’t the explanation for those frustrating extra pounds. We really do have good options when it comes to managing our fertility, better options than most of us thought, better options than our mothers and grandmothers could even imagine.

References:

[1] Trussell J. Contraceptive Efficacy. In Hatcher RA, Trussell J, Nelson AL, Cates W, Kowal D, Policar M. Contraceptive Techology: Twentieth Revised Edition. New York NY: Ardent Media, 2011.

Read More:  http://www.huffingtonpost.com/valerie-tarico/weight-and-contraceptives_b_2558149.html?utm_hp_ref=womens-health

Women’s News: What I Know About Sex Now That I’m in My 50s

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Barbara Hannah Grufferman

Author, ‘The Best of Everything After 50’; columnist, AARP; Chief Pundit, FOF

My husband and I met in the sweltering summer of 1992 and started rocking and rolling immediately. But from the moment we got married a year later, we were 1) thinking about getting pregnant, 2) in a state of pregnancy, 3) recovering from pregnancy or 4) enjoying (and coping with) the results of pregnancy: babies, toddlers and, now, two teenagers. It wasn’t exactly conducive to swinging from chandeliers.

During those early years, sex was focused more on a result (children), but that’s no longer the case. Like most couples over 50, we are free to have sex pretty much whenever we want. But, do we?

I tried to find some statistics about how many times per week married Americans over 50 made love (with each other), but there were so many different studies saying so many different things, it was hard to suss out the truth. One stated that married couples over 50 had sex once or twice a week, while another claimed it was closer to once or twice a month.

Confused and in need of more information, I met with Dr. Margaret Nachtigall, a reproductive endocrinologist in New York City, who shared some statistics from a study done by the National Survey of Sexual Health and Behavior:

A study of married couples found age and marital satisfaction to be the two variables most associated with amount of sex. As couples age, they engage in sex less frequently, with half of couples age 65-75 still engaging in sex, but less than one fourth of couples over 75 still sexually active. Across all ages, couples who reported higher levels of marital satisfaction also reported higher frequencies of sex.

This study left me feeling that the older we got, the less we got it. Not good, especially because the more we get it, it seems, the more satisfied we are.

I raised this topic with some girlfriends one night over a bottle of wine, hoping to get insights into their concerns, and (yes, I admit it) how often they had sex (with their partners).

We all had the same question: I love my husband and he loves me, so why aren’t we having as much hot sex as we used to? We want to have sex, but sometimes we just aren’t into it. How do we get in the mood? We all hated thinking that things were slowing down, and that they might slow down even more. For sure, menopause can sometimes make sex uncomfortable, and our libido can drop off. But just because a woman is post-menopausal, does she automatically lose interest? Forever? Was that my future? Was I supposed to lock this door and throw away the key?

I was getting worried. And whenever I get worried, I do research. Finally, someone suggested I meet with Esther Perel, author of the best-selling Mating in Captivity, which explores many of the questions my friends and I were confronting – specifically, why couples who have been together for a very long time often can’t sustain a rich, enjoyable sexual life … together. Esther was particularly eager to find out because in her view, sex after 50 may be the best sex we’ll ever have.

First, she said, we had to address some long-held views about sex after 50 that may not be true.

    • Women over 50 are sexually dysfunctional due to menopause. According to Esther’s research, the majority of women over 50 are sexually healthy. Sexual problems that are menopause-related can be addressed with simple solutions like lubricants or estrogen.

 

    • Men think women over 50 are sexually undesirable. Esther has rarely encountered a man who says his low sex drive is related to how his wife looks, or her age. But, he will be turned off if she has stopped being interested in sex. Men want women who want sex.

 

 

    • If you’re not having spontaneous sex, it must mean your sex life is over. When, Esther asked, was sex ever spontaneous? When you were first together, you had sex on your mind for hours, maybe even days, leading up to the experience. In many cases, you set the date, thought about it, planned the evening — even what to wear. It may have seemed spontaneous, but it wasn’t. Good sex is planned sex.

 

 

    • If a couple is having less sex, it’s her fault. News flash: If a woman over 50 is having less sex, chances are it’s him, not her. In men, low sex drive is often related to health problems or medications he may be on, many of which are known to create some sexual functioning challenges. Men aren’t used to needing stimulation, and it can be troubling. Sometimes he’ll just avoid it, causing the woman to think he’s no longer attracted to her — which results in a sexual Catch-22.

 

 

    • If you want to have a better sex life, you need to get closer. On the contrary, Esther says, excess information and over-sharing can put the kibbosh on desire, while a little mystery can fuel sexual attraction. Creating an erotic space between you and your partner is essential for good sex. (I share lots of tips on how to do that in The Best of Everything After 50.)

Then, we explored the three main tools that women can use to get into the mood:

 

    • Arousal – Watch a movie or read a book, have a fantasy, put on some sexy lingerie. Many things can arouse us. Arousal can lead to desire, and desire leads to sex. Figure out what gets you going and use it when you need it.

 

    • Desire – Desire means wanting to be turned on. With this entry point, you want to get aroused, and you want to actively engage in getting turned on with your partner.

 

 

  • Willingness – This is the most important entry point for women over 50. If you’ve been ignoring, neglecting or denying your sexual self for a while, then you must consciously decide that you want sex in order to even let yourself feel desire. We talk ourselves into doing things all the time – going out to an event, cooking dinner – but people don’t think about talking themselves into having sex (and they often confuse it with “pity sex”). This makes complete and total sense to me … and, even better, it works!

 

So here’s the big reveal: After 50, we’re at a sexual crossroads, and need to make a choice: We could go through menopause, shut down that part of ourselves, lock the door and throw away the key. Or we could embrace this new life with a sense of freedom and fun – no more periods, no more worries about getting pregnant, no more doing it because there has to be a result. You may very well find yourself having the best sex … ever!

And finally, one little bit of advice: Stop looking for studies about how often other people have sex. No one really knows what goes on behind closed doors (no matter what they say to the survey interviewer). And … who cares?

Read More:  http://www.huffingtonpost.com/barbara-hannah-grufferman/what-i-know-about-sex-50s_b_1621087.html?utm_hp_ref=women&ir=Women

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