How to prevent spontaneous ovulation with premature ovarian failure in the mix?

June 27, 2011 8:23 PM

What to use for birth control when the pill might make it MORE likely to get pregnant?

Let me start with saying, YANMD, and I have an appointment with my gynecologist next week already, so will definitely be bringing this up at that time. However, while she's an awesome doc, she's not an expert in my particular diagnosis, so I could use some assistance in formulating my questions, and possible resources to go in with.

The backstory: About six years ago (at age 29) I was diagnosed with Premature Ovarian Failure (now sometimes called Primary Ovarian Insufficiency, commonly misnomered Premature Menopause). I went to the NIH and participated in the study, learned nothing about the cause but lots about the diagnosis. Ultimately, this wasn't a huge deal for me, since I've never wanted to get pregnant anyway. Combine that with the fact that my next major relationship was with a woman, and the whole thing wasn't a big deal at all, apart from remembering to take my hormone replacement therapy.

Fast forward until now: the relationship with a woman recently ended, and the prospect of a relationship with a man is now on the horizon. Still no change in the decision about not having kids though. The problem is this: women with POF can sometimes spontaneously ovulate, without warning. They usually find out this has happened when they realize they are pregnant. It would be VERY bad if this happened in my situation. The odds are stacked against this; however, the spontaneous "remission" rate is in the area of 10% -- a bit higher than I'm ok gambling with.

In trying to figure out what the best birth control solution is for me right now, I'm finding a bit of difficulty, as follows:
-I could switch from HRT to BCPs. But, there is wildly conflicting information out there as to whether or not the Pill will actually prevent pregnancy in women with POF. Also, I was plagued by side effects while on the Pill previously (which may or may not be pre-diagnosis POF related).
-We'd rather not be using condoms forever.
-I've never had luck when talking to doctors about IUDs, sterilization, etc. since I haven't had a child. Plus, this may just be A relationship, not THE relationship, so it seems like overkill.
-Most internet resources for POF folks are focused on women facing infertility and actively trying to get pregnant. Posing my question in some of those places feels misguided at best, insensitive at worst.

Finally, the questions:
-Can you show me resources online where I can read up and get myself educated before walking into the doctor's office next week?
-Can anyone point me to support groups/forums/etc for POF that are NOT infertility focused?
-What questions should I be sure to ask of the doctor while I'm there?
-What else am I under or overthinking here?

Private comments or questions to [e-mail]. Thanks!

posted by anonymous to health & fitness (18 answers total)

Ask for either an IUD (Mirana is extremely popular now and seems to have a lot less issue than the older copper IUDs) or implant (Implanon). If your doctor does not prescribe or administer these devices for you, say you will go to a different doctor. If that does not work, go to a different doctor, or Planned Parenthood, which will gladly administer either device.
posted by banannafish at 8:28 PM on June 27, 2011 [2 favorites]

Talk to your doctor or Planned Parenthood about an IUD. The new ones are incredibly safe and incredibly effective.
posted by Threeway Handshake at 8:33 PM on June 27, 2011

"I've never had luck when talking to doctors about IUDs, sterilization, etc. since I haven't had a child. Plus, this may just be A relationship, not THE relationship, so it seems like overkill."

Hard to tell if you have a misconception here however IUDs aren't permanent. They can be removed at pretty well anytime in your doctor's office. Removal is routine because they need to be replaced every 5-10 years.
posted by Mitheral at 8:40 PM on June 27, 2011 [1 favorite]

In your position, I might prefer the copper-T IUD to the Mirena. Mirena releases hormones, and the effect on you sounds like it might not be what you're looking for.
posted by Andrhia at 8:46 PM on June 27, 2011

"Hard to tell if you have a misconception here however IUDs aren't permanent."
There are doctors who will refuse to work with you on IUDs if you have not had a baby.
posted by bleep at 8:50 PM on June 27, 2011 [1 favorite]

You're seeing an gynecologist, right? She's a specialist in reproductive organs, so she should know the answers to your questions OR she should be able to find them out. Tell her your concerns, ask if she knows of any support groups or therapists who know of support groups etc. She should be able to answer your questions in regards to the HRT vs BCP question, and whether an IUD is appropriate given your current hormone regimen (Mirena has hormones, you don't want to be doubling up on them really). If you have doubts, get a second opinion. Maybe it would be appropriate to talk to a reproductive endocrinologist as well.
posted by eldiem at 8:53 PM on June 27, 2011

I'm not in your position, but I have tried to get an iud and been refused several times because I don't have children. I know it seems like a hassle but when you think about it, it's really not a hassle to not have to worry about it for years no matter who you're with. That said, I have less than zero knowledge of wether it would fit for you, just putting it out there that you're not the one with the misinformation, the doctors are, keep trying if that's the route you decide is best.
posted by boobjob at 8:55 PM on June 27, 2011 [1 favorite]

I'm no math whiz but - what, you're around 35 now? Once into your 30s, I don't think most OBGYNs will have an issue with prescribing an IUD for you, unless they have issues with IUDs in nulliparous women in general. I've got a whole crazy set of health issues that I won't get into, but OBGYNS have been pushing IUDs at me since my early 30s despite the fact that I've never given birth (and have no plans to, ever).
posted by chez shoes at 9:06 PM on June 27, 2011

Yeah, if your doctor refuses to consider an IUD for you because you have not had babies, FIND ANOTHER DOCTOR. You may need a general anaesthetic to have the IUD inserted and removed, because you haven't had babies, but you should be able to find a gynaecologist who is willing to do this. Even though it's more of a hassle to put in and take out in childfree women, it's still totally, totally reversible, and there is no good reason for your doctor to refuse to do it. (Not that there's any reason for your doctor to be all up in your fertility business, regardless!)

(For other non-contraceptive purposes, an IUD has been recommended to me. I don't have any children, but I plan to get pregnant in the future. It has still been recommended!)
posted by equivocator at 9:10 PM on June 27, 2011

I got an IUD pretty easy from my HMO. I know they're still not very common for women who haven't already been pregnant, but with my medical history (breast cancer and the BRCA1 gene), everybody agreed that the non-hormonal IUD was the way to go. If you're concerned about hormonal BC, and it sounds like you have every reason to be, then you should ask about IUDs.
posted by kendrak at 9:55 PM on June 27, 2011

Given your requirements, Paragard belongs at the top of your list. IUDs are not "overkill" at all. Quick office procedure, completely reversible, extremely high effectiveness rate on par with sterilization, and very nearly zero effort after that.

The American College of Obstetricians and Gynecologists announced a major change to their recommendations a week ago. They now recommend IUD (or hormonal implants, e.g. Implanon) be "encouraged" as "first-line" birth control for all women, regardless of whether they've had children or not. We're long overdue for modern IUDs to become much more common than is currently the case (in US, anyway; in Europe, they're already commonplace). IUD is the most effective, and easiest, long-term birth control method available. Over the long-run it also works out to be cheaper.

Many women have run into trouble in the past getting an provider to recommend/place an IUD, or get an insurer to cover it. Go back. The time has come to get the yes you should have had.

Mirena is indeed a hormonal method; however, since it progestin-only -- no estrogen -- and administered directly to the reproductive system, exposure is ultra-low and usually avoids most of the common side-effects we associate with the Pill. So, worth discussing with your provider whether it's a reasonable option for you.
posted by nakedcodemonkey at 10:56 PM on June 27, 2011 [9 favorites]

I am nulliparous, and I've had an IUD. It roxors.

They hurt a little going in, like stubbing your toe. They hurt like dickens coming out, like stubbing your toe really hard. Breaking my arm hurt a lot more.

The IUD with hormone (brand name Mirena in the US and Canada, called an IUS in the UK) is recommended for women with heavier periods or who have problems with cramping -- both of which can be exacerbated by the copper IUD. The hormone is much lower dose than any pill, and did not affect me (oral contraception gave me somewhat side effects).

that said, an IUS doesn't last as long as a regular IUD (5 years compared to 10), and is much more expensive outside of Europe ($400-500 in Canada, versus $75-100). The copper IUD is fine for people who don't have heavy periods/bad cramping.

I still would have an IUS/Mirena, but for the cost and the fact I'm thinking of having kids in the next 3-4 years (didn't want to pay $500 only to have it out early). I would get one even if I weren't in a hetero relationship -- it offered such peace of mind and (because I had the hormonal one) changed my extremely heavy, difficult periods into light, almost non-existent ones. (this was so wonderful - I hadn't used regular aka non-super-ultra pads since I was 13).

So if you aren't thinking of having children in the next 5 (or 10) years, I would highly recommend the nullaparous IUD experience.
posted by jb at 11:46 PM on June 27, 2011 [1 favorite]

There was a comment above stating that "you might need general anesthetic for the IUD insertion if you haven't had a baby."

This would be highly unusual. It's a pre-medicate yourself with Tylenol experience, not a general anesthesia experience (which would carry a great degree more risk), for the vast majority, unless you have severe anxiety or intolerance to pain.
posted by treehorn+bunny at 4:02 AM on June 28, 2011 [2 favorites]

This would be highly unusual. It's a pre-medicate yourself with Tylenol experience, not a general anesthesia experience (which would carry a great degree more risk), for the vast majority, unless you have severe anxiety or intolerance to pain.

I am a nulliparous woman and have neither medical anxiety nor intolerance to pain (in fact my pain tolerance is very high), but I passed out on two separate occasions trying to get an IUD (Mirena) inserted, and was told that I would probably need general anesthetic if I wanted to continue to try. It wasn't even a reaction to pain as such -- something about the process just triggered a massive blood pressure drop.

I was on oral Valium and a cervical dilator for the second experience.

(This was the first (and second) time this had ever happened for the administering NP, but it does not seem outrageously worse than the experiences of my friends, where it seems to be more like "bad but within a a couple sigmas of normal" than "outrageously unusual".)

FWIW, though, no doctor I consulted regarded my nulliparous state as relevant, except insofar as insertion is more difficult.
posted by endless_forms at 8:25 AM on June 28, 2011

IUD is the way to go. The entire process took less than 10 minutes and simply felt like a mild PMS cramp
posted by Frosted Cactus at 10:08 AM on June 28, 2011

Jumping on the Mirena train. I got one at 22, child free, with no difficulty. In fact, I was able to get it for free at Planned Parenthood. I found the experience uncomfortable, as in it felt slightly wrong, but not at all painful. It also pretty much stopped my periods. I couldn't be happier.
posted by catatethebird at 10:14 AM on June 28, 2011

Nulligravida, nulliparous here. I have a copper-T IUD and love it. Love it! I've got four or five years left on this one and when the time comes am planning to have them pull the old one and put a new one in. With luck, that one will take me into and maybe even past menopause.

I didn't find the insertion terribly uncomfortable, even though they had to do it twice; I've had worse normal menstrual cramps. (The first time it wasn't placed correctly and got dislodged within two days, so I had to go back. The second time they used an ultrasound to make sure it was in the right place. It was kind of neat: Oh, so that's what my uterus looks like!)

My periods got quite heavy for the first three or four months after having it inserted. Since then they've gotten lighter and at this point are even a little lighter than they were before the IUD.
posted by Lexica at 12:50 PM on June 28, 2011

I spent YEARS trying to find a doctor who would just sterilize me already, and only found one a few months ago. It is indeed hard. But I've had less trouble finding doctor who would give me an IUD, even though I've never had children. (And now I never will! Hooray!) The posters above are right-- if your doctor says no, find another doctor. This is a reproductive rights issue, so it's possible that Planned Parenthood might keep a list of doctors who are willing to actually let women make their own decisions (!), even if you have some reason not to go to Planned Parenthood itself. I got the name of the doctor who performed the sterilization procedure on me from an abortion clinic, so obviously people concerned about that sort of thing.

I had the essure procedure, and I must say, it kinda sucked. It was not at all comfortable, and I wouldn't be surprised if an IUD insertion was about as bad for some people. So it's possible that you'll be unable to walk three blocks when it's done and have to sleep for a couple of days, but OH MY GOODNESS TOTALLY WORTH IT. I think most people do have an easier time with it.

Tl;dr-- find another doctor. They'll give you an IUD, even if they won't sterilize you.
posted by Because at 7:59 PM on June 29, 2011