First abortions of the school year

Oops! Guess who’s 4 days late starting her next pack of pills!

Birth control at colleges and Prep schools: Most female students still use oral contraceptives (mostly the combined, estrogen/progestin, pill) for birth control and many of them don’t take them correctly and consistently causing that method on average to be about 92% effective. We are about six weeks into the school year and are beginning to see the first of the students with unintended pregnancies come in for terminations.

Being on hormonal contraceptives takes more care than just taking a pill every day at the same time. That’s primary of course, but the pill and even implants, transdermal, and transvaginal methods, hormonal IUDs and injection methods can be compromised by other meds and supplements. There are a lot of reasons that young women don’t take their contraceptive meds as they should or take interacting meds or supplements: Lack of an effective regimen at the same time every day. Unpleasant side effects that tend to cause users to ‘forget’ to take their pills.

And things to avoid that should have been explained to them such as: weight loss pills taken to counteract the ‘freshman fifteen’ can speed the metabolism to the extent that the contraceptive hormones don’t stay long enough in the bloodstream to keep an effective level to suppress ovulation. Or taking the EC drug ella and then not using another effective method for the rest of that cycle, because the steroid in ella binds with the woman’s progestin receptors and prevents progestin from any pills taken for the next several weeks from being used by her body, leaving her open to ovulation and conception after the encounter of concern for which ella was taken had long passed. And then there is reduced effectiveness caused by some antibiotics. Or Vomiting within two hours after taking a pill and the hormones may not have been digested.

Hormonal contraceptive side effects:

Positives:

99% effective when used correctly
Regulates cycles
Decreases menstrual bleeding and discomfort
Can help clear some cases of acne 

Negative side effects for some women:

Estrogen withdrawal headaches
Vaginal dryness
Breast tenderness
Weight gain
Loss of libido
Hair loss
Depression
Small but real Increased risk of blood clots and strokes especially for Newer Progestins like etonogestrel (Nexplanon & NuvaRing) and Drospirenone (Yaz, Beyaz & generics)
Must be taken correctly, consistently and on time
Effectiveness lessened by some meds and supplements..

My Wards after school Jobs: I’m pleased that we got Bea, Cyndi and the Swan twins using GyneFix copper IUDs so they can continue to cycle while being very effectively protected from pregnancy. That way they can be as sexually active as they like with only having STIs to worry about. I’ve been able to get the twins onto the male escort trainee’s partners list so they will get the benefit of training with professionals. The wide range of escort trainee partners who are clean and frequently checked gives them a very large pool of gorgeous and very experienced men to train with just like Bea and Cyndi who are continuing to volunteer as partners to help train the escorts. Their volunteer effort is superb training for the girls as it lets them experience a wide range of male sexual techniques and they are being paid pocket money for something that they love doing.

Our termination clinic: We are seeing mostly college age girls as they are away from home and are not as closely supervised as students in female prep schools in the area, including St Lucy’s.  All so far have been either hormonal conceptive, or both condoms and hormonal contraceptive failures. From what the patients say it is the newness of their surroundings and the frantic pace of trying to be popular and do everything at once that has caused them not to put as much emphasis on contraception as they should have while sampling the physical delights that new male friends can provide. That part of our clinic is very private with individual waiting rooms (with shielded Wi-Fi for their personal electronics)  and separate entrances and exits so no one sees anyone else while arriving or leaving so the patient’s identities are protected.

At St Lucy’s we have already administered flu shots for the 2013-14 Flu season first thing if the student hadn’t already gotten one. I mention this here because many students who get Flu will try to treat it with an antibiotic retained from a bacterial illness or gotten from a friend; only to find much to their dismay that not only did the antibiotic not treat the Flu, but reduced the effectiveness of her birth control resulting in her carrying someone baby. If she is lucky she knows who’s so she can go to him for support if she wants to.

Most students seeking a termination want a vacuum aspiration.  While it is a bit uncomfortable it’s over in a half hour or so, while with Mifeprex, RU486, the process takes several days and still may require a vacuum aspiration. Too, there have been some fatalities with women using Mifeprex so it doesn’t have quite the cachet it had when first introduced several years ago.