Birth control options for sad ladies

August 9, 2013 6:47 AM

New relationship, long history of depression, looking for birth control advice.

I'm 24, UK-based and have a long (12 years) and well-documented history of severe depression & anxiety. Currently medicated (citalopram), not currently in therapy but I have a good relationship with a therapist who helped me get to a really good place earlier this year and whom I trust and plan to go back as soon as I feel the need.

After ending a mostly-sexless fifteen-month relationship with my ex a few months ago, I've recently started seeing someone new, and it's both absolutely lovely and really sexual. Subject to STD testing for both of us, I'd like to be in a position to have sex without condoms (not least because my new partner has some SSRI-related difficulty orgasming, and condoms don't help with this when we're having penetrative sex), but I have absolutely no idea what my best options for birth control are.

I haven't found any hard data on this from reading around the internet. I've read plenty of anecdotal horror stories about women both with and without a history of depression experiencing negative psychological side effects with hormonal birth control, but I've also heard that insertion of non-hormonal (and hormonal too) IUDs is very painful and can cause massive period changes. My periods are pretty good right now, and I'd rather not make them worse if I can help it. I'm not dead set against trying out either of these options, or something else entirely, but I'm very, very nervous of doing anything that's going to mess with my mental health - it's been a damn hard fight to get as stable as I am right now, and I'd prefer not to take any chances.

Does anyone have any advice/information/anecdata on what I should go for? YANMD, but I don't really trust the GP I see for my meds to take my concerns seriously, and I haven't had a massively good experience at the local sexual health clinic either - if I'm going to have a conversation with one or the other of them, I'd prefer to go into it with a pretty good idea of some decent options for me.

Thanks in advance!

posted by terretu to Health & Fitness (16 answers total)

I would argue that ejaculating during penetration might not be worth disturbing your hard fought mental health. You can have intercourse with a condom and then withdraw/remove and have your partner finish another way (use your imagination). You could also have sex without the condom but use something like a Today Sponge as insurance against accidental ejaculation, and still have your partner withdraw before completion.
posted by telegraph at 6:54 AM on August 9, 2013 [1 favorite]

The pain of IUD insertion is intense, but short-lived. Most people experience period-like cramping for a while after (a couple hours to a few days). It's manageable. I honestly think copper IUDs are excellent for women who have had issues on birth control. The heavier bleeding/longer cycle generally evens out after 6 months (and some people don't have this issue at all), and it's more like a minor inconvenience than anything else. It's annoying, but compared the the side effects I had with a few birth control pills, I'm extremely happy.

The iud_divas community on livejournal is full of a lot of good information. Keep in mind that most people writing about their experiences on the internet are prompted to write by bad experiences. Happy users don't have as much reason to write, but they'll comment on people asking for experiences and anecdata.

Even though I said I had issues on birth control pills, I recently had to start taking them again for a medical issue. It took me a few different pill types (two months trial period for each type), but I found something that worked for me. The first type made me very moody, but the type I'm on now is much better and my only complaint is slightly sore boobs (likely due to a higher estrogen content).

My gyn said that people react differently to the different types of progestin, so if one isn't working for you, switching to a different pill with a different type of progestin can make a big difference.

The today sponge is another nice option. You can talk to your doctor about the possibility of diaphragms as well. There are some newer designs (not sure about what exactly is available outside the US) that are supposed to be better/easier to use than the old school bubble disc thing.

I'd say it depends on how important pregnancy prevention is for you, honestly? The failure rates are much higher for things like the sponge and diaphragms. Of course, perfect use (using it correctly, every time) keeps your chances much lower.

Best of luck!
posted by SugarAndSass at 7:05 AM on August 9, 2013

If you can get the Today Sponge, that was really the BEST birth control that wasn't the pill. Easy to use, non intrusive and reasonably priced.

You can also get fitted for a diaphram, which is another option.
posted by Ruthless Bunny at 7:07 AM on August 9, 2013

For what it's worth, my IUD insertion was a bit painful, but that pain lasted < 2 min. And the hormonal ones tend to make your periods lighter. There are lots of horror stories online, but people who don't have issues don't tend to write about that, yknow? There have been a few past threads on askme with people sharing their experience with iuds and the response tends to be positive. Maybe take a look at older threads if you want more info.

For me personally, getting an iud was one of the best decisions I ever made. I had very little pain, no moodiness, and no more periods.
posted by matildatakesovertheworld at 7:11 AM on August 9, 2013 [2 favorites]

I have a history of depression, and I did poorly with hormonal birth control pills. But the Mirena IUD was WONDERFUL while I had it. It had just enough hormones to clear up my skin. That was it. My moods, which had been on a rollercoaster ride for the last year for other reasons, were A-OK.

Pretty much everyone I know who has/had an IUD has some form of depression, and almost all of them have Mirena. They have all been very, very pleased with it. But this is anecdata from ~10 people in the US, so YMMV.
posted by Madamina at 7:27 AM on August 9, 2013

I am strictly a fertility awareness method person myself. You have to be reliable (temperatures every morning) and sensitive to your body. The Kindara app helps but you have to read Taking Charge of Your Fertility first to understand it all. I have been using this method for YEARS without issue.

I loathe loathe loathe hormonal bc, I barely lasted 3 days on it.
posted by St. Peepsburg at 7:39 AM on August 9, 2013

I've heard good things about Mirena, though I have no personal experience with it as I don't believe it was around when contraception was necessary in my life. I used a diaphragm. No hormones, no pain, no problem -- except it does have a not insignificant failure rate. If you use it along with at least some attention to fertility awareness, you should be OK.
posted by RRgal at 7:45 AM on August 9, 2013

I'm on the pill because of my PCOS--so IUDs or other methods are not an option for me.

I've tried a LOT of different pills. Some worsen my PMS, some do not. However, the best thing I did was discuss this with my psychiatrist, who changed my dosage of my antidepressants. For the 10 days leading up to my period, I take a larger dose of my antidepressant. For me, it works perfectly.

Another thing to remember if you do go with birth control pills is that just because you have a bad reaction to one, does not mean that you react the same way to all of them. Personally, I've had some pretty bad reactions to certain pills (Loestrine, I'm looking at you!), but because of health reasons it was important that I found one that works for me. I've changed pills at lot the past few years, by calling my doctor's office and speaking to a nurse, explaining my symptoms and saying I want a different pill. I never got any resistance, other than the nurse explaining that some side effects do go away after a month or so. The nurse would usually call me later after talking to the doctor with a new Rx for me.
posted by inertia at 7:56 AM on August 9, 2013

I have a history of depression - both chronic low-level and major episodes - and for what it's worth, hormonal birth control has been fine for me, and made my periods better, not worse. (Pill, then Mirena.) The Mirena IUD insertion was not nearly as bad as I had heard or feared; it wasn't a walk in the park but has been so, so worth it.

That said, there's no way to know what's going to work for you unless you've tried it, so if you do want to try hormonal, I wouldn't jump straight to any kind of implant. I'd start with the pill or the ring, something you can stop easily if you determine it's just not working out for you.

I agree with SugarAndSass that somethign like a diaphragm, sponge, or cervical cap seems like it meets your requirements best - but that has to be weighed against the relative effectiveness of your hormonal or condom options. Would an unexpected pregnancy be more dangerous to your mental stability than trying the pill? We can't answer that for you.

I so wish there were one really good "this has all the good things you're looking for and no downside" option. It sucks so hard that there isn't. Good for you for being your own advocate, and taking your own mental and physical health seriously, though. I wish you good luck and fun, protected sex!
posted by Stacey at 7:58 AM on August 9, 2013

I didn't have a long history of depression but starting hormonal BC, even though it was very low dose (Aviane), made me completely lose my shit. Initially I felt like blaming depression and anxiety on BC was a cop-out and that there must have been other stuff going on in my life, but the more friends I talked to and the more I read online, the more I became convinced my BC was at least partially to blame.

I went off the pill for almost 6 months before starting up again 1.5 months ago - I decided to give it one more shot before moving to an implant. So far, I haven't had any negative side effects - but I'm also on a very low dose of antidepressants (Wellbutrin) and making sure to take care of myself (plenty of sleep, regular exercise, etc), so we'll see what happens.

Every one of my girl friends who has Mirena raves about it - no hormonal side effects, short or no periods, etc. But the reviews online totally freaked me out - thus the last resort.

I also have a friend who just started the mini-pill - there is a risk of breakthrough bleeding on it but she hasn't had any issues so far and says the side effects are minimal to none.

And ditto what Stacey says - finding the right BC can be maddening. good luck!
posted by Bokonon11 at 8:37 AM on August 9, 2013

Also, just a plug for the largely overlooked diaphragm. Used properly (inserted ahead of time, reloaded with jelly for extra innings, etc.), it's as protective as the pill, and no hormones -- yay! Given that it can be put in up to two hours ahead, it doesn't have to be a logistical bummer, and it's simple enough for your lady-doctor to fit you for one, so worth a try before taking larger risks? Certainly worth asking about!
posted by acm at 9:14 AM on August 9, 2013

I have a copper IUD and while the pain to put it in place was pretty intense, it was only a few seconds. I say it's a fair price to pay for 10 years of hormone-free protection!

(I've heard that it helps if you get it installed during your period so you can ask your OBGYN if it's possible to have a soft appointment).

As far as period changes, mine were heavy for a year and then settled to medium. They've never returned to the 3-day super light periods that I had on the pill but in exchange, I got twice the hair and three times the sex drive. The latter alone is well worth it!
posted by rada at 10:17 AM on August 9, 2013

I tried the pill, the Nuvaring, and the Mirena, all with terrible results.

I used the Fertility Awareness Method for years until we wanted to conceive and it worked fabulously. You need discipline and a firm understanding of your body's cycles, but it is the least invasive, most comfortable method of birth control I've used.
posted by lydhre at 11:25 AM on August 9, 2013 [1 favorite]

In the UK, you can get Persona at most decent-sized Boots. Its a peeing-on-a-stick fertility awareness method that thinks for you. I've used it and I love it. (and I learned that I ovulate at a really bizarre part of my cycle! Which I might not have trusted if I'd just done temps alone.)
posted by you must supply a verb at 3:45 PM on August 9, 2013

I have had depression for years and I never went on the pill because I was worried about what it would do to my hormones. I got an IUD. I almost passed out during the insertion but that was over a year ago and it's been great. My periods have always been extremely regular and they still are but now they're lighter.
posted by kat518 at 8:21 PM on August 9, 2013

My mood was horrible on the pill. It took me a few months to realize what was making me so blue ( a few months in which I started and stopped anti-depressants before I realized that they were making me feel completely unlike myself). So I stopped cold turkey. I've been using exclusively condoms for the past two years with my boyfriend/now-husband. It's been fine. He has not found it to be an issue, and also understands that I don't want to put substances whose effects are very poorly understood into my body on a regular basis. I feel that hormonal BC is given out without enough thought about what eventual consequences might be. Seriously, take it from someone who has a graduate degree in neuroscience, we really don't understand it at all well.

I have extremely low pain tolerance so a copper IUD was not an option, plus I do want to have kids fairly soon.

I do use Plan B as a back-up in case our condom use was not ideal -- this has happened twice so far, both times in the first few months of condom use -- we've got it down to a science now. FWIW, when I decided to switch from hormonal birth control to condom-only, I brought it up with the nurse-practitioner in charge of dispensing the pills, asking if I was taking too many unnecessary risks. She just shrugged and said she's been using condoms exclusively for all 12 years of her marriage and hadn't had any issues. I know my mom has done the same for on the order of 25 years.
posted by peacheater at 2:21 PM on August 11, 2013 [1 favorite]