Help me pick the right birth control please.

July 18, 2010 9:17 PM

How do I find the right birth control for me?

I just entered into my first monogamous relationship and am looking for the best birth control option. The abundant information online is a bit overwhelming, so I've decided to come here. I don't know if there is an option that would contain all of the following things, but ideally this is what I am looking for...

- Does NOT cause weight gain-this is mandatory
- Does NOT affect the chances of me getting pregnant when I go off. I have no children and have no plans to get pregnant in the very near future, but I know having children is definitely something I want to do... possibly within the next 5 years- this is also mandatory
- Does NOT cause decreased sex drive
- I would be more than happy if I had fewer periods/no periods.
- Obviously the lower the rate of accidental pregnancy, the better.

A few other things about me:
- I am 22
- I tend to get UTI's, bacterial infections, and yeast infections fairly easily.
- I get pretty bad menstrual cramps, but they only last for the first 2 days or so.- I don't really care if the birth control helps with this; the cramps are manageable.
- I am a vegan. I have no idea why that would matter but just in case I would need to supplement something in my diet maybe? I don't know...
- I have no other health issues.

So far I've found that Seasonique, ParaGard, and possibly Mirena are potentially good options. If you have negative or positive experiences with these I'd love to hear.

Lastly, the main reason I would be going on birth control is so that we would no longer have to use condoms. How safe is condomless sex if I am on some kind of birth control?

posted by [e-mail] to health & fitness (27 answers total)

I was on Mircette (generic is Kariva) for 8 years and after an initial adjustment period when I had spotting for a few weeks, it was fantastic. Absolutely no negative side effects and I went from having major PMS and cramps to practically none.

The Pill is extremely effective birth control if used properly. You must take it at the same time every day.
posted by amro at 9:24 PM on July 18, 2010

How safe condomless sex is depends on whether you have both been tested for STDs. If you have both been tested and are STD-free, then your only concern would be pregnancy.

Most of the methods in combination with condoms would give you an effectiveness rate of so close to 100%, the incidence of accidental pregnancy would be negligible. Without condoms, they'll just be as safe as their own effectiveness rate.

For pills, this depends on how good you are at taking pills. I'm terrible at it.
For Paragard and Mirena, they're about good as having a tubal ligation (nearly 100%), except reversible!

I had Mirena and it was fantastic, except that the hormones did have effects on me that I never had with pills. Very mild, but it was stuff like skin breaking out and hair growth. I had it removed a few months before my wedding so that I wouldn't have to worry about breakouts on the wedding day. It was really great otherwise though and I was disappointed that it didn't work out for me. It would occasionally give me a painful uterus twinge to let me know it was there, but that part was fairly bearable considering that it cost me zero (covered completely by insurance) and I never had to remember anything for it!

If you decide not to go with IUD, I recommend NuvaRing if you don't care about expense. I find the $40 a month I pay for it well worth it for 'baby insurance'. It's easy and it works well. I can't ask for much more (aside from a hormoneless Mirena... sigh - maybe I should try Paragard someday)
posted by treehorn+bunny at 9:25 PM on July 18, 2010

p.s. Nuvaring is easy to use to skip periods, you just put in each new ring as soon as you take the old one out. This allows me to skip about once every other period or sometimes 2 out of 3 (my body won't let me do less). I leave each ring in 4 weeks.
posted by treehorn+bunny at 9:27 PM on July 18, 2010 [2 favorites]

Sounds like Mirena is perfect for you. Paragard is great (that's what I have) but my periods are definitely a lot heavier. Many people with a Mirena get rid of their period all together for that time.
posted by roomthreeseventeen at 9:28 PM on July 18, 2010

Mirena. The incidence of weight gain and other hormonal side effects is really rare, and if you do experience them, you can just take the thing out and be done with it. It will cause very light to no periods, most likely, and will definitely help the cramps. I loved my Mirena and will be getting another one at my 6 week postpartum visit (I'm currently pregnant). I have friends who continue to keep a Mirena going even after their husbands have had a vasectomy, they like the effects that much.
posted by KathrynT at 9:30 PM on July 18, 2010

Weight gain and all the other side effects REALLY vary by person. You'll probably need to try a few different pills to get it right.
posted by k8t at 9:37 PM on July 18, 2010 [4 favorites]

I have a paragard, and I love it. It meets all of your criteria, but it could make your periods more painful. It doesn't with everyone, but it definitely has with mine. If you're interested in IUDs, I found this livejournal community to be really helpful when I was trying to decide whether to get one or not.
posted by rosethorn at 9:43 PM on July 18, 2010

IUDs (Mirena, ParaGard), Nuvaring, or patch-based (e.g. Ortho-evra) are good if you're concerned about timing; you don't need to remember to take a pill every day. Particularly nice if your life isn't the same schedule every day or if you don't always stay at the same place every night.

As far as "how safe is condomless sex"-- well, that sort of depends what you want to be safe from. You +your partner(s) should of course also get tested for the full slate of infectious things before losing the condoms, and of course it's a matter of trust to keep your state the same there. If you're interested in being safe from pregnancy, various hormonal b.c.'s are quite effective when used as directed (I believe most pills report 99% effectiveness "when used as directed" and when dosed appropriately for your size-- overweight women sometimes have issues with not getting enough hormone).

BTW effectiveness is generally reported as % of couples who will get pregnant over a year of sex in which they use that method as their only method. Only you can decide what rate you're comfortable with there.

Most hormonal forms of b.c. will change your body chemistry for 1-2 months while you adjust. It is possible this will cause some (temporary) side effects; usually docs will suggest you try a new form for a while to overcome this initial starting effect and see what the longer term behavior will be.

Otherwise, side effects are really personal, and sometimes they take a long time to appear (I was on one form for 5 or 6 years before I started getting mood swings). Your best bet is to be ready to try more than one form of hormonal b.c., and to speak with your doctor about which forms are best for your particular concerns. (Although whether or not you personally get a particular side effect from a particular formulation is still just a matter of percentages, the docs have statistics on this and can tell you which pills/other forms cause which effects how frequently.)

Other than that, be sure you're taking care of your flora+fauna; cranberry juice/pills help prevent UTI, and yogurt with active cultures(eaten, if you do decide to apply it directly make sure it's unsweetened) is good for preventing yeast infections. When you start messing with your hormones it can take a little bit to settle, so it's good to do everything you can to reduce the chance of an infection for that time period.
posted by nat at 9:44 PM on July 18, 2010 [1 favorite]

Both of my good friends who were on Mirena experienced mild weight gain. Seasonique, likewise, might cause that--as with all hormonal birth control.

But really, anecdotes aren't much good for this sort of thing--side effects vary widely, and there's no telling what sort of effect a hormonal birth control will have on you until you try it.
posted by PhoBWanKenobi at 9:45 PM on July 18, 2010

Does NOT cause weight gain-this is mandatory
I would be more than happy if I had fewer periods/no periods.

These two criteria are, sadly, contradictory.

Weight gain is a common side effect of hormonal birth control.

No birth control that is not hormonal is going to affect your periods in any way.

Unfortunately, you will have to choose - risk possible weight gain, or get the possibility of fewer periods.

In terms of the weight gain, I'll say that I haven't noticeably gained weight with either hormonal method I've used (the pill and the ring) - maybe 5-10 pounds, because honestly I don't really keep track, but nothing that even resulted in a change of clothing sizes. I think I may actually have lost weight on the nuvaring.

Is it possible that you'll have some freak side effect and gain 30 pounds if you go on a hormonal form of birth control? Sure. But unless your weight gain issue is mandatory for medical reasons, I wouldn't worry about it.

If weight gain is an issue for medical reasons, I would speak with your doctor before deciding either way what sort of birth control is right for you.
posted by Sara C. at 9:46 PM on July 18, 2010 [2 favorites]

Nthing Mirena. I <3 my Paragard something fierce, but it's definitely given me much heavier periods.
posted by mollymayhem at 9:47 PM on July 18, 2010

I am here to sing the praises of NuvaRing (enthusiastic user and supporter since 2001) and warn you that getting a doctor to prescribe Mirena for you, having never given birth (more painful insertion) and being only 22, will be very difficult and pricey. I don't know what type of insurance you have, but my OB advised me during my annual (me, age 27) that it would be around $1,250 for the device, since my insurance does not cover it for people who have not had children.

But, seriously, NuvaRing. Love it, live it, enjoy every single moment of worry-free BC until I get the iCal notification to take out and then another to put a new one in, twice a month.
posted by banannafish at 9:48 PM on July 18, 2010

just wanted to add re: banannafish's comment.

I was 24 when I got Mirena and had not had any kids. Again, it was free for me, so call your insurance to check on this if you are interested in it. The whole 'no IUD for people who haven't had kids' is old news and if your OB still is on this message, find a new OB if you really want an IUD.

I doubt it was any more painful for me than for someone else whose cervix had seen a baby pass by. I took Tylenol beforehand and it hurt big time for about 10 seconds (but I am a wimp pain-wise). Totally worth it for years of peace of mind.
posted by treehorn+bunny at 9:53 PM on July 18, 2010

I'll also Nth the love of the nuvaring. My insurance covers it, so I only have to pay my prescription copay. Easy to remember, totally comfortable to wear (though I'm also prone to UTI's and have to be really careful that my hands are clean and my nails are trimmed).
posted by Sara C. at 10:09 PM on July 18, 2010

I'm really surprised to hear of skin issues and hair growth on Mirena, as most people I know (including myself) had the opposite reaction. I had had issues with hormonal birth control in the past, both skin and mood, but the Mirena had just enough hormones to help me manage those things without messing with any of my other issues. In fact, I'm really sad that it didn't work out for me (it expelled twice, after the exam, which is VERY rare, though it wasn't painful) because it was pretty much perfect all around. Yes, you're supposed to plan on having it for 5 years, but if you suddenly want to have it removed, it's easy to do so.
posted by Madamina at 10:30 PM on July 18, 2010

warn you that getting a doctor to prescribe Mirena for you, having never given birth (more painful insertion) and being only 22, will be very difficult and pricey.

Huh? Don't let this dissuade you. I don't have insurance (or kids) and managed to get my Paragard for $230 by shopping around. Mirena was more expensive but greatly varied in price depending on who I called to ask about insertion.

I agree with Sara C. in that most methods that stop/lighten your period have a risk of causing weight gain because no one, not even your doctor, can predict how you will react to different hormones. Its really a process of trial and error, unfortunately. I always think its odd that people pay more money for Seasonale when they could pay a lot less for a generic pill (providing its monophastic) and simply skip the placebos. I guess if your insurance covers brand name drugs it wouldn't matter but there are other ways to take pills and skip your period — just make sure you talk to your doctor about it first so she can explain how to do it and so she prescribes an appropriate brand.

If not gaining weight is more important than light periods you could try a Paragard IUD. If lighter periods is more important you could try a Mirena IUD or the pill. Lots of people like Nuvaring but its expensive without insurance and I don't have experience with it.
posted by Bunglegirl at 10:36 PM on July 18, 2010

I bought a mirena for $225 at a Canadian online pharmacy. Mind you, when I received it, I was disconcerted to find its packaging was in Turkish!
posted by leahwrenn at 11:00 PM on July 18, 2010

Weight gain and decreased sex drive are both possible side effects of any form of hormonal BC. But there are some people who don't have either, or who have them in very minor amounts, and it depends on which hormones you're on. Similarly they tend to cause shorter, less painful periods. Some people see mood issues although those are uncommon and tend to go away, at least from what I've heard / experienced. Unfortunately it varies so much by person that we won't be able to tell you one particular variety that will avoid those side effects for you.
posted by Lady Li at 11:13 PM on July 18, 2010 [1 favorite]

Copper-only (no hormones) IUD for the win!
posted by Jacqueline at 11:48 PM on July 18, 2010

If you're prone to yeast infections, that might be a contraindication for NuvaRing. Check with your doc about it.

I had an IUD inserted prior to giving birth with no problems, so perhaps it's a matter of finding the right doctor. It was painful and caused some brief but severe dizziness, but worth it.

I haven't experienced weight gain while on hormonal birth control, but it is a common side effect. Like others have said, it could take some experimenting to find the right hormone profile. You may want to browse this chart.
posted by emkelley at 4:48 AM on July 19, 2010

i think the most important thing to accept upfront is that no BC is perfect. I was very frustrated recently when my Paragard didn't work out and I felt like I was running out of options (I didn't like Nuvaring, didn't like the pill the first time I took them, etc.) Just try what sounds the best and remain openminded- you might not like it as much as everybody else seems to, and then you'll have to switch to something else.

My personal experience with Paragard: Obviously the biggest pro for IUDs is effectiveness, and not having to remember anything (or keep paying for it.) I chose Paragard over Mirena because I was all anti-hormones and figured the period thing wouldn't be a big deal. Well, my periods gradually got longer, crappier, and closer together. By the time I'd had it for 3-4 years, I was getting cramps and spotting after intercourse and it all just became really uncomfortable. I was convinced that I could feel it in my uterus. They say you don't feel it, but I am pretty sure I could. Anyway, this sort of stuff must be highly variable and depend on your uterus and personal sitution (I have a backwards uterus and a well endowed partner, so anatomy just might have been working against me.) But I couldn't take it anymore so I had it removed and went onto LoSeasonique while I waited for my symptoms to improve and thought about my next step. My doc suggested a switch to Mirena, but I am hesitant to put another thing in my uterus since I was sure it was making me crampy before. LoSeasonique is working out better than I expected, except for the obvious drawback of having to take it every day. But my body feels better than it did before, so I guess it's worth it. Also I didn't realize how bad my periods really were until I stopped having them- now I don't think I could ever go back!

I wish IUDs weren't so big. They should make a Mirena lite that's like, the size of my thumbnail. I wouldn't mind getting that switched every 2 years. Or they could make a squishy round one that's like a cross between IUD and Nuvaring . . . that'd be great. But I digress. Anyway, don't underestimate the value of convenience and saving money- I hated that I had to go to the pharmacy every month and shell out 50 bucks for Nuvaring when I was on it. I was broke and uninsured at the time so it really got to be a drag. IUD was a nice change from that. But now my BC is covered, so being on the pill doesn't feel like such a drag as the Nuvaring did. Circumstances change and sometimes it turns out that what's inconvenient one year is ideal the next.

Point of the story- none are perfect, so whatever you settle on, don't decide that its going to necessarily be the best one for you just because it seems that way on paper. Keep an open mind and hopefully it will work out, but if it doesn't, don't be afraid to admit it and switch to something else. You might be surprised. I really never thought I'd be on the pill again but here I am. It was hard for me to give up the IUD because in my mind it was the perfect solution- but I couldn't deny anymore that it was making my body feel like shit.
posted by lblair at 6:24 AM on July 19, 2010

err . . . just to clarify above, I am not trying to knock IUDs. They have a great reputation and are a great solution for tons of people. I'm just trying to make the long point that YMMV and don't get your heart set on any 'perfect' solution because it's different for everybody.
posted by lblair at 6:28 AM on July 19, 2010

It's so true (and frustrating) that there's no perfect birth control.

You should probably stet by checking out what your insurance covers.

I'm a huge fan of IUDs. IF your insurance or financial situation permits, this is what I would do (pretty much have done):

Start with the non-hormonal iud. Heavier crampier periods is a relatively common side effect but NOT universal. I'm so jealous of my friend who didn't get that!

If the periods drive you crazy (or if you don't feel up to the 3+ months adjustment period your body might need), swith to the mirena iud. Give that at least 3-6 months and see whether your getting the bad hormonal side effects. These are much more rare than heavier bleeding on the regular iud. I'm so relieved that that's working out for me so far.

If that doesn't work, you're on the pill roulette game. Most people have side effects on the pill, most people can find at least one formulation of the pill that doesn't cause them bad side effects, and there is absolutely no way to know which pill will work for you except trial and error (though the MDs do know which are most likely to help your skin). Maybe the 1st one you try will work!

Enjoy!
posted by Salamandrous at 6:42 AM on July 19, 2010

I wish IUDs weren't so big.
They do make small IUDs, frameless IUDs, etc. but they're not available in the U.S. (aka not FDA-approved or lobbied for by big pharma).

I should clarify that the $230 I mentioned above for my Paragard included the device ($90), STD tests (free at the city health center!), initial consultation ($40), insertion ($100) and follow-up (free). Planned Parenthood is not always the cheapest option (they quoted me $800 - it varies by location) but usually much cheaper than a typical gyno who is used to charging back to insurance. It pays to do your research. Even at $800 it would be much cheaper than paying for pills or rings every month in the long run if an IUD works out for you.
posted by Bunglegirl at 8:14 AM on July 19, 2010

I am a vegan. I have no idea why that would matter but just in case I would need to supplement something in my diet maybe? I don't know...

If you're taking a pill, it might matter, because most pills contain lactose as an inactive ingredient. There are partial lists of pills that might be lactose-free in various places on the internet, but because they might be out of date, it's best to consult a pharmacist or your doctor.

The other issue wrt veganism and hormonal birth control is that practically all of these products would have been tested on animals.
posted by thisjax at 9:01 AM on July 19, 2010

Thanks for the info about smaller IUDs . . . I wonder if they are coming here anytime soon.

Just wanted to chime in and agree with Bunglegirl about shopping around, especially with Planned Parenthood. I went to one in Chicago first and they quoted me around $500 for the Paragard. So I took a little road trip to Iowa to visit my parents and got it done at a Planned Parenthood there for around $100.
posted by lblair at 9:10 AM on July 19, 2010

Thanks for all the information. I have an appointment to talk to my doctor tomorrow. You've all been super helpful!
posted by [e-mail] at 7:21 AM on July 20, 2010