Birth control question...kind of long, but help would be great

[double elle]

Hi all...need some help here.
I was on the pill for years...just can't remember to take it. I am going into surgery, so I need something dependable and EASY. So, I tried the nuva ring - was great for the first 2 months, then for three months in a row...I got infections and had to take it out. So, I tried the patch, which was somewhat irritating, but I thought I could at least give it a month or so. Had it in for 4 days when the announcement came out about it releasing 60% more estrogen than originally thought and that women are 3 times more likely to die from clots and stuff from the patch than the pill. So, took it off that day. My dad died from bilateral PEs...I am on OB right now (I am an osteopathic intern...have to do a month of OB during internship) and I mentioned the news release to the attending and told her my history a little. She couldn't believe I'd never been tested for a clotting disorder before ever being started on the pill. She said she would have never given me estrogen. For the record, my dad and I have very different lifestyles...he was a good-ol-boy. Smoked, drank...fairly active as far as being outdoors non-stop, but ate the wrong foods, no aerobic exercise...etc. I, however, have an HDL of 86, am training for a marathon and have always been healthy and fit. I just assumed his issues were because of his lifestyle and that I wasn't at risk.

So, when I took off the patch after having it on for 4 days...WOW...I went into the biggest funk. When I took off that last ring, I'd been on nothing for almost 3 weeks. I put the patch on for 4 days and I start to go down hill. Remove the patch (which I don't think it was removing the patch...I think it was just the estrogen being newly - once again - introduced to my body).
That was 3 days ago. Feeling somewhat better with regards to mood. So, I have decided to try to go with something non-hormonal.

My question is this....1)should I be tested for clotting issues? 2)does the hormonal IUD have estrogen? I watched an IUD be placed yesterday. The woman's uterus was tilted posteriorly - almost at a right angle (we know this because 3 days ago the attending tried to insert ESSURE and the hysterscope couldn't manipulate such a tilted uterus). So, she used one of those clamps and clamped onto the cervix to move the uterus into a little more alignment.....I about got sick! Here I am going into surgery, but I get sweaty and about puke during anything that involves causing pain to the cervix!! (colpos w/biopsy, etc...)

I only have 1 kid, I am 31, married...If anyone has any input, I would appreciate it! I worry about the risk of the IUDs...perforation and such. Also, the copper IUD...does it really cause that much more spotting?? I guess I am trying to decide between the copper and the hormonal. This sucks, because I was SO happy with the RING.... Anyway, any help would be great.

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[cali_girl]

My question is this....1)should I be tested for clotting issues? 2)does the hormonal IUD have estrogen? I only have 1 kid, I am 31, married...If anyone has any input, I would appreciate it! I worry about the risk of the IUDs...perforation and such. Also, the copper IUD...does it really cause that much more spotting?? I guess I am trying to decide between the copper and the hormonal. This sucks, because I was SO happy with the RING.... Anyway, any help would be great.

I think the Mirena would be an excellent choice for you. It only has progesterone, no estrogen, and I read the package insert. There is no information about clotting problems being a contraindication to insertion. Because you're married, have a kid (vaginal delivery? Would make insertion easier) you are the right demographic. From what I know the Mirena is a lot more pleasant than the copper, because it does help to decrease your bleeding. Copper is much more likely to cause mucosal irritability and increased bleeding. I think that, while you always tell people perforation is a complication of IUDs, the instance has virtually disappeared. That was a flaw with the initial design of the first IUDs. The ones today are great. I recommend them to patients all the time, and I think they are a greatly under utilized option in this country.
As far as being tested for a clotting disorder, you probably should. Was your father worked up? Anyways, hope this helps. But I do think it's a great option for you.

 

[DoIn06]

I'm with CaliGirl - go for the Mirena. IUD's are incredibly effective and safe, especially when being placed by a trained provider. I'm assuming you don't want kids in the next few years though - if you think you might want a child in the next year, then you'll have to have the IUD removed earlier, which isn't that big of a deal, but isn't exactly comfortable. My understanding is that the progesterone only methods (OCP, mirena) are not thought to contribute to coagulopathies. This said, I know many physicians who avoid progesterone too, just in case.

My mom and uncle both had DVT's at young ages - so I'm familiar with the whole worry about coagulopathy - but my mom was negative for anything so I didn't have to undergo testing. I hope you have good insurance, because when I looked into it the costs were quite high, and my OB (I was pregnant at the time) didn't think it was a reasonable thing to get covered - he wanted to wait for my mom to get tested first. Maybe you'll have a different experience with this since your dad is deceased. Personally, I would opt for testing - it's better to be safe. My mom now goes on prophylactic Lovenox on long plane rides due to her history. Maybe you could prevent a clot by knowing

Hope this helps. DoIn06

 

[double elle]

Okay, thanks......It's wierd that all this is coming up now. I'd just attributed his clots to his lifestyle. I don't know if they ever did a workup on him, that was about 6 years ago when he had his first one in his leg and had to actually take him to surgery. I wasn't even in med school then, so I didn't know which questions to ask. Then, he decided to quit taking his coumadin for a week and that's all it took. (about a year between the initial clot and his death) I wish I'd known more back then so I could have asked the right questions. Perhaps I could call his doc??...just to see if a workup was done - I assume there was.....I mean, I would think there would have been just based on how we do things at my hospital. It's wierd that I've never really thought about all this so in depth before, but I guess I should have. I'm pretty close with our vascular surgeon who first approached me about doing surgery as a third year student...he was in the office yesterday, but is in-house today. I'll ask him what he things. And, yes...it's going to be expensive, but better to do it before my deductable starts over!

About the Mirena...I found a website that had a forum...basically, women were questioning the side effects...weight gain, loss of sex drive, acne, extreme fatigue (I was wondering - since it was just progesterone, if it would have the same overall side effects as the deposhot that I hear about in clinic...sounds like it does) ...and it wasn't just a few entries....it was probably 80 or 90! I was really thinking that was the way to go. There were a few entries about the copper...some loved it and had no extra bleeding, some hated it and bled all the time. I really like how I feel being off ALL the hormones. I just need to make an appointment with my gyn to talk about all this. My husband offered to get fixed (God love him!)...lol...but we are young and only have 1 child. He doesn't want another, but I told him that anything could happen and I could get hit by a bus tomorrow and if he gets remarried it wouldn't be fair in case she wanted to have kids....well...hopefully I'll figure it all out.

 

[double elle]

One more thing.....
If, say, I find out that the clotting thing isn't an issue...that I could be on the pill or something (I HATE the pill, though!)...so, let's just say I can take estrogen...

Is there ANY way to go with the ring again and avoid the infections I had. It was garderella, which I've never had before. I knew something was wrong. I've taken the flagyl and everything's fine now. (LOL...I even sat my husband down and had the 'have you cheated on me' talk because this whole infection thing threw me for such a loop - the poor guy!) The ring seemed to be the answer to my prayers as far as convenience.

However, I have to wonder about it...if the patch - which is constant contact with the body - is releasing 60% more estrogen than originally thought.....shouldn't we be wondering about the ring...which is in constant contact with the mucosal barrier??

Yeah, this is all driving me nuts! Perhaps I should just get pregnant and forget about it!!!!!

 

[saiyagirl]

You need to see a physician and ask these questions to him/her. Do you have an OBGYN you trust?

Find one....they can do the full physical and history and help you make an informed decision.

Even though this forum is generally full of great people, the internet is NEVER the place to ask for medical advice, even if you are a doc!

 

[double elle]

You need to see a physician and ask these questions to him/her. Do you have an OBGYN you trust?

Find one....they can do the full physical and history and help you make an informed decision.

Even though this forum is generally full of great people, the internet is NEVER the place to ask for medical advice, even if you are a doc!

I guess I was hoping the information I found here would help me better prepare for that appointment. (Which it has.) Sometimes, the information helps me think of more questions to ask, depending on what others' experiences have been. I would never read annonymous text and act on it, of course.

Also, sometimes I need several "GET TO THE DOC!"s before I actually go.

 

[Sugar72]

One more thing.....
If, say, I find out that the clotting thing isn't an issue...that I could be on the pill or something (I HATE the pill, though!)...so, let's just say I can take estrogen...

Is there ANY way to go with the ring again and avoid the infections I had. It was garderella, which I've never had before. I knew something was wrong. I've taken the flagyl and everything's fine now. (LOL...I even sat my husband down and had the 'have you cheated on me' talk because this whole infection thing threw me for such a loop - the poor guy!) The ring seemed to be the answer to my prayers as far as convenience.

However, I have to wonder about it...if the patch - which is constant contact with the body - is releasing 60% more estrogen than originally thought.....shouldn't we be wondering about the ring...which is in constant contact with the mucosal barrier??

Yeah, this is all driving me nuts! Perhaps I should just get pregnant and forget about it!!!!!

The way I understand the '60% more' issue is that the basal estrogen of the patch is 60% higher, but the pill has higher peaks of estrogen and the question is which causes problems a higher baseline of estrogen or higher peaks. There are currently 3 ongoing studies looking at this question. I must say it is nice when NPR teaches more about a subject that studying for step 2!

 

[medmom]

Well, I am an ol lonely premed but I think I want to go into OB so I was lurking. Anyways, I have three kids and had my third in July (a surprise). After his birth I knew I was DONE with having kids. I got the copper IUD placed and so far I LOVE it. I am so happy that I got it. i have not had any abnormal spotting at all. The only side effect that I have had is heavy periods. Although they are heavier, they are not any longer and I have not had any cramps what so ever. I am thrilled with my decision and I would highly recommend it. Also, I have a posterior uterus and it was not a problem during the placement.
PM me if you have any questions