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"Weekend House Call"

Aired September 13, 2003 - 08:29   ET


HEIDI COLLINS, CNN ANCHOR: "Weekend House Call" with our Dr. Sanjay Gupta begins right now.
DR. SANJAY GUPTA, CNN CORRESPONDENT: Good morning and welcome to CNN's "Weekend House Call".

I'm Dr. Sanjay Gupta.

Well, a really interesting topic this morning. The FDA has just approved a new oral contraceptive for women called Seasonale. Women will have fewer periods, about four per year. We're going to spend the next half hour discussing Seasonale and some of the other options out there for birth control.

Now, as CNN's Elizabeth Cohen explains, there are -- the market is full of choices beyond the pill.


ELIZABETH COHEN, CNN CORRESPONDENT (voice-over): If not the pill, then perhaps the patch. Both contraceptives contain two hormones. The pill is taken daily, but the patch, which can be placed on the abdomen, upper arm or rear-end, is changed weekly. Both are 99 percent effective if used properly.

A new type of drug has just been approved by the FDA. It's called Seasonale and it's similar to the pill, though it offers women the alternative of having a period only four times a year.

DR. CAROLYN WESTHOFF, OB-GYN: I have not had any side effects from suppressing periods and I think it's terrific.

COHEN: And there's another new option out there, the NuvaRing, which secretes hormones.

DR. MIRIAM ZIEMAN, EMORY UNIVERSITY: This is the ring, also pliable, easy to insert into the vagina, also works like the pill. And the good thing here is you change it once a month.

COHEN: As with the pill, side effects are rare, but can be serious, including blood clots, heart attack and stroke. Alternatives also now included the intrauterine device Mirena. And now available on the Internet and likely due back in U.S. stores in the next few months is the Today sponge, perhaps best known for its appearance on "Seinfeld."

(BEGIN VIDEO CLIP FROM "SEINFELD") UNIDENTIFIED FEMALE: Yes, do you have any Today sponges? I know they're off the market, but I was just...

UNIDENTIFIED MALE: Actually, we have a case left.


I just couldn't decide if he was really sponge worthy.



COHEN: Many complain with all these options for women, drug companies aren't working hard enough to develop more birth control options for men, in addition to vasectomies and condoms.

Elizabeth Cohen, CNN, Atlanta.


GUPTA: Hmmm. So a lot of choices. And that's a good thing. But how do you decide which birth control is best for you at home?

Well, experts say there are four main factors to your decision -- your health, the frequency of your sexual activity, the number of partners you have and your desire to have children in the future.

But there is also a lot of other questions that always come along with this issue. So to help you get some answers today, you can call us at 1-800-807-2620. International charges will apply for overseas callers. Or you can send us an e-mail,

And to help us wade through this topic, we are joined by the Berman sisters to help answer all of our questions, Dr. Jennifer Berman is joining us right now. She's a urologist and a sex therapist. She joins us from Los Angeles. And I believe your sister is going to be joining us in a little while. She's a psychologist and sex therapist in Chicago.

Dr. Berman, thank you for joining us, especially so early in the morning out there in Los Angeles.


That's OK, a good topic.

GUPTA: You look pretty bright.

Well, let's get right to our first e-mail. Lots of them coming in, as you can imagine.

From Stella in California. She's asking about the newest option, Seasonale. The question is, "Is the new Seasonale pill 100 percent reversible? In the long run, could it adversely affect fertility?" And, Dr. Berman, this is something that comes up even with the pill. When women stop taking this, how long does it take before they can get pregnant again?

JENNIFER BERMAN: Well, that all depends on the woman, and, in particular, the age of the woman. But birth control is in -- birth control pills or any birth control in and of itself does not prevent fertility. Now, I will say that the intrauterine device is not recommended for young, fertile women waiting to have children. But in terms of the pill, that is, you know, her, once she starts cycling again, which usually takes anywhere between one and six months, she ought to be able to conceive, assuming everything else is normal.

GUPTA: And that's the same for both the pill and Seasonale?

JENNIFER BERMAN: The pill and Seasonale, yes.


Let's go straight to our next e-mail, which comes from Linda in Texas. She writes, "How would using the patch help reduce the chance of getting pregnant?" Again, that's becoming a popular option, as well, Dr. Berman.

What do you say about the patch?

JENNIFER BERMAN: Well, the patch, really, what it does is just is a more convenient way of delivering the same amount of very low dose hormones. So instead of taking a pill every day, you put the patch on. So it's just a more convenient way of birth control. And it, but it works, it functions exactly the same way.

GUPTA: OK. And a lot of phone calls coming in, as well. Let's try to get one of those in before the break, as well.

Rhonda in Texas, welcome to House Call.

RHONDA: Thank you.

GUPTA: Good morning.

What's your question?

RHONDA: Well, I'm 47 and for the last year I've only had maybe one or two very scant periods. And it appears that I'm going through a natural menopause, but the big scare is do I still need protection?

GUPTA: That's a good question.

JENNIFER BERMAN: That's a good question.


JENNIFER BERMAN: The fact that she's 47 means, by definition, that she's perimenopausal, right before the menopause, if, for that matter, as she said, she might be starting to go through the change now. But just because you're having irregular periods does not mean that you cannot get pregnant. So in answer to your question, you do still need to, at this time, use birth control until you stop menstruating and, for that matter, have your hormones checked with your doctor.

GUPTA: OK, all right, and let's take another call now. It's, I think Deidre (ph) is on the line.

DEIDRE: Oh, yes.

GUPTA: Welcome to House Call, Deidre.

DEIDRE: Hello. Hi.

GUPTA: Good morning.

DEIDRE: Two years ago I had an operation called an endometrial ablation, where they burn away most of the uterine lining. And because of that operation, now I only get a very light period that lasts about two days. And I had this operation because I had very painful, debilitating periods.

I heard about this new pill, Seasonale, which gives you a period only once every three months. And right now I'm not on any birth control, but I'm wondering if I took this pill, how would that affect me and would having a period only once every three months, would it be a heavier period or more painful because you haven't -- I mean is it going to build up inside of you and then, you know what I mean?

JENNIFER BERMAN: Yes. I mean in women such as yourself, with what we call dysfunctional uterine bleeding or heavy periods, the Seasonale, or any medication, for that matter, is not necessarily going to alleviate that, because there is increased growth of the lining of the endometrium.

So these medications, and Seasonale in particular, are for women with normal menstrual periods and no dysfunctional bleeding. But it just decreases the frequency of the menstruation.

So I, honestly, I don't think that that would have solved your problems.

GUPTA: OK. Lots of questions, lots of phone calls coming in.

We have another e-mail coming in, as well, that says, "A new birth control product that seems too good to be true." We'll investigate and have some answers to that question when we come back. And we'll be taking more of your calls, as well, 1-800-807-2620. Our e-mail address,


GUPTA: We're talking about birth control this morning and some of the newest options available for women. You can call us with your questions. That's at 1-800-807-2620. Or send us an e-mail. Our address, Right now, though, we want to check our Daily Dose health quiz. Our question today, "Who pays for the most research for contraceptives?"

We'll have that answer in 30 seconds.

Stay with us.


GUPTA: All right, checking the Daily Dose quiz now, we asked who funds most of the contraceptive research? Well, the answer is the National Institutes of Health, the NIH. It's the world's largest single funder of contraceptive research. It can cost $20 million to $70 million to bring a single new contraceptive method through research, development and final approval for marketing by the Food and Drug Administration.

Well, the phone lines are lit up and we're getting some great questions. We want to hear from you, as well. Send us an e-mail, that's at

Let's get straight to our next one. Molly in Texas writes, "My ob-gyn recently started me on a product called NuvaRing. The product appears to be too good to be true, as I have never felt better. Is there something I don't know about this particular product?"

And we're joined again by Dr. Jennifer Berman from Los Angeles.

Good morning out there, again, Dr. Berman.

JENNIFER BERMAN: Good morning.

The NuvaRing is a good product. It's basically a silicon impregnated ring, so it's a soft ring that has, that slowly delivers hormones into the vagina. Now, there are some advantages and disadvantages of that. But a lot of women do like it and say that it really helps with lubrication, per se, and, for that matter, arousal and sensation.

It can come out of the vagina for up to three hours, but it needs to go back in. It stays in for three weeks and then out a week. It's a very good option for birth control and relatively easy to use.

GUPTA: OK, good information there, as well.

We're getting a lot of e-mails. I just want to get through as many as we can. Our next e-mail says, "My wife and I are in our mid- 30s and are not planning on having children. Both of us have looked into vasectomy and hysterectomy, but several doctors have advised us that we should wait until we are older or that we will not be able to find a willing surgeon to do that due to the fact that we have no kids."

What are the best options for birth control in their case? And that's sort of an interesting -- is that true, first of all? Will most surgeons say not right now, we want to wait until you're older?

JENNIFER BERMAN: Well, certainly I know the laws in the State of California is that you can be younger and you can be single, but you definitely need to be able to give consent and you need consent from both the man and his partner. Vasectomy is not necessarily permanent, but can be depending on how things are able to be reversed, and certainly not in her case, a hysterectomy. But she, I think she was meaning to say a tubal ligation or a ligation of the tubes, and they have temporary ways of doing that.

But in a young, healthy, fertile couple that may, under any circumstances, want to have children later, that's not the ideal way to go. And things such as condoms and these newer birth control pills, patches, rings, are a very valuable option, unless there's a reason why she can't take them.

GUPTA: OK, we're going to hear from someone for who it's even earlier over there than it is for you, Dr. Berman. In Hawaii we have Michelle.

Good morning, Michelle.

MICHELLE: Good morning.

GUPTA: What's your question?

MICHELLE: My friend and I have been trying to research some information. She has lupus, so it's really hard to find birth control for her. And we were wondering if you had any ideas for us?

GUPTA: And, Dr. Berman, a lot of people, we've got a couple of questions now about people who have coexisting medical problems, as well. Is that something you take into account when thinking about birth control methods, whatever they might be?

JENNIFER BERMAN: Absolutely. Yes, sure. Medical conditions and smoking history and family history, all of those things are very important when prescribing any medication, as well as birth control, which is a medication.

In terms of the lupus, there are concerns that probably estrogen can increase coagulation problems. I really don't know what the ideal solution is for her. Things such as an IUD or a diaphragm with spermicidal jelly are an option that are non-hormonal in combination with condoms, and to talk to her doctor because some doctors do allow women with lupus to take very low dose birth control.

GUPTA: OK, and we're going to get into some of the side effects of the various contraceptive methods, as well.

But let's go ahead and take another phone caller first.

Heather in Pennsylvania.

Good morning, Heather.

Welcome to House Call.

HEATHER: Good morning.

How are you?

GUPTA: I'm doing well.

Do you have a question?

HEATHER: Yes, I do. I was wondering if the new birth control pills out -- I know that I've been on a variety and I know some of them cause weight gain. And I've been on a particular one that helped with water weight and PMS and such. Do you know if the newer one does that, as well, the one you can take and only get your period four times a year?

GUPTA: Specifically about bloating there, Dr. Berman, and Seasonale?

JENNIFER BERMAN: Yes, there, I don't think that there is any definitive data about the symptoms related to bloating. But if the bloating is related to periods or having your periods, then, yes, you'll have less episodes of bloating. But some women on the pill just in general feel that they have more weight gain, more breast tenderness, more bloating. And there are some pills that are better for that and some that are worse.

But in answer to your question, the newer Seasonale pill isn't -- wasn't developed specifically for that reason and won't necessarily get rid of all those side effects unless they're associated primarily with your period.

GUPTA: OK, it sounds good.

We're going to try and get your sister with us, as well, here in a moment, Dr. Berman.


GUPTA: It's earlier for her, so I'm not sure why she didn't get up in time. We'll have to figure that one out.

JENNIFER BERMAN: Later for her.

GUPTA: We'll have to ask her when she gets here. But, a lot of topics still coming up.


GUPTA: Oral contraceptives, commonly known as the pill, have been around for more than 30 years and many questions and concerns still remain. We're going to be answering those when we come back.

Stay with us.

COMMERCIAL GUPTA: All right, welcome back to "Weekend House Call".

A really interesting show so far. The pill, also known as the oral contraceptive, is the most popular method of reversible contraception in the U.S. Birth control pills are made up of synthetic hormones that prevent ovulation and impair fertilization. Well, now lower dosages of the hormones are used in today's pills compared to the pill that was first introduced in 1960, 43 years ago. The pill is considered very convenient for most women. It does require a prescription. It costs about $20 to $35 a month.

Now, you should not use the pill or many of the other contraceptives we've talked about this morning if you smoke. That's a really important topic. We're going to talk a little bit more about that now by way of our next e-mails asking about the pill.

Eric in Virginia actually writes, "Birth control pills have been used for several decades, so do we have a better understanding of some of the long-term effects, such as increased risk of ovarian or breast cancer?"

Dr. Jennifer Berman in Los Angeles is joining us.

Listen, this is a huge topic, as well. And hormone replacement therapy really put this on the map again. But talk about these lower dose birth control pills and the risk of cancer.

JENNIFER BERMAN: Well, there is some data to suggest that birth control or long-term birth control use can actually decrease the risk of ovarian cancer. In terms of breast cancer, we don't have enough data yet to really make an informed decision about that. The feeling is that estrogen in and of itself can put women at risk, but the combination of the estrogen plus progesterone and the dose and the type of delivery, we really don't have enough information yet to say whether this is going to cause young women to be at increased risk for breast cancer.

GUPTA: OK. And this is...

JENNIFER BERMAN: My feeling, no, but.

GUPTA: OK. This is going to come up some more, as well.

Let's go ahead and take another phone caller, as well.

Howie from D.C., good morning.

Welcome to House Call.

HOWIE: Hi. I have a question. I have been on birth control pills since, I guess, 1992. So that's about 10 years. While it has virtually reduced all cramps and has dramatically reduced the duration of my period, I'm wondering, am I going to have long-term effects in terms of -- I take the -- the pill that I take has the lowest estrogen amounts. But I'm wondering long-term, will that have any long-term effects for me in the end? GUPTA: Dr. Berman?

JENNIFER BERMAN: Again, the studies have shown that there really aren't any significant long-term negative effects to being on birth control. The one thing that women do experience as they get older and have been on birth control pills for a long time, especially the low estrogen kind, is vaginal dryness and, to some degree, change in desire or libido, because of the estrogen and, in addition, a protein that is raised in the blood due to the birth control. So that's one thing to watch out for.

GUPTA: OK, now let's try to squeeze another, one more e-mail question in here, as well.


GUPTA: This question coming from Marty in California, out your way, Dr. Berman. She says, "I've been on the pill since I was 16. I have noticed the pills make me retain more water. Is there any way to stop the bloating?"

It's sort of along the same lines of what you were just asked a few minutes ago, but if you are taking the pill and getting the bloating, what can you do about it?

JENNIFER BERMAN: There are -- well, a lot of women experience bloating just around their period. The pill can, to some degree, make that worse. There is a pill that has a diuretic in it that helps decrease with water weight gain around your period, and she might consider trying that one and speaking to her doctor about that.

GUPTA: OK. This has been a very interesting show. Seasonale has been the topic that we've been talking about, a new type of birth control pill. We've talked about a whole host of contraceptives.

We're going to have some final thoughts on that, thoughts from myself and Dr. Berman, when we come back.

Stay with us.


GUPTA: All right, well, that's -- there's been an entire show now, an entire half hour on contraception.

We've been joined by Dr. Jennifer Berman from Los Angeles.

A very interesting show. Lots of interest in this, a lot of people calling in.

Do you have a final thought for people today?

JENNIFER BERMAN: I think it's important information to know what options are available to women and the fact that there is research being done right now to develop a male pill. So it'll be good to hear the news and that in the years to come. GUPTA: We will definitely have you back on the show to talk about that.

And we'll mention, as well, your sister wasn't able to join us, as well, but the Berman sisters are well known. They have their own show on Discovery Health Channel, called by "Cosmopolitan" magazine the love doctors. We're definitely going to have them back at some point, as well.

Thank you so much.


GUPTA: All right, communicating with your doctor, that's our topic for "Weekend House Call" tomorrow. We're already getting lots of e-mails on this particular topic saying doctors are in too much of a rush and that "standing on your head" is the only way to get your doctor's attention.

Well, we plan to give you some better tips so that gymnastics aren't involved in your next doctor's visit.

You can send your e-mail questions to us,

We're back at 8:30 Eastern tomorrow.

I hope you'll tune in.


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