T O P I C R E V I E W
Member # 95148
posted 10-25-2013 05:04 PM
So, I went for a woman's wellness exam a few days ago. My provider and I discussed how my birth control (the pill) was going. I mentioned that I had one migraine since I started a year and a half ago. She asked me more about it, and when I described it to her my provider decided that I should not take the pill any more, even though it was an isolated incident. We are having a follow up next week, but I wanted to do some research before the appointment so I could have a better idea of what I wanted and would be able to get a prescription right away without feeling pressured to decided in a little time window.
As far as my understanding goes, it is the estrogen that can cause stroke/clot issues, correct? And my provider is concerned that I have a risk of these things, because I had my first really bad migraine while on the pill, right? So now I have two main questions, assuming that I am understanding this correctly: 1) Do you think her concern is valid? 2) What kind of options are cheap and available to me? And what options are now not available to me? Also: I am female and female bodied, do some sexual activities that do not risk pregnancy (fingering, oral, etc), and my partner and I are STI free and not having vaginal sex. I was taking the birth control for cycle control and piece of mind. I liked the pill, because I could get it for free from my insurance. And I felt like I had a lot of control over it. I liked the idea that if I started getting icky symptoms, I could stop right away with no strings attached. The one thing I didn't like about it was mild headaches that I would get while on the placebo week (not consistent though), and the fact that I sometimes had a hard time remembering to take it when I was travelling a lot. I am afraid that the other options offered to me will be more sensitive (e.i. have to take this pill at 10:00 on the dot or else!) and give me worse symptoms, since I thought estrogen was supposed to help with the negative symptoms that can come with hormonal birth control. As mentioned before, I am also worried about costs and flexibility (i.e. the ability to stop the medication if my symptoms worsen-something I can't have with something like the shot). I am also of course concerned with long-term health affects of some methods vs others (like bone density loss). I am also not sure what kinds of birth controls are NOT available to me anymore, because of the suspicion my provider has. Now that I have spewed all of that out... what do you all think?
Member # 101745
posted 10-25-2013 05:54 PM
Honestly, we can't really speak to confirm or deny a doctor's medical opinion; we can give info on birth control methods but anything that crosses the line into medical advice is outside of our scope here. So if your doctor's concerned I think it's worth listening to; if you really want to keep on with your current birth control method then you could seek out a second opinion from another practitioner.
The minipill may be an option for you: You'd have a smaller window of time to take it in, but it's still three hours, and not a matter of ten minutes or something like that. I can't speak for your insurance, but I'd imagine that if the combination pill is covered, this would be as well. But that's something you could find out either by calling your insurance or through someone at your doctor's office (sometimes staff at clinics are happy to navigate insurance stuff for patients!). Progesterone-Only Oral Contraceptives (Minipills) The main article has a run-down of common birth control methods; maybe give that list a read-through to see how some of those methods sound to you and that'll give you a sense of what to talk about with your doctor when you go in next?
Birth Control Bingo!
Member # 95148
posted 10-25-2013 06:18 PM
Thanks! I will look through them when I have some time. Could I still ask questions here about ones that I am interested in?
Member # 3
posted 10-25-2013 06:29 PM
Member # 79774
posted 10-25-2013 11:21 PM
Kabith, to answer another of your questions, it is the estrogen that's the issue. So, hormonal methods containing estrogen would be the ones that your provider wouldn't want to give you: those are the combined pill, the patch and the ring.
From the worldwide contraceptive health guidance I've seen, the position is that some people with specific symptoms - like some kinds of migraine - may be at slightly higher risk of some more serious complications from using combined hormonal methods. It's still (in most cases) a very low risk indeed, but the medically responsible thing to do and what's usually in the patient's best interests is to drop that risk entirely and find a different method of contraception that the person is happy with. It's a bit fuzzy, but the advice tends to fall on "err on the side of caution", particularly when there are other possible contraceptive options.
Member # 95148
posted 10-26-2013 06:52 PM
I am looking over these options. Here are my thoughts: -I am a type 1 diabetic, and I take a fair amount of other medication in order to manage that disease AND little problems that happen on the side as a result of my disease. Example: I take hormones due to a hypothyroid. Are any of these methods strictly not safe for diabetic women? -I am not sure if I want to go back to hormonal birth control. I gained quite a bit of weight (about 30 pounds total) while on the pill- thought that was probably not only the pills fault, the combination of that with my insulin made it very hard for me to maintain or loose weight, even with vigorous exercise and a healthier diet. -I am interested in the IUD, but I am not sure if I am a candidate. I have never been pregnant, I am 21, and I have diabetes. Do any of these things cause more risk with this method, and if so, is the risk great? If I am a candidate, what is the procedure like to have it put in/taken out?
Member # 3
posted 10-26-2013 07:18 PM
1) When you're making these choices, your healthcare provider should be considering any other medications or conditions you have. So, that's a thing they will do for you per diabetes. But in general, none of the currently available methods can't be used by diabetics overall.
2) The pill actually isn't associated with long-term of big weight gain, and what kind of gain it has been associated with is around a five-pound temporary gain when people start it. So, that's something else you can discuss with your provider, but it's unlikely your weight gain had to do with your pill. the only hormonal method that has been found to be strongly associated with gain is depo-provera (and even that, that's mostly the case for black women, pretty exclusively.) 3) Diabetics can use IUDs like anyone else, as can people who have never been pregnant. With the latter, it's just that the risk of expulsion is slightly higher than in people who have been (but is still very low), and discomfort with it or insertion is something found more in those who have not been pregnant. Per what IUD insertion is like, this is a good user-friendly walkthrough: http://contraception.about.com/od/iud/ss/iudinsertion.htm
Member # 95148
posted 10-26-2013 07:38 PM
If I were to use IUD, should I couple it with condoms? I had planned on coupling the condoms and the pills before, just because the pills have a lower protection rate with typical use. But it seems like the IUD have a very low pregnancy risk. Would coupling with a condom be excessive? (I am in a monogamous relationship, and neither of us have STI's, so I am not concerned about that).
Also, how is the removal of IUD's different from the insertions? Can you have a removal/insertion in the same day? Can you have it done at the same time as a woman's wellness exam, or are these usually done in a completely separate appointment? If so, how many appointments would a woman expect to go to before, during, and after the implant? (just thinking cost wise here!) Finally: how more invasive would this procedure feel vs a regular woman's wellness exam (e.i. pap smear?) Is it significantly more uncomfortable, or just mildly so? (If anyone has tried it, I would love to hear your stories! None of my friends/family has had this done so I can't ask anyone else!) If I do not decide to do either of these methods (the minipill/IUD), how could I couple other methods in order to have a similar risk? Would having two compatible and non-hormonal options at the same time (example: condoms and spermicide) be at a similar risk as using hormonal options/IUDs? Thanks, you guys are great!
Member # 3
posted 10-26-2013 07:53 PM
If you do or don't want to use more than one method is up to you, and there's no right answer: it's up to you and about what you feel best doing and want to do. Only you can make a call of what is or isn't "excessive," here.
I don't know why anyone would have a removal and insertion in the same day: bit confused by the question. IUDs cost around $600 -- then removals, cost, too -- so I'm not sure who'd want to spend somewhere around a thousand bucks just to try it out for a sec. But i also don't see the situation in which a removal and insertion would be happening on the same day in the first place. Again: confused. Removal is basically just insertions backwards. When you can have an insertion done per appointments is something only the clinic or provider you see can tell you: that'll depend on them. Really, with what's required appointment-wise, these are questions for an individual clinic or provider, not something we can generally answer. (But you know in our state about the repro healthcare/birth control plan for people who are not insured if you're not, yes? If not, know that you can likely get any method you want for free if you are unemployed and uninsured.) What an insertion feels like varies a lot, but on the whole, generally it's not as comfortable for people as a pap smear but either more comfortable, or around the same level of comfort, as a first-trimester abortion, if that helps. Per the data you're asking for with combining methods, I think you mean effectiveness, not risk, yes? If so, you can check that out here:
The Buddy System: Effectiveness Rates for Backing Up Your Birth Control With a Second Method
Member # 95148
posted 10-26-2013 08:01 PM
I was asking about inserting/taking out for when the 3/5/12 years is up. I am assuming that I will not want children for at least 5 years, potentially 10 years. I was also assuming that when it said it was effective for 3/5/12 years, that I just needed to take the old one out and put a new one in. Does that make sense? Is that assumption correct?
And yes, I meant effectiveness! Thanks for the link, I'll check that out!
Member # 3
posted 10-26-2013 08:03 PM
Ah, gotcha. And yep. (I was thinking *first* insertion and removal the same day, which is why my brain got all busted up about it.)
Member # 95148
posted 10-26-2013 08:10 PM
Haha yeah, I should have made that more clear! That would not make sense at all!
Thanks again for the info, and for helping me towards finding what methods are best for me!
Member # 3
posted 10-27-2013 10:42 AM
For sure. And if you want a great sexual healthcare provider, not sure where you are in the state, but because this is also where I'm at, I'm well-connected with quite a few here, and we have some GREAT ones. Just ask.