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Best birth control for younger women?

Discussion in 'Ob/Gyn' started by Habeed, Dec 1, 2008.

  1. Habeed

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    In general, what is considered the best form of birth control for younger, breeding females today?

    My seventeenth edition copy of the Merck Manual has a description of each method, and it is overwhelmingly clear that one method is best. The copper IUD has a 2% failure rate over 10 years, equivalent to sterilization, and does not interfere with female hormone cycles.

    As I understand it, all of the hormonal birth control methods have several unwanted effects. Common, significant "side effects" are changes in which MHC pheromones females respond to, reduced sex drive, and weight gain.

    These 3 "side effects" probably occur in almost all women, as estrogen is thought to cause each of these effects.

    I read recently that the copper IUD has fallen out of favor, because there is a small risk of uterine infection that can result in permanent sterility. It is also painful and expensive and invasive to install. However, as near as I can tell, it appears to be the "best method" by an overwhelming margin. It is the most effective, requires nothing of the patient, and after the first few weeks causes essentially no systemic side effects in most women.

    But with IUDs off the table, what is now considered the "best method" of birth control for women who intend to have children in the future?
     
  2. LadyGrey

    LadyGrey Member
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    Not sure why you think IUDs are off the table. They get a bad rap for PID, and some old-fashioned ob-gyns are obsessed with this risk, but more recent studies show that with the "newer models" now available it isn't really as much a risk as it used to be. (The string is a monofilament which is less of a bacteria highway). Also, the greatest risk of infection comes with insertion, not once it's just sitting there, so if you check for GC/Chlamydia before insertion you decrease that risk. They are very unpopular in the US, but very common in other countries.

    The Mirena IUD, which secretes levonorgestrel for five years, is pretty awesome. As a "side effect" it can decrease or even eliminate menstrual bleeding, which is basically the best side effect ever. As far as expensive, either the Mirena or the copper IUD are expensive as far as having a high one-time cost, but actually cheaper than the pill if you divide the cost by the number of months you use it.
     
  3. OP
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    Habeed

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    Does this levonorgestrel act on the CNS? The problems with all the hormonal birth control methods is that the CNS detects and is affected by the hormone. As far as I know, the brain cannot detect the trace amounts of copper leaching off a copper IUD, or the presence of the IUD at all, once the pain of insertion is over with.
     
  4. Global Disrobal

    Global Disrobal Along for the ride
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    You are better off consulting a more up to date source of information than the 17th edition of the Merck, which if I am not mistaken, was published in 1999 and likely written during the preceding 2 years.

    With respect to contraceptive options, you are better off getting your information from a gynecologic text or an updated on-line resource such as uptodate.com or similar entity.

    As for Mirena's levonorgestrel effect on the CNS, you will find the comprehensive physician information at the following link:
    http://berlex.bayerhealthcare.com/html/products/pi/Mirena_PI.pdf

    Best of luck!
     
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  5. LadyGrey

    LadyGrey Member
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    It's supposed to be a purely "local" effect on the uterine lining -- no CNS effects.

    The website Managing Contraception is a pretty good source, as is the associated book, Contraceptive Technology.
     
  6. Snube

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    The information I've read says that approximately 7% of the hormones in the Mirena make it into systemic circulation. Haven't read if the 'CNS effects' of hormonal regulation are seen with the Mirena--my patients who have trouble with the side effects of OCPs have found the Mirena much more tolerable.
     
  7. OP
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    Habeed

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    Well, it does sound like IUDs should be the only method even considered, then. In terms of effectiveness, and not affecting the woman's behavior and hormone systems, it seems obvious that this is the only way to go.

    So, what does it cost to go under the hood and install an aftermarket accessory like a Mirena or Copper IUD? I'm trying to see why women don't do this more often.
     
  8. nic23

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    Can you not mix your metaphors. Are we cars or animals?
     
  9. Jochebed

    Jochebed Ye Must Be Born Again
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    First off - vet student here, not med. It's been a slow day for SDN on the vet boards and I started wandering... I obviously can't answer your question (why women don't choose an IUD) for others, but for me (and I'm not trying to start an argument or political/ethical/moral discussion, just offer a viewpoint) I believe that life starts at conception and so I would not use an IUD as I view it as a silent method of abortion since it works by preventing implantation. Making the uterus a "hostile" environment, as I've read elsewhere. Again, not trying to start a heated argument or anything, I just saw the thread and your question and felt I'd offer a view on the other side for why IUDs may seem medically perfect and yet women would turn them down.

    LOL
     
  10. smq123

    smq123 John William Waterhouse
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    You mean the copper IUD. The Mirena IUD affects the hormonal system.

    A Mirena will cost around $300, depending on the type of insurance you have and whatnot. It's certainly not cheap, although it eventually starts to pay for itself over the years. But for someone who is pretty strapped for cash RIGHT NOW, an IUD is probably not the most cost-effective method. Pills and condoms are cheaper in the short term.

    IUDs, especially in nullips, have a reputation for being painful, both upon insertion and after a period of time. Some women have terrible cramps for a while after having their IUD placed.

    Some women DO prefer condoms, because, unlike the IUD, condoms are the only form of birth control that protects against STDs as well. If they or their partner might have an STD, might as well use a form of birth control that will protect against that, too.

    These side effects are not experienced by everyone. And weight gain is often a somewhat overblown side effect - while OCPs may cause bloating, it rarely (if ever) causes the extreme weight gain that many women fear.
     
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  11. free09

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    I think birth control pills do directly promote weight gain, not only through fluid retention, but also because altering the estrogen/progesterone balance causes insulin resistance. so as a doctor, i would perhaps be cautious to prescribe bcps to typically insulin resistant populations, such as south asians...since extreme insulin resistance can give symptoms of pre-diabetes.

    that said, i think it is better to advise a patient to get something which will cause 5 lbs of potential weight gain than no intervention, which would cause 25 lbs of definite weight gain (i.e pregnancy).
     
  12. Tours2

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    This happened with my girlfriend, too. :soexcited: I'm seriously thinking about buying a Yaz! t-shirt.

    What's not to like about that? I think I'd get in trouble if I asked her to double the dose, though. :laugh:
     

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