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Ever since birth control pills were FDA-approved in 1960, elements of mystery and danger have surrounded this first-ever oral contraceptive. As a result, many women still don’t have a clear understanding of how the pill works and what it does and doesn't do.

Worse still is that many women have been discouraged from taking birth control pills based on advice from family members, friends, and even doctors who don’t believe or comprehend the science behind them. Women are often told that the pill has horrible side effects—including weight gain and long-term infertility—that simply haven’t been proven through research.

Health spoke to reproductive health specialist Sophia Yen, MD, to get to the bottom of the myths. Dr. Yen is the founder of Pandia Health, a California-based birth control mail service (the only such service led by a female practicing reproductive health doctor).

Dr. Yen says that “anti-birth control sentiment” is still alive and well today. “It’s becoming even more crazy with the current administration,” she says. Dr. Yen adds that when faced with strong statements about the supposed dangers of birth control “we need to ask, ‘Where is the data?’” These four frequently circulated lies about birth control are the ones Dr. Yen hears all the time—but have no basis in reality.

RELATED: How Long Is Too Long to Take the Pill?

Birth control pills will cause you to gain weight

Actually, women who don’t take birth control pills will gain more weight, Dr. Yen says. The reason? Periods cause bloating, which makes the number on the scale rise every 28 days or so.

Dr. Yen cites a published review of research, which concludes that combination birth control pills (meaning they contain both estrogen and progestin) have not been found to cause weight gain. “Concern about weight gain can limit the use of this highly effective method of contraception by deterring the initiation of its use and causing early discontinuation among users. However, a causal relationship between combination contraceptives and weight gain has not been established,” the review states.

If you take them, you’ll be infertile forever

Dr. Yen says the reason this myth gets circulated has to do with a hormone disorder called polycystic ovary syndrome (PCOS). Up to 10% of women have PCOS, yet women don’t always know they have it because of a lack of public awareness of the condition. If you go off the pill and have a hard time getting pregnant, there’s a good chance you can blame PCOS, which makes conceiving difficult.

However, “it has nothing to do with the birth control” pill, Dr. Yen says. In fact, if you don’t have PCOS and are otherwise healthy, you might conceive as early as one week after coming off birth control pills, she adds.

If you do have PCOS, you’ll actually be most fertile right after you stop taking birth control pills. This is because the pill works by regulating hormones, which are out of whack if you have PCOS. The more time that passes after you go off the pill and no longer get that hormone regulating effect, the less likely you are to get pregnant. “For the women [with] polycystic ovarian syndrome, the most fertile time is right after they come off birth control. Now is the time to get pregnant. Don’t wait,” Dr. Yen says.

It’s unsafe to not bleed every 28 days

This myth goes all the way back to when birth control pills were developed. The scientists behind it wanted the pill to be approved by the Catholic church. They suspected, however, that the church would only be okay with it if women on the pill had a cycle that mimicked the natural female cycle, with a monthly period. So they built in a "period" week of placebo pills that would cause women to bleed. It wasn't technically a period, however, and there was no medical reason for it.

RELATED: How Your Period Changes During Your 20s, 30s, and 40s

Not only is it not necessary for women to menstruate every 28 days, but skipping periods used to be the norm. “In our natural state, we have 100 periods in our lifetime. Now, [women are having] 350 to 400 periods,” says Dr. Yen. Many factors have contributed to this increase. Women of previous generations had far more children than women tend to have today, and they started having kids at a much younger age. They also didn't eat as well as we do today; how much nourishment you get affects the number of periods you have. “We were supposed to be incessantly pregnant or breastfeeding. Now, we’re incessantly bleeding [instead],” Dr. Yen says.

Dr. Yen notes that some women believe that having a monthly period helps their body get rid of toxins. “Aren’t there toxins in my body that I have to release?” women ask her. The answer is no. If you’ve decided against having kids for the moment, there’s nothing unsafe about choosing a birth control method that allows you to skip your period altogether.

Birth control pills don't have any health benefits

If you’re a woman alive in 2019, you’ve almost certainly been warned about the horrible side effects of birth control pills. But what you should have been hearing is that birth control pills are a safe, effective way to manage your lifestyle, Dr. Yen says.

In fact, birth control pills can help with a number of medical issues. The pills help patients who are diabetic or suffer from seizures. Stable hormonal activity will improve these conditions, Dr. Yen says. She adds that the pill can benefit some women who are depressed. Again, regulated hormones can do a lot for you.

This isn’t to say that birth control pills are the perfect answer for every woman or every condition. But what we do know is this: If someone has blamed a health problem on your birth control pills, there’s a good chance that they too have been misinformed. “You’re like, ‘Oh, it’s the birth control.’ [But] these are hard things for non-scientific people to look at,” Dr. Yen explains.

While we know birth control pills are safe and effective, it can’t hurt to share any concerns about your prescription with your ob-gyn. It’s probably in your best interest to consult someone who specializes in reproductive health as opposed to a primary care doctor.

RELATED: 10 Conditions That Could Be Messing With Your Period

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Fat women have sex. This shouldn’t come as a surprise to anyone. But the media’s portrayals of plus-size sex lives—or the decided lack thereof—might cause you to think a vow of celibacy comes with shopping in the plus-size section. “Hello, ma’am, we’ve noticed you’ve picked up a plus-sized article of clothing—please be sure to check out our row of chastity belts.” That’s not how it works. In this apparent media blackout on all storylines relating to plus-size women and their sex lives, the very first episode of Hulu’s new series, Shrill, based on the memoir by Lindy West, will surprise you. The show revolves around the life of protagonist Annie, a plus-size woman who is trying to make her voice heard, both in her journalism and in her everyday relationships. And, yes, she does have sex.

[The rest of this article contains spoilers for Shrill]

From the very first episode, the audience sees Annie hooking up with her boyfriend/fuckboi Ryan (Luka Jones) in his bedroom after a text invitation similar to an eggplant emoji. Though the sex doesn’t appear to be all that enjoyable on her end…and he asks her to hop the back fence afterward to avoid running into his friends, the scene suggests that Annie has sex on the regular.

RELATED: How to Buy the Morning-After Pill Without Setting Foot in a Pharmacy

As Annie puts her clothes back on, Ryan casually mentions the fact that they didn’t use a condom. In the next scene, Annie races towards the pharmaceutical counter at the back of a convenience store in search of the morning after pill. Then, a few months after taking said pill, Annie begins experiencing certain symptoms: irritability, a stomach bug that doesn’t seem to go away, and, you guessed it, she’s pregnant.

It turns out that a lot of emergency contraceptives like Plan B are less effective on women over 175 pounds—but we don’t hear that in conversations about EC.

Considering that the average American woman weighs 166 pounds, this statistic is more than a little frightening—especially when abortion access is shrinking by the day, making access to Plan B or similar over-the-counter brands especially important to prevent unintended pregnancies.

RELATED: Emergency Contraception Is Supposed to Be Available on Drugstore Shelves—but It May Not Be as Easy to Find as You Think

Annie is stumped when the pharmacist discreetly asks her if she’s over the weight limit, and she demands to know why the pill’s weight limitation isn’t common knowledge.

And just as in the show, this fact is not common knowledge in real life either. Whenever I’ve casually mentioned it to my friends, the straight-size women are baffled and the plus-size women are appalled. What are they supposed to do if they find themselves in an emergency? Despite years of studies proving this troubling link between weight and effectiveness, there are still no emergency contraceptives available that work specifically for plus-size women. It’s as if society has been taught that weight is linked with desire, so plus-size women can’t possibly have enough sex to require such a medication.

RELATED: How Many Times Can You Actually Take Plan B? Asking For a Friend

This problem can be linked to another disturbing factor: The medical field doesn’t take plus-size women’s reproductive health seriously.

Even after research into BMI and the morning after pill’s effectiveness, the medication still doesn’t have any warning label regarding these outcomes. Medical professionals being less likely to listen to their female patients is a universal problem regardless of the patient’s size, but plus-size women must also compete with the idea that any medical problem would be fixed if they just lost a few pounds. This mindset can prevent professionals from giving a proper diagnosis to their patients, and it can prevent women from even going to see their doctors for fear of receiving nothing but that faux universal cure. This medical assumption also does very little to address gaps in health care because there is no incentive to alter medicines or create an alternative.

The media is taking steps to portray plus-size characters in control of their own narratives, including Netflix’s adaptation of Dumplin’ and the character of Kate in NBC’s This Is Us, but there is still a lot of work to be done. Annie’s navigation of sexual health opens up an inclusive dialogue about sex, contraception and, yes, abortion. As shows like Shrill successfully out the dirty little secret that plus-size women have sex and shed light on how their health is overlooked, I hope the public will start to realize that all women and all bodies deserve access to safe sex options.

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Since the first birth control pill was approved in 1960, tens of millions of people have used oral contraceptives to prevent pregnancy and regulate their periods. Many have been on the pill for decades. And yet, scientists know basically nothing about how birth control affects our brains.

We know plenty about the ways oral contraceptives can affect our physical health. Common side effects include headaches and dizziness, nausea, decreased libido, and breast tenderness. Many of these side effects are temporary and will go away as you continue to take the pill. Hormonal contraceptives can also sometimes (but rarely) cause more serious side effects like blood clots, heart attack, and stroke and are therefore generally not recommended for anyone who has a heart condition.

Even though mood swings are one of the most commonly reported side effects of hormonal birth control, there’s hardly any research into how the pill interacts with our brains. “There’s really very little research I’m aware of on this topic, despite the fact that the pill has been around for more than half a century,” Justin Lehmiller, PhD, a research fellow at the Kinsey Institute and author of Tell Me What You Want, tells Health. "The studies that do exist tend to have quite small samples and aren’t well suited to determining cause and effect.” There’s so little research that Lehmiller doesn’t feel confident saying anything about birth control and the brain—except that we need more research.

RELATED: 6 Birth Control Mistakes You Didn't Realize You Were Making

Ob-gyn Felice Gersh, MD, author of PCOS SOS: A Gynecologist's Lifeline To Naturally Restore Your Rhythms, Hormones and Happiness, however, feels quite confident that birth control affects our brains. “To think [birth control] won’t affect the brain would actually be ludicrous,” she says. That’s because birth control was designed as an endocrine disruptor. While we often call certain types of birth control—such as the pill, IUDs, vaginal rings, and skin patches—“hormonal” birth control, there aren’t any "real" hormones in them. Instead, there are chemicals meant to mimic the hormones progesterone and estrogen.

These pretend-hormones, as Dr. Gersh calls them, have some similarities with real hormones but can have different effects. And by essentially “replacing” your body’s real progesterone and estrogen with the synthetic versions, the pill may tinker with your brain, she says. “We do know that hormones are hugely important to brain health and brain function," she says.

For starters, estrogen is involved in maintaining your circadian rhythm, or your internal body clock. Research indicates that when that time-keeping gets thrown off—which can affect the sleep-wake cycle, hormone release, eating habits, digestion, and body temperature, among other 24-hour cycles—we’re at higher risk for psychiatric illnesses like depression and anxiety.

RELATED: How to Know If Your Bad Mood Is Actually Depression

Birth control may also alter our gut microbiomes, the community of bacteria that live in our stomachs and intestines, Dr. Gersh says, "and we know that the gut microbiome is related to brain function.” If taking birth control changes the population of bacteria in your gut, and the bacteria in your gut affect your brain, then it stands to reason that taking birth control will also alter your brain. Will it change your brain in good ways or bad? That we still don’t know, because there is so little research—especially research with large-enough sample sizes to say anything conclusive.

There are certain things we can guess at, thanks to the past 50 years of people taking birth control. We know that many people on oral contraceptives report anxiety and/or depression as a side effect. Up to 9% of women who take combined hormonal pills report changes in mood, according to Kelley T. Saunders, MD, an ob-gyn with Banner University Medicine Women's Institute.

Some studies that have looked into this phenomenon suggest that people who are already at risk for mood disorders, because they have a family history, are most likely to be triggered by birth control. Other studies claim that women who are on the pill are no more likely to experience symptoms of depression than women who aren’t on the pill. “There’s a lot of conflicting data, and no consistent evidence,” Dr. Saunders says.

Yet she’s seen birth control actually help some patients with mood disorders such as PMS or PMDD (premenstrual dysphoric disorder). Many of us have likely blamed a crabby mood or two on PMS, but PMDD is more severe. It’s a condition that causes extreme irritability, depression, or anxiety in the weeks leading up to menstruation.

Birth control is one of the common treatment options for PMDD, Dr. Saunders says. “The fluctuations of natural hormone levels may be contributing to these mood disorders,” she says. “And we’ve seen women with pre-existing PMS and PMDD do better on continuous-use hormonal contraceptives.” For some, it seems that a steady level of “fake hormones” is better than up-and-down levels of real ones.

RELATED: Is It Really OK to Skip a Period Using Birth Control?

It’s important to remember, though, that all of this is still theory. Does taking birth control change your gut bacteria and therefore your brain? Does it throw off your circadian rhythm and put you at risk for psychiatric disorders? Does it cure pre-menstruating people of their irritability and depression? Maybe. But science hasn’t conclusively told us any of that yet.

And it’s hard to question nearly 60 years of reproductive freedom based only on theory. Hormonal birth control has without a doubt changed lives simply by making it possible to choose when to start a family. “Overall, oral contraceptives have a number of benefits,” says ob-gyn Kecia Gaither, MD, who’s also board-certified in maternal fetal medicine. Those benefits include pregnancy prevention, of course, but also clearing acne, treating severe cramping and heavy bleeding, decreasing symptoms of endometriosis, preventing ovarian cysts, treating symptoms of PCOS, and decreasing risk of ovarian and endometrial cancer.

So the first step isn’t to drop your birth control. The benefits still seem to outweigh the costs for many. Instead, we need more research about what birth control is really doing to our brains. As Dr. Gersh points out, “If we aren’t aware of what we’re doing, we’ll never get quality alternatives.”

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Birth control has lots of perks: it can clear up your skin, regulate your periods, and nix PMS, not to mention prevent pregnancy. So if you've been popping the pill for years, it's understandable that you might be a little nervous about what will happen to your body when you quit.

The good news? "For the most part, women don't notice too much of a difference [when they go off the pill]," says Alyssa Dweck, MD, a gynecologist in New York and author of the upcoming book The A to Z of the V. But if you were taking birth control for a specific reason, such as alleviating cramps or acne, you could very well see a return of those symptoms once you're no longer on it.

RELATED: How Long Is Too Long to Be on Birth Control? Ob-Gyns Weigh In

"A lot of the changes women see go back to the reason they were taking birth control in the first place," Dr. Dweck explains. 

The side effects of stopping birth control depend on what kind you've been taking (combination, progestin-only, or extended-cycle) and your dosage. And two women taking the same exact pill could still have totally different experiences when they quit. Still, there are some common changes that may happen to your body when you stop taking birth control pills. Here's what you should (and shouldn't) expect to happen.

RELATED: 7 Health Benefits of Birth Control Nobody Talks About

You could get pregnant right away

No, your body doesn't need time to clear birth control from your system. For most women, normal ovulation resumes within a month or two, and one study found that 20% of women were able to get pregnant one cycle after stopping birth control. (It may take longer after you stop getting birth control injections, though.) If you're not trying to get pregnant, make sure to use condoms or another type of contraception immediately after you stop taking your pills. 

Your weight will probably stay the same

Don't ditch birth control solely to drop a few pounds. Though many women believe they've gained weight on the pill, scientific research hasn't actually found a link between oral contraceptive use and weight gain. In a 2014 review of 49 relevant trials, birth control did not appear to have a major impact on weight. "There has been no definitive evidence showing that starting—or stopping—birth control pills will affect your weight," says Neha Bhardwaj, MD, assistant professor of obstetrics, gynecology, and reproductive science at Icahn School of Medicine at Mount Sinai in New York City. (One exception: progestin-only birth control injections may cause weight gain in some women.)

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Your skin might break out

Combination birth control pills (the most common type), which combine estrogen and progestin, clear up acne in many women because they can lower the body's levels of androgen, a hormone that produces oils on the skin. You may discover new crops of pimples after you stop taking the pill—especially around your period, when hormone levels fluctuate.

"Going off birth control pills may return acne symptoms to what they were before starting birth control pills," says Dr. Bhardwaj. If you do decide to go off the pill, there are other ways to manage your hormonal acne, like switching cleansers, reducing stress, or taking probiotic supplements.

RELATED: What to Know About the Surprising Modern History of Contraception

You might lose a bit of hair

Switching birth control pills or going off it completely could trigger telogen effluvium, a temporary condition that causes your hair to shed. Telogen effluvium usually subsides within six months, after your body has adjusted to not being on birth control. Some women who had hormonal-related hair loss (as a symptom of polycystic ovary syndrome, for example) before they went on birth control might notice that it returns when they go off of the pill. All that said, hair loss is complicated, explains Dr. Dweck, and is often related to other factors, such as stress.

The bottom line? "Most women won't see a significant net effect on their hair after stopping birth control pills," says Josh Klein, MD, chief medical officer at Extend Fertility in New York City.

On the flip side, some women may grow more hair, but not necessarily on their heads. Dark, coarse hairs can pop up in unwanted spots like the face, back, and chest if the body produces too much androgen. PCOS is the most common culprit. 

RELATED: My New Birth Control Made My Skin Go Haywire. Here’s How I Learned to Combat the Acne

Your period might be heavier and less regular

One of the biggest benefits of the pill is that it regulates your menstrual cycle. "Birth control pills typically lighten periods and decrease pain associated with periods," says Dr. Bhardwaj. When you first stop taking oral contraceptives, it's not unusual for your period to be a little unpredictable in terms of how heavy or light it is, how long it lasts, or how crampy you get.

"Some women who have been on the pill for many years assume their cycles are very regular," says Dr. Klein. "But when they stop the pill, they learn their cycles are not as regular as they thought." After two or three months, your period should return to normal, he adds.

Another surprise guest that could reappear when you quit the pill? PMS. "This is a big reason why many women go on birth control in the first place," says Dr. Dweck. If you originally started taking the pill to ease PMS, don't be surprised if symptoms like moodiness and irritability become more noticeable now that you're off it.

RELATED: How to Treat Hormonal Acne Without Birth Control

Your vitamin D levels could drop

A recent study in the Journal of Clinical Endocrinology & Metabolism found that many women experience a drop in vitamin D levels when they stop taking birth control pills. This is especially problematic for women who are trying to conceive, since vitamin D helps support the fetal skeleton in pregnancy.

Let your doctor know you're quitting birth control pills, and ask about ways you can get your daily vitamin D, whether by spending more time outside (with SPF!), eating vitamin D-rich foods like fatty fish, or possibly taking a supplement.

Your boobs may feel a little different

Many women report achy breasts before their period (you can thank hormones for that—a spike in progesterone before your period stimulates growth in the milk glands, which can cause tenderness). Since birth control pills regulate your hormone levels, they may alleviate this symptom for some women. So going off the pill could mean that your breasts start to feel a little more sensitive post-ovulation, says Dr. Klein. 

However, breast tenderness can also be a side effect of being on the pill, says Guirlaine Agnant, MD, chair in the department of obstetrics and gynecology at Montefiore Mount Vernon Hospital in Mount Vernon, NY. If your breasts felt super-sensitive at certain times of the month when you were taking birth control, it might actually go away once you stop taking it. For these women, "stopping the pill will bring back normal breast tissue, and no tenderness should be experienced."

You might also notice slight changes in the appearance of your breasts: "Some women will see their breasts deflate a bit when they go off the pill," says Dr. Dweck.

RELATED: This Woman Thought Her IUD Fell Out—Until Doctors Found It In Her Abdomen 10 Years Later

You could get more headaches

About half of women report migraines around the time that they get their period, according to a 2004 study. (This is most likely due to a drop in estrogen levels.) Certain birth control pills that let you skip periods or go longer between them, such as extended-cycle pills, may prevent migraines. For these women, going off birth control pills could cause their headaches to become more frequent. 

Your libido might be affected

Dr. Agnant tells us that some of her patients complain their sex drives took a hit when they first went on the pill. "This is most likely due to changes in hormonal production," she says, adding that these women usually experience an increase in libido when they stop taking birth control.

But again, every woman is different—and for some, sex could be more stressful without the protection from unplanned pregnancy that birth control pills offer. 

"Decreasing the risk of pregnancy for a woman may allow her to enjoy the experience of sex more," says Dr. Bhardwaj.

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Soon after Melinda Nichols delivered her youngest son in 2007, she decided to get an intrauterine device (IUD) to prevent future pregnancies. But when Nichols returned to the doctor for a checkup just a few weeks after having the device implanted, the Ohio mom was told her IUD was nowhere to be found.

Nichols’ doctors told her the device must have been expelled from her body without her knowledge, according to an article in the New York Post. So imagine her surprise when, more than a decade later, the tiny T-shaped device reappeared in a completely unrelated X-ray of her midsection—all the way in her upper abdomen.

“It’s been in me 11 years,” Nichols wrote in a Facebook post that’s now been shared more than 50,000 times. “The doctors told me it fell out.” The post includes a photo of the X-ray with the outline of her IUD circled in red. A lower yellow circle indicates where the IUD should have been.

Nichols told the Post that the IUD was spotted on an X-ray while she was receiving treatment for a strained muscle in her back. (A doctor told Nichols she needed to call her ob-gyn because her IUD was “in a weird spot,” according to the newspaper.) Had she not had an X-ray at that time, “there’s no telling how long she may have kept going with the IUD missing inside her body,” the article states.

Well, that’s certainly disturbing. But before you start worrying about your own IUD—or swear off the idea of ever getting one—it’s important to know that this type of thing is extremely rare. To learn more, Health spoke with Christine Greves, MD, an ob-gyn with Orlando Health System in Florida. Dr. Greves did not treat Nichols, but she does see lots of patients with IUDs—including a few that have dislodged or migrated. Here’s what she wants everyone to know.

RELATED: What It Really Feels Like to Get an IUD

IUD migration is rare, but it can happen

The failure rate of IUDs is very low. For every 1,000 women who receive one, only about four women on average will have a problem with their IUD not staying put and working the way it’s supposed to, according to the CDC.

Very rarely, an IUD can perforate the uterine wall and make its way out of the uterus and into the abdominal cavity—a phenomenon that was first described in the 1930s and has an incidence rate of about one in 1,000. This scenario has also been called the “wandering IUD” or the “ectopic IUD.”

It was originally thought that uterine contractions were responsible for IUDs migrating to other parts of the body. But according to a 2017 review in the Open Access Journal of Contraception, it’s now believed that it’s much more common for IUDs to be “forced into or through the uterine wall at the time of insertion,” sometimes by inexperienced physicians.

RELATED: The Most Effective Birth Control, Ranked

Yes, IUDs can fall out

IUDs can also become dislodged and make their way out of the body—also known as expulsion. This is also rare, but it is most likely to happen during a woman’s period. If this happens, women might find their IUD when they remove their tampon or change their pad. It could also be flushed down the toilet without a woman noticing at all.

If an IUD becomes partially expelled, it may become lodged in the cervix or vaginal canal—which can cause pain, discomfort, or heavy bleeding. Instead of trying to move the device back into place yourself, call your doctor right away.

If your doctor can’t find your IUD, you need further testing

After an IUD is inserted, a woman should see her doctor the following month for a “string check,” says Dr. Greves. Her doctor will feel for the two strings that hang down from the bottom of the IUD to ensure that it’s still in its proper place in the uterus. (Women can check themselves by feeling for these strings every month, but they may not always be able to find them.)

“If a woman comes back and we can’t feel those strings, we perform an ultrasound,” Dr. Greves explains. “And if we still don’t see it on an ultrasound, and the patient doesn’t remember it falling out, an X-ray can usually find it if it’s made its way to the abdominal cavity.” As for Nichols, it’s not clear why her doctors didn’t see her IUD on her X-ray back in 2007, and she told the Post that she never went back to that office to ask about what happened.

RELATED: 5 Women Reveal What It's Really Like to Have an IUD Removed

A misplaced IUD may cause health complications

It’s possible for an IUD that migrates to the abdominal cavity to stay there for years without being noticed or causing any harm, says Dr. Greves. (In one case in the scientific literature, a woman’s missing IUD wasn’t found for 43 years!) “But other times, if it’s entangled in the bowel or it’s near a vital organ, for example, that can be a concern,” she adds.

It’s also possible that an out-of-place IUD could cause scar tissue to form around it or trigger an infection. It could also continue to release chemicals into the body for longer than intended, says Dr. Greves—although the level of hormones released by these devices decreases every year, so that may not be too big of a concern. (That’s why the Mirena IUD, for example, must be replaced after five years.)

Nichols, by the way, is fine: She underwent laparoscopic surgery—involving a tiny incision and a small camera to guide doctors—to locate and remove her left-behind IUD. She says she occasionally had strange stomach pains over the last decade (which may or may not have been related to her IUD), but otherwise had no symptoms that something was amiss.

RELATED: 6 Birth Control Mistakes You Didn’t Realize You Were Making

Consider the risks and the benefits

Even though she knows IUD migration is a (very slim) possibility, Dr. Greves is still a huge proponent of this method of birth control. “Everything in medicine is risks versus benefits versus alternatives, and it’s important people know that the benefits of IUDs far exceed the risks for most women,” she says.

IUDs are highly effective at preventing pregnancy and, unlike oral contraceptives, you don’t have to remember to take a pill every day or pick up your prescription from the pharmacy every month. IUDs may also come with other perks, like fewer cramps and lighter periods.

Plus, says Dr. Greves, IUD usage has gone up in recent years—which means that doctors have become more experienced with insertion and more familiar with their usage. “We have more strategies in place to deal with complications,” she says, “and to make sure that women are having a good experience and making the best choice for them.”

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Being diligent at taking a pill at the same time every day can be stressful (and tough). Having an IUD inserted is also not the most pleasant experience. And buying the morning-after pill can be heavy on your wallet. With a super-limited number of male contraceptive methods available, the burden of pregnancy prevention has historically fallen primarily on women.

So when we heard that there could be a male topical gel to actually prevent pregnancy, we got a little excited. Most improvements have been female-focused (think: oral contraceptives like the pill and the morning-after pill, the patch, the IUD, etc.), so a new contraceptive option in which men have more responsibility over pregnancy prevention is a welcome relief.

The up-and-coming gel for men isn't yet available. Rather, it's set to be studied in a new clinical trial funded by the National Institutes of Health (NIH). Here's what you need to know in the meantime.

RELATED: The Most Effective Birth Control, Ranked

How does the gel work?

Developed by the Population Council and the NIH's National Institute of Child Health and Human Development (NICHD), the gel, called NES/T, contains a combination of testosterone and a progestin compound called Nestorone. The progestin blocks a guy's natural testosterone production, which reduces sperm production to extremely low or practically "nonexistent" levels, according to an NIH statement. Then, the testosterone in the gel makes sure he still has his normal sex drive–and that other bodily functions that depend on testosterone continue as normal, too.

While it might sound like the kind of thing he'd smooth over his penis like lube, it's actually applied to the back and shoulders and absorbed through the skin. And in theory that's easy-peasy–except how many men have the ability and flexibility to fully reach their backs to apply this gel properly by themselves? We're imagining a super-awkward Cirque Du Soleil-esque performance by a half-dressed man trying to lather a sticky gel on his back. Not sexy. (But definitely hilarious.)

However, if a woman lends a helping hand and applies the gel for the man, there's some concern the exposure to those hormones in the gel could have an effect on her. Since it's still unclear if that can happen, the best thing to do would be to vigorously wash your hands following the application to avoid having these hormones absorbed into your own skin, says Sherry Ross, MD, an ob-gyn in Santa Monica, California, and author of She-ology: The Definitive Guide to Women's Intimate Health.

RELATED: What It Really Feels Like to Get an IUD

What will happen in the clinical trial?

Researchers are going to enroll 420 couples. In the first phase of the study, the men will apply the gel daily for four to 12 weeks to first evaluate for any negative side effects. If, after 12 weeks, their sperm levels haven't decreased enough to prevent pregnancy, they'll keep using the gel for up to 16 weeks.

Once sperm levels have declined enough to consider the gel safe to use as contraception, the couples will have a 52-week trial period to see if it actually works to prevent pregnancy. After that, men will be monitored for another 24 weeks once they have stopped using the gel to see if there are any lingering side effects.

RELATED: 16 Worst Birth Control Mistakes

Male birth control available now is limited

Men are currently limited to condoms, the pull-out method, and sterilization by vasectomy as means of birth control. Experts discourage using the pull-out or withdrawal method, since it's not a fool-proof or reliable means of preventing pregnancy or STIs.

When used correctly, condoms can prevent pregnancy and STIs. However, many couples skip condoms when things start to heat up because they don't have one on-hand, are living in the moment, or believe the barrier decreases pleasure. Even when used correctly, condoms can still slip down or break, which then leaves both people vulnerable to risk.

On the other hand, vasectomies are more permanent solutions. They require surgery, in which the man's vas deferens duct, a tube that transports sperm to the urethra, is cut or tied off. Less than 1% of men who've had vasectomies experience unplanned pregnancies with their partners. While they can sometimes be reversed, it's not always possible, so this is not a great solution for couples who do want to get pregnant in the foreseeable future.

RELATED: 7 Common Birth Control Side Effects

Could this gel replace condoms?

Since many women can't or don't want to use hormonal contraception and male contraceptive methods are so limited, this gel is certainly a step in the right direction. “A safe, highly effective, and reversible method of male contraception would fill an important public health need," investigator Diana Blithe, PhD, chief of NICHD’s Contraceptive Development Program, said in a press release.

However, experts aren't thrilled with the idea of condoms being totally replaced by this gel, since condoms help prevent sexually transmitted infections, points out Dr. Ross. You might also want to take into account that not every partner will apply it properly or when they should, making it less reliable (similar to you missing a birth control pill). "I would not have women stop using their form of contraception even if a man is doing his part in preventing pregnancy," Dr. Ross says.

Having men make contraception a personal priority as women have done for decades is definitely an improvement. This promising gel may not be the answer–at least, not yet–but experts are on the right track by bringing men more fully into the picture. "We are 'seconds' away from having men join women in the contraceptive responsibility," says Dr. Ross. "Even though more studies are needed, researchers are getting closer to having men join in on the responsibility of birth control."

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Most of us spend the better part of our fertile years actively trying not to get pregnant, so it's always an unpleasant surprise to learn that it's not actually that easy to conceive. The reality is there is a relatively short window during a woman's cycle that she can get pregnant whether or not she's on birth control or actively trying.

RELATED: Can Men Tell if You're Ovulating? Here's What Science Says

In fact, there's really only a 48-hour period that is ideal for conceiving, according to Anate Brauer, M.D., a reproductive endocrinologist at the Greenwich Fertility and IVF Centers and assistant professor of OB/GYN at NYU School of Medicine. Of course, every woman is different, as are her monthly cycles, so it's never a sure bet to say that there's any week or day when you absolutely cannot get pregnant (so always use protection if you're not trying to conceive).

If you're wondering which occasions make for the least likely opportunity to conceive, however, here are some expert-stamped scenarios where your chances are low.

You're on birth control

If you're on birth control, be it the pill, patch, ring, implant, IUD, or the shot (Depo-Provera), and you're following all instructions, your chances of getting pregnant are less than 1 percent. "Hormonal contraception works by preventing the recruitment of a mature egg," explains Dr. Brauer. Even if you're committed to taking your birth control, you still have to be careful, since traditional pill packs typically contain 4-7 days of sugar pills that do not contain hormones, and, in some women, 4-7 days without exposure to hormones may be long enough to allow for recruitment of a mature egg. "This is often referred to as 'escape ovulation' and is one reason for oral hormonal contraception failure," says Dr. Brauer.

RELATED: Your Birth Control Should Probably Change as You Get Older—These Are the Best Options in Your 20s, 30s, and 40s

You have your period

While it's not totally impossible to get pregnant while Aunt Flo is in town, your chances are pretty darn slim. If you consider what's actually happening inside your body while you're on your period, you can understand it a bit better: The egg that was growing inside your ovaries and waiting to be fertilized wasn't and, as a result, your uterine lining sheds (this is the "blood" that's released) and prepares to grow new follicles (aka eggs) for your next cycle. In other words, the egg that was viable for fertilization has now been flushed along with your period. The exception, however, is if you have particularly short cycles. "Sperm can live in the uterus for up to five days, so if you have intercourse towards the end of your period, sperm can still hang around long enough to fertilize an egg that is released days after your period ends," explains Dr. Brauer.

RELATED: 5 Reasons You Should Have Sex on Your Period

You use the "pull out" method

This old-school method of preventing pregnancy is a far cry from a myth. No, it's not foolproof and it can certainly result in pregnancy, but it does significantly decrease your chances of getting pregnant. In case you need a refresher course on the pull-out method, it involves the male partner pulling out of the vagina before he ejaculates. The problem, however, is that pre-ejaculate, or precum, the bodily fluid that's released from the penis before an actual ejaculation, very well may contain active and viable sperm. Additionally, Mark Trolice, M.D., reproductive endocrinology and infertility specialist at My Fertility CARE: The IVF Center in Winter Park, Florida, explains that most men aren't aware of when they release this precum. "Because it's hard to predict when pre-ejaculation occurs, the withdrawal method is often fraught with peril and certainly not the most reliable method out there," he says.

You use a condom 

Your chance of getting pregnant with condom use is about 15 percent, and that's accounting for human error. With perfect condom use every single time, those odds decrease to 2 percent, according to Planned Parenthood. Correct usage means the condom is rolled onto the male partner's penis before there's any contact between genitals and skin (see the above note on the potential potency of pre-cum). There are ways to make rubbers even more effective, though: Pair them with another form of birth control, like an IUD or the pill, or use them in combination with the pull-out method. 

RELATED: What to Know About the Surprising Modern History of Contraception 

You're breastfeeding

If you haven't had a period after giving birth, especially if you're breastfeeding, it's actually unlikely that you can become pregnant. "While breastfeeding, the hormone, estrogen, which is responsible for getting your period each month, is suppressed," explains Sherry Ross, M.D., OB/GYN, Women’s Health Expert in Santa Monica, and author of She-ology. "Additionally, the hormone that stimulates breast milk production, prolactin, also prevents ovulation from occurring because it inhibits the FSH hormone that triggers your ovaries to grow and release eggs." Bottom line: Without a period, you will not ovulate regularly so it is less likely, though certainly not impossible (ever heard of Irish twins?), that you can become pregnant.

RELATED: Pinpointing Fertile Days

You're over 44

Thanks to that good-old biological clock that has hardly changed its tickers since the dawn of time, women's chances of getting pregnant wane over time. While we're born with some 1-2 million eggs, there's only about 300,000 left by the time we get our first period and only about 25,000 by the time we're in our late 30s. This means that a woman's chances of becoming pregnant in her early 40s are pretty slim, though it's by no means impossible. According to Dr. Ross, women over the age of 44 have a less than 5 percent chance of getting pregnant each month. "As we get closer to 40, the ticking of our biological clock becomes louder and by 44, it can be deafening," she says. "Fertility decreases by as much as 95 percent in women between 40 and 45 years of age."

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When the birth control pill hit its 50th anniversary of its 1960 FDA approval, TIME commemorated its influence on the world as having “rearranged the furniture of human relations.”

But as influential as the pill was and continues to be, it’s only one small slice of the enormous influence contraception has had on modern history. Few people know that as well as Donna Drucker, a historian who is currently writing a book about its history. As it turns out, that history is just as complex as you probably think, but in ways that may still surprise you.

Drucker says she started studying contraception in a roundabout way: after the 2014 release of her book The Classification of Sex: Alfred Kinsey and the Organization of Knowledge, she saw that there was a missing element in the story of the famous sex researcher. “I realized how little attention Kinsey paid to contraception in the role of particularly women’s pleasure and general satisfaction,” she says. “Looking back, I thought he’d really underplayed the role of safe contraception in women’s decisions to have heterosexual sex or not.”

For World Contraception Day on Wednesday, Drucker talked to TIME about contraception’s complicated past.

TIME: Where would you place the beginning of the modern history of contraception?

DRUCKER: I would place it at the first clinic where a woman could get a diaphragm on her own from a female doctor. That was in Amsterdam in 1882 and the doctor’s name was Aletta Jacobs. That door opening was the first time that a woman could get a mechanical contraceptive fitted by a doctor for her and not need anyone’s approval.

This history is obviously a huge topic and really complex. Are there any overarching trends that you’ve noticed showing up throughout time?

One is the back-and-forth tussle between men and women over who controls contraception in a heterosexual relationship. For most of recorded history and even into the ancient past, men had total control over whether they used withdrawal. Condoms became part of the reproductive repertoire somewhere around the 18th century. Some women did use herbal methods, like pennyroyal, but they tended to be very dangerous. When diaphragms were first developed and became popularly manufactured in the 1880s and 1890s, that was the first time women had a device they had control over. There are waves back and forth over who should have that control. You hear women in the present saying that men should take responsibility, but men were given responsibility for millennia and they didn’t do it very well.

Is the history of contraception generally something that varies a lot from region to region?

Very much. I can give you two examples to compare and contrast. In Ireland, all contraception was made illegal in 1935 and condoms weren’t legalized [until 1985], but you could get a pill for a menstrual disorder. On the other hand, in Japan, the Japanese Health and Welfare Ministry only legalized the birth control pill in 1999. The pill had been available in the U.S. for almost 40 years. A lot of the ways people think about contraception are very much embedded in their national legal and medical context.

How much of a modern phenomenon is government involvement in these questions?

It ebbs and flows. The classic example in American history is the Comstock Act, in 1873, when basically it became illegal to manufacture, sell, distribute or mail any sexual or contraceptive devices. It was more or less on the books until 1936 and it got overturned by a case called U.S. v. One Package, which was about a shipment of diaphragms that was coming into the U.S. to a physician. Those laws were weakened in the 1920s or ‘30s, but really even though you could get condoms as disease preventatives, you could not get condoms as contraceptives. There’s a historian named Rachel Maines who argues there are lots of technologies that have a secret life outside their public face. Condoms were among those.

What tends to inspire laws like the Comstock Act? Is that usually about the law responding to a technology, or is it more frequently about changing social norms?

The Comstock Act wasn’t a direct response to a particular technology, since rubber condoms were available soon after the vulcanization of rubber in the 1840s, but Anthony Comstock himself was very determined to stamp out vice and anything that promoted vice, so that law was more of a social response. You could say the same thing for Ireland also. After the Republic was founded, they thought that one thing they wanted was to be a Catholic nation. Forbidding contraceptive technologies was one signal to the world and to Irish people that it was falling in line with Catholic teaching.

Speaking of Catholicism, what’s the historical background on the link between faith and ideas about contraception?

The Catholic Church more or less allowed, throughout the 19th century, a kind of periodic abstinence as a way to limit families. If you confessed that, you were O.K. In 1930, Pope Pius XI puts forward an encyclical called Casti Connubii, which is the church’s first declaration of its stance on marriage and the family and contraception. Really the only method the church allows is periodic abstinence, because the only acceptable use of sex is for procreation. You can abstain or roll the dice. That’s it. That gets confirmed in Humanae Vitae from Paul VI in 1968, after a very long process with priests and nuns and laypeople trying to advise the pope, a lot of them coming out and saying that the Pill doesn’t interfere with consummation and could be good for people who can’t afford to have any more children or women who were ill. That was a major way for the church to slam the door shut. But on the flip side of that, something like 90% of American Catholics [approve of the use of] so-called artificial birth control. That encyclical was a real challenge for a lot of people who wanted to stay faithful to their beliefs but didn’t want to have more children than they could afford.

Are there any moments you see as the stand-out episodes that exemplify the history of contraceptives?

The first one was a protest by Irish feminists in 1971 who were calling attention to the absurdity of condoms being illegal in Ireland. A group of women from the Republic of Ireland took a train to Belfast, which isn’t very far, and bought all the contraceptives they could find and brought them all back to Dublin intending to get arrested for illegal transit of goods. But the customs officials just weren’t going to touch it. They didn’t want to pick a fight in that way. It doesn’t change the law for another 20 years, but it does raise awareness about the absurdity of not being allowed this kind of basic contraceptive.

The other one is when Margaret Sanger was arrested for distributing flyers for her new birth control clinic in Brooklyn in 1916. That was a moment where a woman out of her own conviction really stepped up to confront powers that were preventing women from being able to have healthy pregnancies and space them the way they wanted. Margaret Sanger is a very problematic figure in a lot of ways, but at that time she was purely advocating for women’s health and safety.

Is there anything people tend to get wrong about the story of contraception?

It’s easy to see contraception as a sign of progress, that we’re continually moving forward, finding new technologies. That’s a mistake in two ways. The first is an over-dependence on technology without thinking about the science. For example, you may have seen that there was a new app approved by the FDA that allows anybody with a uterus and ovaries to plot out so-called safe periods when they might not be ovulating, but it’s very problematic. In a way, it’s a step backwards in knowledge about natural family planning. The other thing is that access to contraception should never be taken for granted. It’s clear in the U.S. — there are plenty of pharmacies that have pharmacists who can refuse to give you medicine if it disturbs their conscience.

It’s obvious why this subject might be interesting in a salacious sense, but what makes contraception interesting to a historian?

It provides a way to think about so many things, encapsulated in something as mundane as a condom — ideas about heterosexuality, marriage, feminism, manufacturing, technology. Also, contraceptives have been the tools of many negative movements in history. For example, forced sterilization in the U.S. and in countries like Peru and India. It’s provided incredible benefits to people but at the same time it’s also been a tool of control and dehumanization. It provides a window into how a particular country at a particular time valued women’s rights and, more broadly, human rights.

Correction appended: Sept. 26, 2018

The original version of this article misstated the timing of the introduction of the diaphragm. That technology was developed and popularly manufactured in the 1880s and 1890s, not the 1880s and 1980s.

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Karlie Kloss rose to fame in her teenage years, as a size 0 model able to fit in any designer’s clothes. But after going on birth control and gaining weight, she started losing out on jobs.

Kloss, 26, said that she went up to a size 4 or 6 in one year, and believes her work suffered because of it.

“I started taking birth control, and my body became more womanly — hips and thighs appeared,” she told Vogue for their October issue. “I started losing jobs; I wasn’t getting booked for the runway; designers stopped working with me. It felt as if my world had been turned upside down.”

Kloss said that was a difficult time, but it helped her reflect on herself.

“I’d always measured myself against Gisele [Bündchen] — to me she was the pinnacle of modeling success — and that was not productive,” she said. “That’s when I had a breakthrough: I realized it was time for me to do me, to embrace the things that make me who I am.”

Kloss, who recently got engaged to Josh Kushner, said in 2016 that she now prioritizes self-care.

“I don’t sit still very often, so that’s why I’ve had to learn how to really take care of myself, and feel my best even when I’m not in my routine, when I’m not sleeping in my own bed and working out in the same place doing the same thing every day,” she said. “I love to dance…to kind of just move. There’s nothing more gratifying than a good sweat.”

And while Kloss loves cookies — she does have a line of them with Milk Bar, after all — she said she’s more careful about what she eats ahead of New York Fashion Week.

“I think during crunch time I’m just a little more careful about the sweets,” Kloss said. “I have a serious sweet tooth. I started a cookie line because I have that much of a sweet tooth, but still gotta indulge and enjoy life.”

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Whether you're 15 or 50, one rule remains the same: If you haven't hit menopause and you don't want a baby, then you need some kind of birth control.

But that doesn't mean you should stick with the same method for all of your fertile years. In fact, it's often wiser to make some changes along the way. The best pick for you today might no longer be a winner in a few years, and if you haven't thought about your contraception in a while, it could be time for an update. So what's the ideal option for you right now?

To make your selection, you and your doctor should discuss a number of factors, including your age. Age is important both because of certain health issues and risk factors as well as because your lifestyle habits tend to change, Mary Jane Minkin, MD, clinical professor of obstetrics and gynecology at Yale University School of Medicine, tells Health. Here's a guide to getting smarter about birth control in your 20s, 30s, and 40s.

RELATED: 7 Health Benefits of Birth Control Nobody Talks About

In your 20s...

The Pill is a popular pick at this age, and it might be ideal for you—or maybe not. Many 20somethings live a hectic lifestyle, notes Dr. Minkin. "Can you remember to take a pill every day? That's the major question," she says. "If you look at the scientific literature, you'll see that the average number of forgotten pills can be as high as 4 per month!" Each missed pill further reduces the efficacy of this method, so skipping several is pretty risky if you're trying to avoid getting pregnant.

Fortunately, the Pill isn't your only option. "I have a patient, a very smart girl who's a college student, who just can't remember to take the Pill, so every 3 months she comes in for a Depo-Provera shot instead," says Dr. Minkin. (Depo-Provera relies on the hormone progestin to thicken cervical mucus so sperm can't get to an egg.) 

For other young and busy women, NuvaRing might work well. This hormonal method requires you to insert a ring and remove it after 3 weeks, which might be less of a hassle than taking an oral med every day. The catch: "You have to be comfortable touching your vagina," says Dr. Minkin. If the idea of inserting a ring makes you squeamish, it isn't for you. (The FDA just approved a vaginal ring called Annovera that can be used for a full year, but it likely won't hit pharmacy shelves until 2019 or 2020.)

RELATED: How Many Times Can You Actually Take Plan B? Asking for a Friend

Also worth remembering: If you have multiple partners, you need to use a condom every time to protect against sexually transmitted infections (STIs), even if you're using hormonal contraception. "I've had so many young women tell me, 'But I've had the HPV vaccine!' That's great—I'm delighted—but there are many other [STIs] out there that it doesn't protect against," says Dr. Minkin.

In your 30s...

If you're happy with the method you were using in your 20s, you might be able to stay with it, but there are some important caveats. "If you're over the age of 35 and you're a smoker, you shouldn't be taking birth control pills," says Minkin. Ditto for rings and patches, because the hormones will raise your risk of a heart attack, stroke, or blood clot. These risks exist for non-smokers and younger smokers, too, but are much lower.

Whether you're a smoker or not, one method you may want to consider in your 30s is an IUD. Although you can get an IUD at any age, they're most popular in the U.S. among women who've finished having children or who don't plan to get pregnant again for a while. Once you've given birth, your cervix has been stretched out, so insertion tends to be less painful than if you haven't had a baby—though most women (including those who've never had kids) can just take an OTC painkiller before the procedure and feel fine, says Dr. Minkin.

The two most commonly used IUDs are the Mirena (which releases a small amount of progestin and can stay in for at least 5 years) and ParaGard (which is made of copper and can stay in for at least 10 years). Dr. Minkin says IUDs have become increasingly popular, and she's seen a surge of interest in her practice since President Trump got elected. "Contraceptive coverage is up in the air, along with funding for Planned Parenthood," she explains. "IUDs are covered for now and can stay in for 5 to 10 years."

And again, if you have more than one partner, a condom—with or without another form of contraception—is a must.

RELATED: 6 Ways Your Breasts Change When You Reach 40

In your 40s...

You've probably heard that your fertility takes a nosedive in this decade, and that's generally true. But there are also plenty of "surprise" pregnancies among women in this age group. "I have personally delivered babies for three women who were 47 years old and not trying to get pregnant!" says Dr. Minkin. You're not in the clear until you've gone a full year without a period.

If you're dealing with symptoms of perimenopause like hot flashes, night sweats, and irregular periods and you aren't a smoker, then low-dose birth control pills might be a good bet. "I use them a lot for women in their early- to mid-40s, because it helps control their symptoms," says Dr. Minkin.

Concerned about your breast cancer risk, which starts to rise in your 40s? Some research has suggested that hormonal birth control might further raise the chances of the disease, though Dr. Minkin isn't too concerned. (She says any increase appears to be minimal.) Still, if you're worried—perhaps because you also have a family history of breast cancer or other risk factors—then consider the copper IUD. "If your periods are regular and you just want reliable contraception, ParaGard is fabulous and there are no hormones," says Dr. Minkin.

RELATED: What It's Like to Get Nexplanon, the Birth Control Implant in Your Arm

The contraceptive sponge, which is back on the market, might also be a good pick for some women in this age group. "I don't want a teenager using it exclusively, but if you're 48 years old and you've gone 9 months without a period, the chances of you getting pregnant are pretty darn small," says Dr. Minkin. "So if you want to stop the method you were using before for whatever reason and use the sponge now, that's fine."

Of course, if you have multiple partners—maybe you're starting to date again after a long hiatus—you still need to use condoms, because you can get an STI at any age.

No matter how old you are, Dr. Minkin says finding a birth control method that fits your personal needs is really what's key. "I want to make sure that patients are using something they're comfortable with and that's compatible with their lifestyle," she says.

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