Saturday, June 13, 2009

Hormonal contraceptives and ballet


A dial pack of Estrostep birth control pills

Ballet and the Pill: The St Lucy’s summer ballet intensive is well underway and several of the students who had started on birth control pills shortly before coming to Vegas have had such annoying problems, things like tender swollen breasts, weight gain and irregular bleeding that can quickly erode a students confidence they decided to switch to a cervical barrier for protection at least for the summer. Painful breasts and bleeding are both fairly common during the first few cycles on the pill so the girls should have started their pills several months ago to allow time for their bodies to adjust to the hormones. It’s a real downer being away from home and not feeling well and having body changes (weight gain, and swollen breasts) affect performance in something as competitive as a summer intensive. Weight gain, a pound every two weeks for these girls, was of great concern and major a blow to their self esteem. Swollen breasts can throw a girl off her center for pointework and make jumps unbearably painful and not knowing when you are gong to bleed makes it hard to successfully wear a tampon in anticipation because a dry tampon is very painful to remove. Diva cups work well during menstrual periods but you can’t be prepared to have sex with a Diva inserted so the obvious answer is an Ortho All-Flex or a Cooper Surgical (Milex) silicone diaphragm that will collect flow from irregular bleeding while permitting penetrative sex.

GyneFix vs. Cervical barriers: If the girls had been full time students at St Lucy’s I would have recommended they have GyneFix IUDs implanted but for a summer student who isn’t covered by the schools health insurance the up-front cost of a GyneFix even with the clinic discount is $600 which is more than their parents can afford so a properly fitted diaphragm to wear while bleeding and a strapless FemCap to wear for contraception and thrust buffering is an excellent low cost alternative. A properly fitted and correctly used cervical barrier can be almost as good as a GyneFix but a CB does take discipline to use correctly and misuse can easily lead to pregnancy. However, the ballet dancers selected for the intensive have been carefully chosen and are very disciplined so barring accidents I don’t anticipate any unplanned pregnancies. Once a girl stops her pills the bleeding and swollen breasts begin to go away immediately and are gone within a week. Weight loss takes a bit longer but decreasing appetite and not suppressing the metabolism should make it much easier to effectively control a dancer’s weight while eating a healthy diet. The girls are so pleased to be off the Pill and free of side effects. Using an expertly fitted cervical barrier they are sure of effective contraceptive protection with no annoying side effects which has given them their confidence back and lets them focus on their art and perfecting their technique.

Other hormonal methods: In addition to the pill there is the contraceptive injection, Depo-Provera, which is good for three months; a single rod implant, Implanon, good for three years; ‘the patch’, Ortho Evra, which is a series of three transdermal patches one of which is applied to the skin each week for three weeks and then there is a patch free week for your period; ‘the ring’, NuvaRing, which is a disposable soft polymer ring that slowly releases a combination of estrogen and progestin. NuvaRing is worn in the vagina for three or up to four weeks and then removed for a week for your period.

The Depo-Provera injection, a large dose of a harsh progestin, has been proven to cause weight gain in a large percentage of users and leeches calcium from the bones so the FDA warns against prolonged use. It’s not something a dancer would want to use unless it is a last resort. Ortho Evra delivers a very high amount of estrogen into the bloodstream (about 60% more than a 30mcg pill) which has been shown to cause more serious side effects (blood clots) than a comparable pill plus the patch can be seen through small or tight costumes and advertising ones method of birth control is considered gross. NuvaRing is tolerated well but depending on the woman’s pelvic anatomy the ring can slip out or be hooked and pulled out by a thrusting penis. Women using NuvaRing are advised to check before and after each act of intercourse to make sure the ring is still where it should be. Implanon is a progestin-only device and uses the same progestin that is used in NuvaRing. The main complaint about Implanon is that there can be a lot of irregular bleeding since there is no hormone free interval for a period and it can dry out a woman’s vaginal tissues.

Progestin and vaginal atrophy: More serious side effects can occur for some women with some progestins. The progestin and formulation (the estrogen/progestin mix) will vary from woman to woman but for one who is sensitive the effect, over time it can not only increase her hunger and decrease her natural testosterone (which causes her libido to disappear) but for some unlucky few will dry out the delicate vaginal tissues to the extent that sex becomes unbelievably painful even when using a good intimate lube like Astroglide, Replens or Dive-Gel. If those women are not seen by a Gyn expert in hormonal contraceptives their condition can be easily misdiagnosed as Vulvodynia and no effective relief can be managed because they continue on the pill that is causing their genital tissues to atrophy.

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Powys , Wales, United Kingdom
I'm a classically trained dancer and SAB grad. A Dance Captain and go-to girl overseeing high-roller entertainment for a major casino/resort