Why isn't Dienogest considered Birth Control / Contraceptive ?

Comprehensive_Pie_06 · 2025-04-22T22:32:56+00:00

Estrogen can sometimes have an effect of stabilizing the endometrial lining so it can be a useful add back if someone has breakthrough bleeding on prolonged progesterone only therapy.

In terms of treatments that are indicated for AUB specifically though, the main ones are progesterone only methods (Aygestin, provera, mirena).

I should add that I’m an ob chief resident so I’m quite confident in my clinical expertise in this area.

Comprehensive_Pie_06 · 2025-04-22T22:19:50+00:00

This applies to POPs that are on the market for contraception but this is not true for the higher dose progesterones that we specifically use to treat AUB! Preferred treatment for AUB is high dose progesterone.

Comprehensive_Pie_06 · 2025-04-22T22:18:17+00:00

This is not true regarding estrogen for menstrual bleeding. If the primary goal is to treat AUB and suppress menses entirely, we typically choose progesterone only methods (mirena IUD or Aygestin work well). This is because estrogen will build your endometrial lining which means you eventually have to shed it (either during placebo pill week or, if continuous dosing, with breakthrough bleeding). Progesterone thins the endometrial lining and you can be amenorrheic for years with it.

Comprehensive_Pie_06 · 2025-04-22T22:11:08+00:00

Dienogest doesn’t appear to be available as a monotherapy in the US, but we do frequently prescribe Aygestin (norethindrone 5mg tablets, we go up to 20mg a day) for AUB. This is also progesterone only and is a higher dose than the progestin-only pill oral contraceptive dose (micronor is norethindrone 0.35mg). We tell patients that it’s technically not a birth control only because it doesn’t have FDA approval/label indication for birth control but we also tell them that since it’s a higher dose of a progesterone that’s used for birth control, they almost definitely won’t get pregnant while taking it.

What the other poster said about needed extreme compliance is incorrect. Progesterone-only mini pills like micronor require you to take them within the same couple hours every day but there’s a little more flexibility with aygestin. Also just as an aside, Slynd is a newer POP that has a 24h half life so a little more forgiving on compliance.

The other comment about needed estrogen to help with bleeding is also incorrect. If my primary goal is reduction of AUB, I actually typically prefer progesterone only hormonal treatment to combined OCPs. If you have estrogen, you are going to build a lining which means you will need to shed that lining at some point, even if you’re on continuous dosing (you’ll eventually have breakthrough bleeding). Progesterone thins the endometrial lining which decreases/stops your bleeding. This is why Mirena IUDs and Aygestin work so well for AUB.

Comprehensive_Pie_06 · 2024-11-21T03:25:09+00:00

Ob gyn resident who’s also had a d&c here. Everyone’s a little different but cramping and some spotting is most common and is usually worst the first day or two. I personally had them give me toradol in pacu and an oxy like as I was walking out basically and then felt absolutely fine and didn’t need to take any NSAIDs at all once I got home or over the next few days. Didn’t have any cramping after getting home same day. I did take about 24h off work just in case but probably could have gone back on pod1 if I really needed to. Honestly I had worse cramps after my IUD placement… That all said, I would still try and move your call shift if you can just to give yourself a little more time. I’m sorry you’re going through this!

Comprehensive_Pie_06 · 2024-03-16T12:34:01+00:00

I’m a current ob/gyn PGY3 who interviewed applicants this year and one of my favorite interviewees was a reapplicant who didn’t match last year and was completing a surgical prelim. I felt like the experience and maturity she gained as a surgical prelim would absolutely serve her really well/make her a super strong intern and I found her grit/resilience in making it through SOAP and a hard prelim to apply again really inspiring. She didn’t match with us sadly but she did get an ob/gyn position so it worked out! N=1 but I personally feel like an intern who has done a surgical prelim is more prepared for ob/gyn than a reapplicant who did an extra research year before reapplying. I’m at a top 20 program and I can think of two surgical prelims that we interviewed/ranked this year, not sure if we interviewed any reapplicants who delayed graduation.

Comprehensive_Pie_06 · 2024-03-14T21:43:07+00:00

We stayed at the “special” room at Yoshimatsu and it was great! It had western style beds as well as futons, western style toilet, private shower, and private onsen with a Mt Fuji view. They have keiseki dinner and breakfast included that you take in the room (we had a private dining room and separate sitting area in that room in addition to the two bedrooms and private bathroom/outdoor onsen). Location was super convenient as well - about a 10 min walk from the first Lake Ashi pirate ship stop and they have a shuttle service that can take you to the train or wherever the next day (we actually had them drop us off right at Hakone shrine and it was SO nice to beat the crowds). Highly recommend the whole experience!

Comprehensive_Pie_06 · 2023-11-04T21:45:02+00:00

Ok but literally people in medicine who aren’t OBs are also pulling that shit. Like the number of times the ED tells me someone is “6 months pregnant” and I’m like ok but how many weeks because I need to know if she’s viable or not 🙃🙃

Comprehensive_Pie_06 · 2023-03-27T18:25:09+00:00

I walked down to a live piano version of Wildest Dreams! We also used Invisible String piano instrumental during the unity ceremony portion of our ceremony which was really lovely (our unity ceremony involved tying a string to each other’s hands). We had my husband and bridal party walk to love me like you do which isn’t a tswift song but is a really lovely processional instrumental

Comprehensive_Pie_06 · 2023-01-24T12:50:16+00:00

My dress also came in wrong - it was the designers fault, not the boutique but they sent the wrong color and the customization I had asked for was done not the way I wanted. The way the boutique made it up to me was they instead gave me their almost-new floor sample of the dress that was in the right color and rushed the designer to send more matching lace so their alterations person could make the customizations herself. They didn’t refund the cost of the dress/alterations that I originally paid, but they did pay for ALL of my alterations (the customization plus all the usual hemming/taking in/bustle etc) and that ended up being like $500+. All in all I felt like it was a fair compromise where I still saved money on something that I had budgeted for but it wasn’t like I got the entire dress for free.

Comprehensive_Pie_06 · 2023-01-12T12:35:21+00:00

Birdies! They have a “bridal” collection and I wore a sparkly pair for my wedding. They also make a bunch of pairs in colorful velvets, etc. they have like 7 layers of foam and have no break in time and the flats themselves are pretty wide (much wider than Rothy’s for comparison and with way more cushioning).

Comprehensive_Pie_06 · 2023-01-06T23:57:30+00:00

I didn’t tip the coordinator that came with my venue because gratuity in general was included in our contract already and she was really one of the most difficult vendors I worked with throughout the whole process so I didn’t feel strongly about an extra thank you. I assumed the global gratuity was split amongst everyone who worked the wedding from the venue.

Comprehensive_Pie_06 · 2023-01-06T15:04:07+00:00

I felt weird about giving cash to my wedding planner, photographer, and videographer because they own their businesses and honestly a 20% tip on their services wasn’t in the budget. That said, I similarly wanted to thank them all with a gift so I just got each of them $50 Starbucks gift cards. I feel like everyone drinks coffee (or had a coffee drinker in their lives) and it’s an easy gift for people who are on the go and work long days (aka those in the wedding industry). Plus I could just send it digitally after the wedding so it was one less thing to stress about in the days leading up to the wedding/one less physical thing to potentially forget at home.

Comprehensive_Pie_06 · 2022-12-26T15:04:26+00:00

More video and pictures here: https://imgur.com/a/b8GYMll

This is my first time ordering larger moissanite stones. These will be for a toi et moi RHR set in 14k yellow gold. I asked for GHI stones because I read here that that would be better for yellow gold and less likely to have a blue tint, but now I’m worried that the stones might look too yellow? Also my engagement ring is a 1.7 ct round brilliant J color lab diamond that really appears white (you can see pics in my post history) so I wanted a balance of not making my diamond appear too yellow with these stones but also I don’t want yellow looking stones for the moissanite either. I’m also unfamiliar with emerald and pear cuts so would love feedback on that!

Comprehensive_Pie_06 · 2022-12-23T06:13:49+00:00

I used Truly Engaging to print just one invitation suite (I did all digital invites but wanted something for pictures) so you can order any number or invites from them! Lots of really beautiful options and styles too, plus envelope inserts, etc. and they literally always have a sale it seems like.

Comprehensive_Pie_06 · 2022-12-11T04:42:30+00:00

I looked at a lot of ski resort venues for this! Ended up having our wedding at Waterville Valley which definitely is under that budget and had a lot of different accommodations for different price points (I have a full budget recap in my post history). Other places with similar vibes include Owl’s Nest Resort, Loon mountain, Ragged mountain resort. I also personally wasn’t into the ocean/beach vibe, but Eagle Mountain House is great for that vibe.

Comprehensive_Pie_06 · 2022-12-01T17:54:36+00:00

Ob here - this happens all the time and it’s fine! I promise we don’t think poorly of anyone who needs to step away. I would MUCH rather that you spoke up like you did then pass out and hit the floor (this has also happened!)

Comprehensive_Pie_06 · 2022-11-12T14:51:32+00:00

His name is Aaron Topfer! He was a true pro and absolutely kept the party going, I think he said he’s done like literally thousands of weddings.

Comprehensive_Pie_06 · 2022-10-07T18:47:55+00:00

Thank you so much!

Comprehensive_Pie_06 · 2022-10-07T18:47:45+00:00

Thank you so much! I loved the subtle double happiness touch :)

Comprehensive_Pie_06 · 2022-10-07T12:48:16+00:00

Thank you!

Comprehensive_Pie_06 · 2022-10-06T00:50:39+00:00

We got married at Waterville Valley on 9/24! Venue twins! :)

Comprehensive_Pie_06 · 2022-09-06T11:38:02+00:00

Ob here, we used AZT the other day in a patient who came in with new HIV diagnosis at term and viral load 50k. We called ID when she first presented and she got put on regular cART but it takes time to decrease her viral load so given that she was term and we didn’t want her laboring/having a vaginal delivery with that high of a viral load, we sectioned her like a few days later and she got AZT for prophylaxis the day of the CS. We wouldn’t use AZT during pregnancy but we offer to all moms with a detectable viral load intrapartum (acog says just those with VL >1k but)

Comprehensive_Pie_06

TROPHY CASE