But as I grew up, started using the pill as a contraceptive, and became a scientist myself,

但隨著我長大，開始使用避孕藥，自己也成為一名科學家。

I started asking more questions about what exactly the pill is doing in our bodies. Because not only do I take it, but millions of other people around the world do too.

我開始問更多關於藥片在我們身體裡到底有什麼作用的問題。因為不僅是我在服用，而且全世界數以百萬計的人也在服用。

Now, there are a ton of different methods of birth control out there. We've got the hormonal ones, like the pill, IUDs, shots, implants,

現在，有一大堆不同的節育方法。我們有荷爾蒙類的，如避孕藥、宮內節育器、注射、植入物。

and then the physical barriers like condoms and diaphragms. The list of choices is growing and frankly, it's kind of overwhelming.

然後是物理屏障，如保險套和避孕膜。選擇的清單在不斷增加，坦率地說，這有點讓人不知所措。

So I figured we could focus on two of the most popular ones: the pill and the hormonal IUD,

所以我想我們可以把重點放在兩個最受歡迎的方面：避孕藥和荷爾蒙宮內避孕器。

both of which have a ton of interesting effects on the bodies of people who menstruate, some of which we're still figuring out.

兩者都對來月經的人的身體產生了大量有趣的影響，其中一些我們仍在摸索之中。

Sometimes I think birth control can be a little bit of a mystery to some people.

有時，我認為生育控制對一些人來說可能有點神祕。

About half of people who are on a birth control pill are on it for things other than pregnancy prevention.

在服用避孕藥的人中，大約有一半是為了預防懷孕以外的事情。

When the birth control pill was first invented, part of its purpose was to be able to give the person

當初發明避孕藥的時候，其部分目的是為了能夠讓人

who was ovulating the power to decide what they wanted to do independent of their partner.

處於排卵期的人有權力決定他們想做的事情，而不是他們的伴侶。

Dr. Stacy T. is right, this tiny but mighty pill prevents pregnancy, but it can also help the person taking it have more control over

Stacy T.醫生是對的，這種微小但強大的藥丸可以防止懷孕，但它也可以幫助服用者更有效地控制

lots of other things to do with their sexual and reproductive health. So how exactly does it work?

很多其他與他們的性和生殖健康有關的事情。那麼它究竟是如何工作的呢？

There are lots of different formulations of the pill, but the most common is the combination pill. If you've watched my video on menstrual cycles,

有很多不同配方的避孕藥，但最常見的是複合避孕藥。如果你看了我關於月經週期的視頻。

which you can check out now, you'll remember that two of the important sex hormones that influence fertility are estrogen and progesterone.

你現在可以查看一下，你會記得影響生育的兩種重要的性激素是雌激素和孕激素。

The combination pill contains synthetic versions of both of those hormones: those are called ethinyl estradiol and progestin.

組合藥片包含這兩種激素的合成版本：這些激素被稱為炔雌醇和孕激素。

When you take both of these together, what it does is it suppresses ovulation.

當你同時服用這兩種藥物時，它的作用是抑制排卵。

There's a couple of other secondary factors that it does as well, it might alter motility of the tubes themselves, and it might thin out the lining of the uterus.

它還有其他一些次要因素，它可能會改變輸卵管本身的運動能力，並可能使子宮內膜變薄。

Basically the pill makes it so no baby-making equipment is up and running. On top of that, the progestin in the pill thickens the mucus of the cervix.

基本上，避孕藥使它沒有製造嬰兒的設備在運行。此外，避孕藥中的孕激素會使子宮頸的粘液變稠。

And yes, your cervix naturally produces mucus, it's totally normal and healthy and cool, and by making that thicker, it acts as a 'no sperm allowed' zone.

是的，你的子宮頸會自然產生粘液，這完全是正常的、健康的、冷靜的，通過使粘液變稠，它可以作為一個 "不允許精子 "的區域。

So even if a sperm manages to get to the cervix, it would get stuck, kind of like a sticky trap for insects.

是以，即使精子設法到達子宮頸，它也會被卡住，有點像昆蟲的粘性陷阱。

And yes. The pill does prevent pregnancy, but there are lots of other reasons to take the pill.

而且是的。避孕藥確實可以防止懷孕，但是還有很多其他的原因需要服用避孕藥。

There are some other benefits and pleasant side effects that the pill can sometimes offer,

該藥片有時還能提供一些其他好處和令人愉快的副作用。

such as decreased bleeding with periods, decreased cramping with periods.

如經期出血量減少，經期痙攣減少。

It can help treat acne, as my teenage self discovered, and in the long-term, research is also telling us that taking the pill can reduce our risk of

它可以幫助治療痤瘡，正如我十幾歲的時候發現的那樣，而且從長遠來看，研究還告訴我們，吃藥可以降低我們的風險。

uterine, colon and ovarian cancers. And for those suffering from endometriosis or fibroids, conditions that cause really painful and really heavy periods,

子宮癌、結腸癌和卵巢癌。而對於那些患有子宮內膜異位症或子宮肌瘤的人來說，這些疾病會導致真正的疼痛和非常沉重的月經。

the pill can provide relief by alleviating some of those symptoms.

該藥可以通過緩解這些症狀而提供救濟。

Now, obviously, the birth control pill is not curing any of these conditions per se. It's meant to control symptoms.

現在，很明顯，避孕藥本身並不能治癒任何這些疾病。它是為了控制症狀。

Meaning, birth control isn't necessarily treating the root cause of an issue. And everyone is different.

意思是說，控制生育不一定是在治療問題的根源。而且每個人都是不同的。

So, while some people do get huge benefits out of taking it, the crappy side effects of birth control aren't talked about as much.

是以，雖然有些人確實從服用避孕藥中獲得了巨大的好處，但避孕藥的蹩腳副作用卻沒有被談論得那麼多。

Things like headaches, breast tenderness, or nausea. And one reason why these side effects happen is the hormones in the medication are synthetic.

諸如頭痛、乳房脹痛或噁心。而發生這些副作用的一個原因是藥物中的激素是合成的。

They mimic your natural ones, but they don't 100 percent match them. And that's why the pill's side effects are a little different

它們模仿你的自然的，但它們並不是百分之百的匹配。這就是為什麼避孕藥的副作用有點不同的原因

from the effects of, say, just the natural progesterone that your body produces.

從，比如說，只是你身體產生的天然黃體酮的影響。

And just by taking these synthetic hormones, the symptoms of your menstrual cycle may be amplified.

而僅僅通過服用這些合成激素，你的月經週期的症狀可能會被放大。

And in the long term, there are still some unanswered questions about birth control. Like what effect can these hormones have on mental health?

而從長遠來看，關於節育的問題仍有一些未解之謎。比如這些荷爾蒙會對心理健康產生什麼影響？

What effect does the pill have on our vaginal microbiome? And some of the side effects we do understand relatively well can be really serious,

藥片對我們的陰道微生物組有什麼影響？而我們相對了解的一些副作用可能真的很嚴重。

like the increased risk of blood clots, but we'll get more into that later.

比如血栓的風險增加，但我們以後會更多地討論這個問題。

Because, to be most effective, the pill has to be taken daily around the same time so that the levels of these hormones in your body are kept nice and steady.

因為為了達到最佳效果，藥片必須每天在同一時間服用，以便使你體內的這些荷爾蒙水準保持良好和穩定。

So what about the other popular contraceptive we mentioned?

那麼，我們提到的另一種流行的避孕藥呢？

The intrauterine device, or the IUD, is implanted directly into the uterus, which sounds a little intimidating

子宮內避孕器，或稱宮內節育器，直接植入子宮，這聽起來有點嚇人。

but IUDs fall under the category of LARCs, or Long-Acting Reversible Contraceptives. These little “t” shaped devices come in two main flavors: hormonal and copper.

但宮內節育器屬於LARC的範疇，即長效可逆避孕藥。這些 "t "形的小裝置有兩種主要類型：荷爾蒙和銅。

And it's a favorite for those who want a more low maintenance option. Because once it's in the uterus, you can keep it there for years,

而且它是那些想要一個更低的維護選項的人的最愛。因為一旦它進入子宮，你可以在那裡保持多年。

depending on which one you get, and you don't really have to give it much thought. The hormonal IUD's lifespan can be anywhere from 3 to 7 years,

這取決於你得到的是哪一種，而且你真的不必考慮太多。荷爾蒙宮內節育器的壽命可以是3到7年。

depending on the brand. And apart from abstinence, LARCs are one of your best non-permanent bets to avoid pregnancy,

取決於品牌的不同。除了禁慾之外，LARC是你避免懷孕的最好的非永久性賭注之一。

because they have more than 99% efficacy rate.

因為他們有超過99%的療效率。

So how exactly does it work? The hormonal IUD is constantly releasing a small amount of progestin into the uterus

那麼它究竟是如何工作的呢？荷爾蒙宮內節育器不斷向子宮內釋放少量的孕激素。

while it's chillin' up there, so it's a localized hormone delivery as opposed to the pill, which is releasing its hormones system-wide via your bloodstream.

當它在上面冷卻的時候，所以它是一種局部的激素傳遞，而不是像藥片那樣，通過你的血液在全系統釋放激素。

And like the pill, the IUD's progestin thickens the mucus of the cervix. The hormonal IUD does also come with a “fun” array of side effects:

和避孕藥一樣，宮內節育器的孕激素會使子宮頸的粘液變稠。荷爾蒙宮內節育器也有一系列 "有趣 "的副作用。

things like irregular bleeding patterns, headaches, cramping, bloating

諸如不規則的出血模式、頭痛、痙攣、腹脹等問題。

but typically, these are supposed to go away about 3-6 months after insertion.

但通常情況下，這些應該在插入後3-6個月左右消失。

There are also very rare cases of complications, like the device causing damage to the uterus, or your body can choose to just expel the IUD entirely

也有非常罕見的併發症，如裝置對子宮造成損害，或者你的身體可以選擇完全排出宮內避孕器。

like, just yeet it out of your uterus, but again, these are very rare.

比如，把它從你的子宮裡取出來，但同樣，這些都是非常罕見的。

So as you can see, these two popular choices, the IUD and the pill, are far from perfect.

所以你可以看到，這兩個流行的選擇，即宮內節育器和避孕藥，遠非完美。

And remember that increased risk of blood clots? Here's the sitch on that.

還記得血栓風險的增加嗎？情況是這樣的。

We know that the increased risk of blood clotting is mostly from the estrogen components, because estrogen is thought to be what we call pro-thrombotic.

我們知道，血液凝固風險的增加主要來自於雌性激素成分，因為雌性激素被認為是我們所說的促血栓形成。

That essentially means that your blood is more likely to clump together into clots. And these can be dangerous because

這基本上意味著你的血液更有可能凝結成血塊。而這些可能是危險的，因為

they can block blood flow to other parts of your body. Research suggests that the synthetic estrogen in the pill is what's increasing

它們可以阻止血液流向你身體的其他部分。研究表明，避孕藥中的合成雌激素是增加

certain blood clotting factors, while also decreasing anticoagulants, or the substances that can thin out your blood,

某些凝血因子，同時也減少抗凝血劑，或能稀釋血液的物質。

all of which together makes a big, blood, roadblock more likely.

所有這一切加在一起，使一個大的、血的、路障的可能性更大。

So the higher estrogen state, the higher that risk is. So when birth control pills were first invented, and the dosages were significantly higher,

所以雌激素狀態越高，這種風險就越高。是以，當避孕藥剛發明時，而且劑量明顯較高。

that risk was much higher. And as we've moved down those dosages, that risk has become lower.

這種風險要高得多。而隨著我們降低這些劑量，這種風險變得更低。

There are also cases where some kinds of progestin have been linked to blood clots, but we still need more research into that.

還有一些情況是，某些種類的孕激素與血凝塊有關，但我們仍然需要對此進行更多研究。

Like Dr. Staci said, those cases are rare, but this is why it's really important to be aware of the risks before choosing a birth control method,

就像Staci醫生說的那樣，這些情況很少，但這就是為什麼在選擇避孕方法之前瞭解風險真的很重要。

especially within the context of your personal health history, because some individuals may have a higher baseline risk to begin with.

特別是在你個人健康史的背景下，因為有些人可能一開始就有較高的基線風險。

And how about the long-term impact of taking synthetic hormones?

那麼，服用合成激素的長期影響如何呢？

I think a common misconception about birth control pills, in general, is that it can affect long term health overall.

我認為關於避孕藥的一個常見誤解是，一般來說，它可以影響長期的整體健康。

Most of the risks and side effects involved are more immediate when you're taking it and for some of them, for the short period after you're taking it.

大多數涉及的風險和副作用在你服用時比較直接，對於其中一些，在你服用後的短時間內。

I think it's important to take a minute here and recognize that while birth control has changed the world and so many individual lives for the better

我認為有必要在此花一分鐘時間，承認雖然節育措施已經改變了世界和許多人的生活，使之變得更好

it's not as good as it could be. And yes, it lets those of us who ovulate have more bodily autonomy. We get to decide if and when we get pregnant

它並不像它可以做到的那樣好。是的，它讓我們這些有排卵的人有更多的身體自主權。我們可以決定是否以及何時懷孕。

which is arguably one of the most important decisions for our lives and our health, and one that used to be much more out of our hands.

這可以說是對我們的生活和健康最重要的決定之一，而這一決定過去更不在我們的掌控之中。

But the burden of birth control, the cost, the responsibility, and certainly the health risks, still mostly rests on the shoulders of the person

但是節育的負擔、費用、責任，當然還有健康風險，仍然主要由當事人承擔。

who can get pregnant, and they might be left with lots of questions, or stuck between choices that may not be quite right for them.

誰能懷孕，他們可能會有很多問題，或者在可能不太適合他們的選擇之間徘徊。

Because aside from the pill and the IUD, there are a ton of other options out there, and each comes with their own pros and cons.

因為除了避孕藥和宮內節育器之外，還有很多其他選擇，而且每一種都有自己的優點和缺點。

One of the most common questions that I get all the time, is what is the best form of birth control?

我一直收到的最常見的問題之一，就是什麼是最好的避孕方式？

And that question is really difficult because it's different for each individual person, because everyone has different priorities.

這個問題真的很困難，因為它對每個人都是不同的，因為每個人都有不同的優先事項。

Everyone has a different health background.

每個人都有不同的健康背景。

Everyone has different ideas of if they want to prevent pregnancy, or if they want to treat symptoms of something else.

每個人都有不同的想法，他們是想預防懷孕，還是想治療其他方面的症狀。

So best is not really a generalizable thing. It is what is best for you and your personal priorities.

是以，最好的東西並不是一個可以概括的東西。它是對你和你的個人優先事項最好的東西。

My hope is that the more we talk about our existing birth control options, like which parts work and which parts don't,

我的希望是，我們越是談論我們現有的節育選擇，比如哪些部分有效，哪些部分無效。

and ask for more research into some of the side effects we still don't have a clear picture on, then the science world may be motivated

並要求對一些我們仍然不清楚的副作用進行更多的研究，那麼科學界可能會有動力

to come up with better and better options. And who knows, male birth control may become a reality sooner rather than later, and that would be rad!

來想出越來越好的選擇。誰知道呢，男性生育控制可能會盡早成為現實，而不是晚些時候，那將是非常好的。

The upshot is, I hope learning more about the ins and outs of your own bodily cycles and how birth control works within those

結果是，我希望更多地瞭解你自己的身體週期的來龍去脈，以及在這些週期中如何進行節育。

can give you the power to take your time. Talk to your healthcare provider, ask questions, do your own research, and make informed decisions

可以給你力量，讓你慢慢來。與你的醫療保健提供者交談，提出問題，做你自己的研究，並做出明智的決定。

about what's best for you and your goals. Good luck out there.

關於什麼是最適合你和你的目標。祝你在外面好運。

I know it's tough but now at least you have some info to get you started.

我知道這很困難，但現在至少你有一些資訊可以讓你開始。

Thanks for watching Seeker's new series Body Language. I hope you've enjoyed this video.

謝謝你觀看Seeker的新系列《身體語言》。我希望你喜歡這個視頻。

And if there's another women's health topic you want us to cover, leave us a comment. I'll see you next time!

如果你想讓我們報道其他的女性健康話題，請給我們留言。我們下次再會!