Jump to content
  • Welcome to Celiac.com!

    You have found your celiac tribe! Join us and ask questions in our forum, share your story, and connect with others.




  • Celiac.com Sponsor (A1):



    Celiac.com Sponsor (A1-M):


  • Get Celiac.com Updates:
    Support Our Content
    eNewsletter
    Donate

Stick-on Birth Control Patches, Etc


skbird

Recommended Posts

skbird Contributor

Does anyone know if those stick on birth control patches are gluten free? I know we've discussed Band Aids, etc, but was just wondering if anyone knows about medical patches (I guess there would be a question about nicotine patches and pain relief patches, too).

Stephanie


Celiac.com Sponsor (A8):
Celiac.com Sponsor (A8):



Celiac.com Sponsor (A8-M):



frenchiemama Collaborator

I'm not sure if they have gluten, but I warn you that I broke out horribly from it. The rash lasted for 3 weeks after I stopped using the patch.

bluelotus Contributor

I used those patches at one time too (before being dx'd). I didn't react to them, but they did slide around on my skin (didn't fall off though) and would leave a nasty little sticky smear that caught a bunch of lint off my clothes. So, although they may work, they aren't very attractive nor are they completely unoticeable.

skbird Contributor

Thanks for the info. I get rashes about half the time from regular band aids so I am not sure if this is a good idea for me. What I like in theory about the patch and the ring (Nuvaring) is that they are transdermal and don't require your liver to process them. But I didn't like the experience of the Nuvaring at all, and am wondering about the patch.

I guess birth control hormones might not be the answer for me. I am not sure what else to do though, because if I do have endometriosis, especially on my bowel, as my symptoms indicate, the only other option seems to be surgery. Blech!

Oh well...

Stephanie

KaitiUSA Enthusiast

The Ortho Evra patches are gluten free.

MySuicidalTurtle Enthusiast

Stephanie, you could still use barrier methods, right?

tarnalberry Community Regular
Thanks for the info. I get rashes about half the time from regular band aids so I am not sure if this is a good idea for me. What I like in theory about the patch and the ring (Nuvaring) is that they are transdermal and don't require your liver to process them. But I didn't like the experience of the Nuvaring at all, and am wondering about the patch.

I guess birth control hormones might not be the answer for me. I am not sure what else to do though, because if I do have endometriosis, especially on my bowel, as my symptoms indicate, the only other option seems to be surgery. Blech!

Oh well...

Stephanie

<{POST_SNAPBACK}>

If the hormones are for the endo, can you try using topical hormones? They may have to be compounded if you need progesterone as well, but estrogen already comes in an insertable cream that's often used by menopausal women.

If it's for birth control reasons, I've switched to a combination of FAM (fertility awareness method) and barrier methods (no spermicide though, my body can't handle that stuff) and we've been happy with it, though it takes dedication and strict adherence.

What trouble did you have with the Nuvaring? (I tried it without any problems with the method itself, but my body just doesn't do all that well with added hormones that I don't need, particularly the progesterones.)


Celiac.com Sponsor (A8):
Celiac.com Sponsor (A8):



Celiac.com Sponsor (A8-M):



Noelle126 Apprentice

The Ortho Evra Patches are gluten free...and I never had a problem with them...just wanted to add my two cents!

jenvan Collaborator

yeah, if anyone else here has had experience with nuvaring i'd be curious to know. i was going to try to switch to it next month...

frenchiemama Collaborator
yeah, if anyone else here has had experience with nuvaring i'd be curious to know.  i was going to try to switch to it next month...

<{POST_SNAPBACK}>

I've used it, and I liked it. My doctor had me stop using it for a while because we suspected that the estrogen was making my DH flare up. Right now I'm trying the minipill to see if there are any changes.

Jnkmnky Collaborator

Birth control pills to control the pain of endometriosis is more like a medication for a serious problem... Does anyone see a problem with using birth control pills to control pregnancy? I cringe when I hear women are using those pills/patches. Of course, you may cringe when people bring up the "don't use them" train of thought... :D I just don't see why women believe they're safe. There are alternatives to hormones. And isn't it a CRAZY idea when you separate it from what you're trying to control....? You're putting Hormones into your body and changing around your natural state of being to ensure you don't get pregnant. I feel like women have been duped into abusing their bodies with this junk. Sure, you don't get pregnant..but at what cost? If you clean out your body, you'll see your body has a natural cycle of fertility. When used correctly, NFP has as high a rate of effectiveness as birth control pills..without the side effects. No, I am not a religious right hyper conservative republican evangelical christian born again catholic right winger george bush loving pro life planned parenthood hating anti liberal anti roe vs wade stereotype. .... I just think a woman's body should be free and clear of as many synthesized drugs as possible. We're all trying hard to be healthy, avoid gluten and the other foods that cause discomfort and then there's a conversation about birth control options focusing mainly on hormones we can take to supress ovulation... why don't women just realize that ovulation is our friend...a natural cycle in our bodies and realize we can learn to recognize the signs of ovulation, allow our bodies to function NORMALLY, and avoid pregnancy by knowing our own body cycles? It's a really healthy thing to do for ourselves. Of course, exceptions made for the trauma of endometriosis. That's a medical condition that needs attention. Ovulation is NOT a medical condition that requires "fixing". I'm just trying to point out we can live with our female bodies without drugs. Not pushing *values* other than the value of the female experience. :)

jenvan Collaborator

thnx carolyn... i don't always understand which hormones are in which at what strength etc. i have been on oral ortho tri-cycline for 10 years...and wanted to switch to nuvaring b/c it has about a 1/3 less hormones than my oral pill i believe. it would be great to not be on any...but i can't take a risk of another cyst or getting pregnant right now...

elonwy Enthusiast

I don't have endometriosis, but I do take the pill (Ortho Novum 7/7/7) because without it I can't live a normal life. I have crippling periods that last a minimum of 7 days and make me unable to work or ineract with society because of pain. I've been on the pill since I was 14 because I started passing out at school. Over the years I've tried other pills ( Ortho Tricyclin was one) and methods, and with them I felt the hormonal effects greatly, whereas with the one I take, it just makes me normal. Every few years I stop, and try to see if anything's changed and if I can live without it.

I wonder what the hormones are doing, I wish I didn't have to take it, and I don't take it for birth control reasons ( though its nice to have a backup) as we use barrier methods as well, but its definitly a personal thing.

I think the patch looks ugly, especially with all the low-cut jeans. Think very carefully about where you apply it, as its on for a week. Nothing more attractive that staring at your waitress's birth control patch, which was a recent experience I had with them.

I did the nicotine patch, back in the days of giving up smoking, and I'm not convinced the delivery method is down yet as far a dosage control. A weeks worth of hormones in one patch? Peoples skin absorbs at diff rates, depending on alot of factors. I'm wary of getting some crazy burst of hormones making me all insane. I don't like being pissed for reasons I can't control :)

And bandaids make me itch like crazy.

Thats all my opinion :)

Elonwy

frenchiemama Collaborator
Birth control pills to control the pain of endometriosis is more like a medication for a serious problem... Does anyone see a problem with using birth control pills to control pregnancy?  I cringe when I hear women are using those pills/patches.  Of course, you may cringe when people bring up the "don't use them" train of thought... :D  I just don't see why women believe they're safe.  There are alternatives to hormones.  And isn't it a CRAZY idea when you separate it from what you're trying to control....?  You're putting Hormones into your body and changing around your natural state of being to ensure you don't get pregnant.  I feel like women have been duped into abusing their bodies with this junk.  Sure, you don't get pregnant..but at what cost?  If you clean out your body, you'll see your body has a natural cycle of fertility.  When used correctly, NFP has as high a rate of effectiveness as birth control pills..without the side effects.  No, I am not a religious right hyper conservative republican evangelical christian born again catholic right winger george bush loving pro life planned parenthood hating anti liberal anti roe vs wade stereotype.  ....  I just think a woman's body should be free and clear of as many synthesized drugs as possible.  We're all trying hard to be healthy, avoid gluten and the other foods that cause discomfort and then there's a conversation about birth control options focusing mainly on hormones we can take to supress ovulation... why don't women just realize that ovulation is our friend...a natural cycle in our bodies and realize we can learn to recognize the signs of ovulation, allow our bodies to function NORMALLY, and avoid pregnancy by knowing our own body cycles?  It's a really healthy thing to do for ourselves.  Of course, exceptions made for the trauma of endometriosis.  That's a medical condition that needs attention.  Ovulation is NOT a medical condition that requires "fixing".  I'm just trying to point out we can live with our female bodies without drugs.  Not pushing *values* other than the value of the female experience. :)

<{POST_SNAPBACK}>

I know some people who use NFP, and they seem happy with it. However these people are also the kind who would be ok if they had an "oops". I am NOT one of those people. It goes beyond just not wanting kids, I think I have some kind of kid-phobia. I absolutely don't want to be around them under any circumstances. In fact, I dread the day that either of my siblings decides to reproduce. I'm sure everyone is going to think that I'm horrible because of this, but for me it's BC + barrier until we can afford surgical sterilization.

Jnkmnky Collaborator
I know some people who use NFP, and they seem happy with it. However these people are also the kind who would be ok if they had an "oops". I am NOT one of those people. It goes beyond just not wanting kids, I think I have some kind of kid-phobia. I absolutely don't want to be around them under any circumstances. In fact, I dread the day that either of my siblings decides to reproduce. I'm sure everyone is going to think that I'm horrible because of this, but for me it's BC + barrier until we can afford surgical sterilization.

<{POST_SNAPBACK}>

You're not horrible. My sister has NO desire for kids either. I don't quite understand it, but I don't have a problem with a person choosing a kid-less life. I only want to stress the use of bcpills as they relate to women's health. I understand not wanting to get pregnant, but I don't understand choosing bcpills as the preferred method. I think it's such a barbaric thing to do to a woman's body and I think the way we accept this as our main method of bc is due to the fact that we're not taking better care of our health. We undervalue our natural state of being female. Don't tell me they couldn't have invented a male bcp by now that would be available to alter the hormones of men. But they know men won't take them and there'd be little or no profit... WOMEN, however, will do this to themselves. Just boggles my mind. For medical reasons- to control pain- as a last, best resort... that's understandable. But for bc? I can't believe we haven't revolted against this form of female abuse. The truth is, we're using the hormones because men have convinced us condoms are so awful for THEM, that if we don't wreck our bodies with hormones to control unwanted pregnancies, we don't love them enough.

tarnalberry Community Regular
I just don't see why women believe they're safe.  There are alternatives to hormones.

...

Sure, you don't get pregnant..but at what cost? 

...

When used correctly, NFP has as high a rate of effectiveness as birth control pills..without the side effects. ... why don't women just realize that ovulation is our friend...a natural cycle in our bodies and realize we can learn to recognize the signs of ovulation, allow our bodies to function NORMALLY, and avoid pregnancy by knowing our own body cycles?

<{POST_SNAPBACK}>

Note: I'm responding in general, to the board, not specifically to Jnkmnky, just following on to the points she brought up.

Women think that the hormonal birth control pill is "safe" because a number of studies (and it's really a very large number) have shown that for *most* women, the risks are *minimal*. That doesn't mean for all women, and it doesn't mean no risks, but people often minimize these things anyway, so may see it as just plain safe, instead of 'safe, with the standard medical bits added on'. Based on how many women do with it over the course of their lifetimes, the pill (particularly the lower dose pills that became available in the 80's) certainly doesn't seem to qualify as "risky" in the general sense of the word, but at the same time, there are a lot of side effects that, while not major in any way, are marginalized by the drug companies and doctors. That is particularly unfortunate, I think, as many people may not realize that an unwanted symptom may be caused by a pill they are taking, but many people who know it will accept it as a tradeoff for what they gain by being on the pill. (And that varies for a lot of people as well. Cramp reduction is definitely a big reason.)

I think the "cost" of pregnancy question is an interesting one, and one that has so many interpretations, and so many correct ones. The 'cost' of pregnancy (emotional, financial, social, psychological, professional, familial, etc.) is so different for each and every different person, and varies for each person at different times in her life. There are some times when, even if you're married, getting pregnant is NOT an option, even medically speaking. I think it's the hardest factor to pin down in deciding what the best method of birth control is for a person at a given time, and not enough people think about it.

As for NFP (or FAM, which is the same, except not calling for abstinence during fertile days), being a practitioner of this method, I do wish more women would use it, but teaching it, and getting women to be fastitious about it can be tough. I dropped charting for a month while moving, because it was too cumbersome. There are plenty of women out there, particularly younger ones in college, who are not going to have the set schedule and committment to be able to effectively use FAM, let alone NFP. Not to mention that, in the case of NFP, many people may find that five to seven days of abstinence (assuming sex during menstruation is acceptable to the person, if not, its 10 to 14 days) each month is just completley untenable to them. Of course, there's a good debate to be had on that one too! (If you really, really can't have kids right now, why have sex, which is the only cause of pregnancy?) I support NFP and FAM, I really do. But I have serious worries that if many people started fully relying on it without practicing it correctly (and understanding the risks associated with each decision, particularly in the case of FAM, where you may use a backup method during fertility windows), it would get a worse reputation. Already too many people confuse it with the rhythm method, which is notoriously ineffective. But it would also help many people identify fertility problems earlier, and become more aware of their body, which they would find helpful in day to day life.

KaitiUSA Enthusiast
I understand not wanting to get pregnant, but I don't understand choosing bcpills as the preferred method.  I think it's such a barbaric thing to do to a woman's body and I think the way we accept this as our main method of bc is due to the fact that we're not taking better care of our health.  We undervalue our natural state of being female. Don't tell me they couldn't have invented a male bcp by now that would be available to alter the hormones of men.  But they know men won't take them and there'd be little or no profit... WOMEN, however, will do this to themselves.  Just boggles my mind.  For medical reasons- to control pain- as a last, best resort... that's understandable.  But for bc?  I can't believe we haven't revolted against this form of female abuse.  The truth is, we're using the hormones because men have convinced us condoms are so awful for THEM, that if we don't wreck our bodies with hormones to control unwanted pregnancies, we don't love them enough.

I totally agree with what you are saying. I am not for all of those artificial hormones because I do not think it is good for your body. My mom told me she was on it for a while and it screwed her up. Some people in my family have also used it and are not fans of them because they did not have good experiences either. I think there is a more natural way to get rid of cramps and if you have to last resort would be to take them to help with cramps and pain.

jenvan Collaborator

i haven't investigated it much...but i have yet to find a 'natural' alternative to bc for those women who take it for control of cysts per se, like myself. anyone ever heard of anything? i know it can improve over time, but when i've missed a pill i feel like i go right back to pain city... i am curious for when i do try to get pregnant...and hope it takes several months at least...so i have time to "feel" what its like not on bc again. i do agree with tiffany on drs and companies minimizing side effects. my ob always says to me--its totally safe, you can take it forever, and has no side effects. talk about spinning it!! i have contemplated NFP...and i am the type of person that could stick to it, take organized etc...but like i said, i just feel like i can't take a risk...and the sex issue. my dh and i are so busy, finding time for sex on any day can be difficult. i hope to only be on it for 2 more years or so... we'll see. maybe i'll do some more reading on it more. i do appreciate the challenge from you two :)

tarnalberry Community Regular
i have contemplated NFP...and i am the type of person that could stick to it, take organized etc...but like i said, i just feel like i can't take a risk...and the sex issue.  my dh and i are so busy, finding time for sex on any day can be difficult.

<{POST_SNAPBACK}>

If you would stick to it, I'd give it a try. That's the biggest part, dealing with the responsibility. If you're willing to use barrier methods, then during fertile times, you can still have sex, but you KNOW you're fertile and you know that you're relying on the barrier method(s) you choose in order to prevent pregnancy. Then you can still have sex (as long as you have your backup method around).

skbird Contributor

Wow, lots of replies. I'm not wanting to use BC for pregnancy control, my husband had a vasectomy when we got back from the honeymoon (I don't want to ever have kids... I knew when I was 12 and my mom got her tubes tied - I asked her then! She laughed and told me to wait until I was 30...)

Just for endometriosis purposes. I have been using progesterone cream as I am estrogen dominant, and I have been taking Brevail which is a flax lignan supplement which is supposed to help flush out excess estrogen. They both help but not quite enough. I was pretty excited about the idea of having no periods - the goal with using the nuvaring, keeping one in at all times.

My side-effects were this: irritation, feeling it all the time, no matter how it was positioned, uncomforable sex, lowered libido (like night and day), feeling racing thoughts, and this was only in the first week! I took it out after that and have had a really weird spell of getting deeply depressed. I would not have thought that was connected until I looked online last night and found a lot of experiences posted that said some people had problems with their moods even a few weeks after stopping nuvaring, even after using as little as 2 weeks. So I think that might be what was happening for me. Also, now that I look back, I was using BCP since 17 - 30 and that was the main time in my life I had a lot of emotional problems, was diagnosed bipolar the first time. This recent bout with nuvaring prompted my doc to want to reinvestigate my being bipolar. I am thinking it's hormones for me...

I have also read that having endometriosis on the bowel is not stopped by BCP or other hormone treatments, that it needs to be surgically removed. Yipes! So I think I will just keep going until I really have to do something about it.

What happens now:

Day 14 of cycle (from the day period starts) - I get a big colon cramp, makes it hard to sit down, move around, go to the bathroom. This is also the day of ovulation for me. Really bad IBS/C. I am constipated for at least a week, I go every day but it's very hard and there is mucus and gas. After the first day the big cramp dies down but my bladder starts feeling like I have an infection, urgency of going, might have an accident. This calms down a little after a few days, and then right before my period start again, I have horrible cramps that I can feel down my legs to my ankles, and mood swings. Usually really heavy period that lasts 6 days, and sometimes hurts worse at the end than at the beginning. Then the IBS all goes away and I'm good for about a week or so until it starts again. This has been going on for about 2 years, getting more predictable every month.

Sometimes using the bathroom under these conditions is beyond painful...

Blech.

Not sure if emotional upheaval is the best trade, though...

Stephanie

skbird Contributor
Stephanie, you could still use barrier methods, right?

<{POST_SNAPBACK}>

Hey Turtle -

Fortunately I'm not in danger of getting pregnant. But barrier methods were problematic for me. I have a tilted uterus and they couldn't fit me for a diaphragm. And condoms are ok, but rough on me, spermacide seems to give me allergies. Anyway, if not one thing, another. I was really glad my husband didn't want kids (he has a lot of weird genetic things in his fam, including cystic fibrosis, his little sister died of it) because it made the whole decision for him to get a vasectomy easier. And BTW, if any men read this far, I offered to get a tubal ligation - I would feel better, honestly, if I had one, but he thought it would be less invasive for him to get the vasectomy and wanted to have that done instead.

Nice guy!

Steph

floridanative Community Regular
I'm sure everyone is going to think that I'm horrible because of this, but for me it's BC + barrier until we can afford surgical sterilization.

<{POST_SNAPBACK}>

jenvan Collaborator

way to go men! its refreshing to see some who are taking an active role in bc : ) i was telling my dh about this thread last night. he said after we have kids he will get a vasectomy. gotta give him props for that...

skbird Contributor

Jen - tell him it's not as bad as it seems. After they got done with my husband, I thought he'd want to go home and sit on ice, but instead we went out to dinner and drank margaritas! I think we were both glad it was done.

Anyway, woo-hoo! Go men!

Stephanie

  • 2 weeks later...
elonwy Enthusiast

Was watching the news tonight and the makers of Ortho-Evra ( Bc patch) are telling women on it to go see thier doctors, because its releasing higher hormones levels than they thought and women have been dying of strokes and blood clots.

Was always one of my concerns with that thing, I never did believe they could get that dosage right.

Just wanted to bring it to the attn of anyone using it.

Elonwy

Archived

This topic is now archived and is closed to further replies.

  • Celiac.com Sponsor (A19):
  • Member Statistics

    • Total Members
      133,050
    • Most Online (within 30 mins)
      7,748

    Rima
    Newest Member
    Rima
    Joined
  • Celiac.com Sponsor (A20):
  • Celiac.com Sponsor (A22):
  • Forum Statistics

    • Total Topics
      121.5k
    • Total Posts
      1m
  • Celiac.com Sponsor (A21):
  • Upcoming Events

  • Posts

    • tiffanygosci
      Hi Cristiana! It's so nice to meet you! Thank you for the kind reply I am glad I live in a time where you can connect with others through the Internet. That is a mercy I am grateful for.
    • knitty kitty
      In the study linked above, the little girl switched to a gluten free diet and gained enough weight that that fat pad was replenished and surgery was not needed.   Here's the full article link... Superior Mesenteric Artery Syndrome in a 6-Year-Old Girl with Final Diagnosis of Celiac Disease https://pmc.ncbi.nlm.nih.gov/articles/PMC6476019/
    • knitty kitty
      Hello, @Jordan Carlson, So glad you're feeling better.   Tecta is a proton pump inhibitor.  PPI's also interfere with the production of the intrinsic factor needed to absorb Vitamin B12.  Increasing the amount of B12 you supplement has helped overcome the lack of intrinsic factor needed to absorb B12. Proton pump inhibitors also reduce the production of digestive juices (stomach acids).  This results in foods not being digested thoroughly.  If foods are not digested sufficiently, the vitamins and other nutrients aren't released from the food, and the body cannot absorb them.  This sets up a vicious cycle. Acid reflux and Gerd are actually symptoms of producing too little stomach acid.  Insufficient stomach acid production is seen with Thiamine and Niacin deficiencies.  PPI's like Tecta also block the transporters that pull Thiamine into cells, preventing absorption of thiamine.  Other symptoms of Thiamine deficiency are difficulty swallowing, gagging, problems with food texture, dysphagia. Other symptoms of Thiamine deficiency are symptoms of ADHD and anxiety.  Vyvanse also blocks thiamine transporters contributing further to Thiamine deficiency.  Pristiq has been shown to work better if thiamine is supplemented at the same time because thiamine is needed to make serotonin.  Doctors don't recognize anxiety and depression and adult onset ADHD as early symptoms of Thiamine deficiency. Stomach acid is needed to digest Vitamin C (ascorbic acid) in fruits and vegetables.  Ascorbic acid left undigested can cause intestinal upsets, anxiety, and heart palpitations.   Yes, a child can be born with nutritional deficiencies if the parents were deficient.  Parents who are thiamine deficient have offspring with fewer thiamine transporters on cell surfaces, making thiamine deficiency easier to develop in the children.  A person can struggle along for years with subclinical vitamin deficiencies.  Been here, done this.  Please consider supplementing with Thiamine in the form TTFD (tetrahydrofurfuryl disulfide) which helps immensely with dysphagia and neurological symptoms like anxiety, depression, and ADHD symptoms.  Benfotiamine helps with improving intestinal health.  A B Complex and NeuroMag (a magnesium supplement), and Vitamin D are needed also.
    • knitty kitty
      @pothosqueen, Welcome to the tribe! You'll want to get checked for nutritional deficiencies and start on supplementation of B vitamins, especially Thiamine Vitamin B 1.   There's some scientific evidence that the fat pad that buffers the aorta which disappears in SMA is caused by deficiency in Thiamine.   In Thiamine deficiency, the body burns its stored fat as a source of fuel.  That fat pad between the aorta and digestive system gets used as fuel, too. Ask for an Erythrocyte Transketolace Activity test to look for thiamine deficiency.  Correction of thiamine deficiency can help restore that fat pad.   Best wishes for your recovery!   Interesting Reading: Superior Mesenteric Artery Syndrome in a 6-Year-Old Girl with Final Diagnosis of Celiac Disease https://pubmed.ncbi.nlm.nih.gov/31089433/#:~:text=Affiliations,tissue and results in SMAS.  
    • trents
      Wow! You're pretty young to have a diagnosis of SMA syndrome. But youth also has its advantages when it comes to healing, without a doubt. You might be surprised to find out how your health improves and how much better you feel once you eliminate gluten from your diet. Celiac disease is an autoimmune disorder that, when gluten is consumed, triggers an attack on the villous lining of the small bowel. This is the section of the intestines where all our nutrition is absorbed. It is made up of billions of tiny finger-like projections that create a tremendous surface area for absorbing nutrients. For the person with celiac disease, unchecked gluten consumption generates inflammation that wears down these fingers and, over time, greatly reduces the nutrient absorbing efficiency of the small bowel lining. This can generate a whole host of other nutrient deficiency related medical problems. We also now know that the autoimmune reaction to gluten is not necessarily limited to the lining of the small bowel such that celiac disease can damage other body systems and organs such as the liver and the joints and cause neurological problems.  It can take around two years for the villous lining to completely heal but most people start feeling better well before then. It's also important to realize that celiac disease can cause intolerance to some other foods whose protein structures are similar to gluten. Chief among them are dairy and oats but also eggs, corn and soy. Just keep that in mind.
×
×
  • Create New...

Important Information

NOTICE: This site places This site places cookies on your device (Cookie settings). on your device. Continued use is acceptance of our Terms of Use, and Privacy Policy.