What next in my quest to not have babies?
March 14, 2015 5:16 AM Subscribe
If you have a mood disorder/other mental illness, and you are a person of childbearing age, what contraception do you find works best?
I've had Nexplanon for two years, and for a variety of reasons I don't feel it#s a good fit. I went to the clinic (I'm in the UK) thinking I should get a copper IUD, and was persuaded this was a good option. I've since put on three stone in weight and, more importantly, have noticed the down cycles of my bipolar disorder have been worse. It might be a trick of the mind, but when I looked up the full side effects (at the time I was just asked to sign a consent form confirming I knew it was likely to increase weight, headaches and acne) and saw things like 'depersonalisation' and 'loss of personality', it seemed to make a lot of sense. So I think it will be worth having it removed and seeing how things are without hormones. However, I have no idea what to try next. I am in a long-term relationship so it is something I need to think about. As I'm in the UK, cost is not a factor, but there are several options which I have to rule out:
The pill - i have heart disease on both sides of my family, so the doctor last time was reluctant to prescribe.
Depo-Provera - I used this in my early 20s and gained significant weight in a short period. I already take a mood stabiliser which makes weight gain likely, and I want to lose what I've put on before my health is affected.
The copper IUD - this is what I had before the implant, and I found my periods unmanagably heavy - I would bleed through clothing and developed anaemia. Oh, and I got pregnant four years in. I didn't mind the pain of insertion too much but frankly I don't want to go through that experience again.
Permanent solutions - I don't like the idea of having invasive surgery, and getting a doctor to refer a childless woman in her early 30s for it is damn near impossible. I also wouldn't want my partner to have a vasectomy in case he wakes up one morning five years later and realises he really wants children.
I know the best answer will be to talk to the family planning people, but I really wanted to hear some experiences from people who for one reason or another can't go with something hormonal. Can I feel confident using a barrier method only? Is there something new in the past couple of years which I should know about? Do I need to start thinking about getting one of those ovulation machines? Hope me!
I've had Nexplanon for two years, and for a variety of reasons I don't feel it#s a good fit. I went to the clinic (I'm in the UK) thinking I should get a copper IUD, and was persuaded this was a good option. I've since put on three stone in weight and, more importantly, have noticed the down cycles of my bipolar disorder have been worse. It might be a trick of the mind, but when I looked up the full side effects (at the time I was just asked to sign a consent form confirming I knew it was likely to increase weight, headaches and acne) and saw things like 'depersonalisation' and 'loss of personality', it seemed to make a lot of sense. So I think it will be worth having it removed and seeing how things are without hormones. However, I have no idea what to try next. I am in a long-term relationship so it is something I need to think about. As I'm in the UK, cost is not a factor, but there are several options which I have to rule out:
The pill - i have heart disease on both sides of my family, so the doctor last time was reluctant to prescribe.
Depo-Provera - I used this in my early 20s and gained significant weight in a short period. I already take a mood stabiliser which makes weight gain likely, and I want to lose what I've put on before my health is affected.
The copper IUD - this is what I had before the implant, and I found my periods unmanagably heavy - I would bleed through clothing and developed anaemia. Oh, and I got pregnant four years in. I didn't mind the pain of insertion too much but frankly I don't want to go through that experience again.
Permanent solutions - I don't like the idea of having invasive surgery, and getting a doctor to refer a childless woman in her early 30s for it is damn near impossible. I also wouldn't want my partner to have a vasectomy in case he wakes up one morning five years later and realises he really wants children.
I know the best answer will be to talk to the family planning people, but I really wanted to hear some experiences from people who for one reason or another can't go with something hormonal. Can I feel confident using a barrier method only? Is there something new in the past couple of years which I should know about? Do I need to start thinking about getting one of those ovulation machines? Hope me!
In the US, Essure is available, which essentially provides a tubal ligation without surgery. I used condoms and withdrawal for 16 years. I did get pregnant when I was 24, but that was due to not using a condom, not because it physically failed.
posted by metasarah at 5:52 AM on March 14, 2015 [1 favorite]
posted by metasarah at 5:52 AM on March 14, 2015 [1 favorite]
Is there a reason why a hormonal IUD would be unacceptable? Those tend to make periods lighter (or absent yay) rather than heavier, the hormones are more localised than an implant so tend to have fewer systemic effects, and they're far more effective than the copper ones as they have two mechanisms of action (physical + hormonal). My sexuality makes this an academic question for me but I have a friend with a Mirena who appreciates it greatly. She was unable to tolerate the side effects of oral contraception.
posted by Acheman at 6:05 AM on March 14, 2015 [3 favorites]
posted by Acheman at 6:05 AM on March 14, 2015 [3 favorites]
As a data point, the hormonal IUD gave me similar physical and emotional side effects as other types of hormonal contraception. You can always try and have it removed if it doesn't work out for you, but my body didn't seem to care about "localized" when it came to hormones.
posted by lydhre at 6:15 AM on March 14, 2015
posted by lydhre at 6:15 AM on March 14, 2015
I use a hormonal IUD (Mirena) after having had terrible problems with the pill and the copper IUD. Mirena could not have been a better choice for me. No noticeable problems, and I haven't had my period in almost three years.
posted by roomthreeseventeen at 6:18 AM on March 14, 2015
posted by roomthreeseventeen at 6:18 AM on March 14, 2015
I have a Mirena IUD that I got last summer. (I am bipolar II with GAD and PTSD.)
I went to my doctor because my insomnia was the worst around my period. I wasn't sure what options she'd suggest, and I wasn't sexually active enough to actually be concerned about the contraceptive effects of contraception (though now am glad for it).
I think it's worked out pretty well as far as being a low dose of hormones. The pill used to make me so moody.
posted by mermaidcafe at 6:19 AM on March 14, 2015
I went to my doctor because my insomnia was the worst around my period. I wasn't sure what options she'd suggest, and I wasn't sexually active enough to actually be concerned about the contraceptive effects of contraception (though now am glad for it).
I think it's worked out pretty well as far as being a low dose of hormones. The pill used to make me so moody.
posted by mermaidcafe at 6:19 AM on March 14, 2015
I was on Depo Provera for about 10 years before a doctor finally connected the dots between the shot and my anxiety/depression. I went off it about 2.5 yrs ago and have never looked back -- not being on hormonal birth control (for me) is amazing. Since then, my husband and I have used a combination of fertility awareness and withdrawal. It helps that I have a very regular cycle; I'm sure it would be harder to use this method if you don't have a predictable cycle.
I read Taking Charge of Your Fertility cover to cover. For the first year, I very religiously took my basal body temp every morning, used OPK strips (the cheap, bulk kind from Amazon) around the predicted ovulation date, and was very conservative about the safe vs unsafe days (erring on the side of a larger unsafe period). During the "you should abstain" days, we didn't abstain but instead used a backup method. For some, this could be condoms; we chose withdrawal (which can be as effective as condoms) -- this is what worked for us, our bodies, and our relationship; I wouldn't rely on withdrawal if I were not in a long-term trusting relationship with someone who was completely on board with it. Now I know I have a predictable cycle and I'm much more aware of the secondary signs for me surrounding ovulation, so I don't do the BBT anymore, but that's a personal risk assessment decision. We haven't had any need for emergency contraception thus far.
posted by melissasaurus at 6:50 AM on March 14, 2015
I read Taking Charge of Your Fertility cover to cover. For the first year, I very religiously took my basal body temp every morning, used OPK strips (the cheap, bulk kind from Amazon) around the predicted ovulation date, and was very conservative about the safe vs unsafe days (erring on the side of a larger unsafe period). During the "you should abstain" days, we didn't abstain but instead used a backup method. For some, this could be condoms; we chose withdrawal (which can be as effective as condoms) -- this is what worked for us, our bodies, and our relationship; I wouldn't rely on withdrawal if I were not in a long-term trusting relationship with someone who was completely on board with it. Now I know I have a predictable cycle and I'm much more aware of the secondary signs for me surrounding ovulation, so I don't do the BBT anymore, but that's a personal risk assessment decision. We haven't had any need for emergency contraception thus far.
posted by melissasaurus at 6:50 AM on March 14, 2015
There are different types of pill and it might be worth exploring those with your doctor as some of them work differently and your family history might not be so much of a concern. When I had a migraine, they recommended that I stop taking my combined pill and switch to a progesterone-only pill (cerezette). For me, that led to no periods at all and improved moodswings.
posted by kadia_a at 6:53 AM on March 14, 2015
posted by kadia_a at 6:53 AM on March 14, 2015
I think it's kind of telling that when doctors choose their own contraception, they choose an IUD. I am on my second Mirena and I will never, ever look back unless I have to for some reason.
There is apparently another hormonal IUD on the market now - I can't remember the name - so evidently you would have choices. For efficacy there is nothing like it, and I've not had a period in . . . seven? years. A long time. And if it doesn't work out, you can have it removed. Completely reversible.
posted by Medieval Maven at 7:27 AM on March 14, 2015 [2 favorites]
There is apparently another hormonal IUD on the market now - I can't remember the name - so evidently you would have choices. For efficacy there is nothing like it, and I've not had a period in . . . seven? years. A long time. And if it doesn't work out, you can have it removed. Completely reversible.
posted by Medieval Maven at 7:27 AM on March 14, 2015 [2 favorites]
For what it's worth, the only contraceptive that has actually been shown to cause weight gain is Depo (the shot).
Skyla is a lower-hormone IUD, but I would seriously recommend starting with Mirena. Even though it is the same hormone as Nexplanon, the fact that it isn't as systemic makes the side effects much less.
posted by aint broke at 8:58 AM on March 14, 2015
Skyla is a lower-hormone IUD, but I would seriously recommend starting with Mirena. Even though it is the same hormone as Nexplanon, the fact that it isn't as systemic makes the side effects much less.
posted by aint broke at 8:58 AM on March 14, 2015
Mirena IUD for the win. I haven't had a period in nine years. This has done wonders for bipolar 2 as some of my mood swings were related to my menstrual cycle. I have gained and lost weight over the course of my nine years, most likely related to other med changes and life stressors. I love it and will keep it until menopause if I can.
posted by crazycanuck at 10:49 AM on March 14, 2015
posted by crazycanuck at 10:49 AM on March 14, 2015
When birth control pills began causing me migraines and I finally concluded, yeah, it's The Pill, I sat my husband of many years down and said "Okay, I plan to take the rest of the prescription I have on hand. When it runs out in three months, we need to have a different form of birth control."
He volunteered to get a vasectomy. Our marriage had always been challenging and I said "Are you sure? What happens if we get divorced? Will you regret it?" Much to my surprise, he had strongly held political views about world overpopulation and he felt that the two kids we already had were all he was "due." We did end up divorced. He remarried several years ago. He's never once said anything indicating he regrets getting a vasectomy.
I suggest that if you haven't done so already, you have a heart-to-heart with your partner. This is not just YOUR issue. He should have some say in this and if he wants to volunteer to get a vasectomy, you do not have a duty to put yourself through hell to protect him from things that he may not care about at all.
My current plan, as someone who should not be using hormone based birth control, is one of the following: condoms, man with a vasectomy, celibacy, wait until after menopause. I don't know if I will add to that list at some point. I am not suggesting it should be your full list. I am just saying those are things that I feel a high degree of confidence in as viable options.
best of luck.
posted by Michele in California at 11:05 AM on March 14, 2015
He volunteered to get a vasectomy. Our marriage had always been challenging and I said "Are you sure? What happens if we get divorced? Will you regret it?" Much to my surprise, he had strongly held political views about world overpopulation and he felt that the two kids we already had were all he was "due." We did end up divorced. He remarried several years ago. He's never once said anything indicating he regrets getting a vasectomy.
I suggest that if you haven't done so already, you have a heart-to-heart with your partner. This is not just YOUR issue. He should have some say in this and if he wants to volunteer to get a vasectomy, you do not have a duty to put yourself through hell to protect him from things that he may not care about at all.
My current plan, as someone who should not be using hormone based birth control, is one of the following: condoms, man with a vasectomy, celibacy, wait until after menopause. I don't know if I will add to that list at some point. I am not suggesting it should be your full list. I am just saying those are things that I feel a high degree of confidence in as viable options.
best of luck.
posted by Michele in California at 11:05 AM on March 14, 2015
nth-ing the Mirena IUD. I am prone to lengthy bouts of existential depression and very sensitive to hormone-based birth control -- and was squicked out about the idea of having a THING inside MY BODY -- but all things considered it is 100% better than any other solution I've tried and I would do it again in a heartbeat. No moodiness or waves of feels, no period, no worries.
What doesn't work?
* birth control pills of any variety: MY EMOTIONS
* condoms: orthogonal to my long-term partnership arrangement
* the NuvaRing: sex drive evaporated and my mood was best described as dontfuckingtouchme
* withdrawl: I've had past success with it, but the slim risk of babbies right now would completely derail my planz
posted by Snacks at 1:25 PM on March 14, 2015 [1 favorite]
What doesn't work?
* birth control pills of any variety: MY EMOTIONS
* condoms: orthogonal to my long-term partnership arrangement
* the NuvaRing: sex drive evaporated and my mood was best described as dontfuckingtouchme
* withdrawl: I've had past success with it, but the slim risk of babbies right now would completely derail my planz
posted by Snacks at 1:25 PM on March 14, 2015 [1 favorite]
IUD. It's worth the side effects.
posted by Jacqueline at 3:34 PM on March 14, 2015
posted by Jacqueline at 3:34 PM on March 14, 2015
If I were you, I would have another conversation with a doctor about the safety of the pill for you. It is quite common to have an extensive family history of heart disease in your family because heart disease is so very common. Unless you have an unusual hereditary disorder, if you are under 35 and don't smoke, your chances of stroke and heart disease are probably negligible. While estrogen containing pills do increase the risk of those adverse events, even after doubling the risk of stroke, for example, studies suggest the likelihood of having a stroke is still minute. Additionally, I believe the non-estrogen containing hormonal birth control is not thought to increase the risk of stroke or heart attack, so the progesterone-only pill might be an option for you. (This article provides a decent explanation of some relevant recent research.)
However, I am not a doctor, and you are the one who has to decide on how much risk you are comfortable with. Also, there may be some factors in your personal or family history that make your situation different. But it wouldn't hurt to have a conversation with your primary care doctor or gynecologist to make sure you aren't overlooking a viable method of birth control.
posted by reren at 4:29 PM on March 14, 2015
However, I am not a doctor, and you are the one who has to decide on how much risk you are comfortable with. Also, there may be some factors in your personal or family history that make your situation different. But it wouldn't hurt to have a conversation with your primary care doctor or gynecologist to make sure you aren't overlooking a viable method of birth control.
posted by reren at 4:29 PM on March 14, 2015
I prefer Nuvaring if that is an option in the UK. Essure would also be a good option if available. it can be placed during an office visit and is similar to IUD placement procedure-wise.
posted by treehorn+bunny at 6:05 PM on March 14, 2015
posted by treehorn+bunny at 6:05 PM on March 14, 2015
This article is 10 years old, but AFAIK hasn't been disproven in the time since then: Is The Pill Playing Havoc With Your Mental Health? based on research by Dr. Jayashri Kulkarni.
Birth control pills made me suicidally depressed. I love my copper-T IUD and would honestly wear a "TEAM IUD CHEERLEADER" t-shirt if I had one.
posted by Lexica at 7:32 PM on March 14, 2015
Birth control pills made me suicidally depressed. I love my copper-T IUD and would honestly wear a "TEAM IUD CHEERLEADER" t-shirt if I had one.
posted by Lexica at 7:32 PM on March 14, 2015
Didn't see these mentioned at all yet:
Sponge: Kind of messy, may be hard to find. When I was using them, they eventually became unavailable, so I switched to a diaphragm. Not that high of an effectiveness rate, though. (Wikipedia says 77-91%, depending).
Diaphragm: Kind of messy also. I used it with spermicidal jelly. More effective than sponge. I eventually got sick of dealing with it and got a tubal ligation.
I think your best bet might be condoms, but if you want a backup, sponge or diaphragm might be useful for you.
About the surgery: it was easy-peasy for mine. They did it laparascopically, and it was at a day surgery center, not a hospital. Went in in the morning, was home by noon. Tubes hurt but they gave me good pain meds, and I was able to transition to just OTC stuff pretty soon. Two small scars (one in the belly button, not noticeable at all), and some bruising and that was it. If you are 100% sure you will never want children, you might want to consider pushing for it if you can.
My situation is also different from yours - I am in the US, and I was 37 with one child when I got the surgery, so they didn't really try to talk me out of it. They did ask me about seven times "Are you sure? Are you really really sure?" which I understand is what they have to do.
I am bipolar as well, and I found that hormonal birth control made me miserable, to put it mildly. Pills were a nightmarish disaster and made me want to die. When I decided to try Nuvaring, I was reassured quite strongly that it had hormones that were "localized, so it won't cause you any mental issues" but that was dead wrong. I became horribly unhappy and downright bitchy, everything seemed set up to piss me off as much as possible.
So I would say trust yourself and your own impressions of your mental state, if you do decide to give anything hormonal another try. If you feel "off", there's probably something going on. I know it can be hard to navigate. Good luck.
posted by megafauna at 1:44 AM on March 15, 2015
Sponge: Kind of messy, may be hard to find. When I was using them, they eventually became unavailable, so I switched to a diaphragm. Not that high of an effectiveness rate, though. (Wikipedia says 77-91%, depending).
Diaphragm: Kind of messy also. I used it with spermicidal jelly. More effective than sponge. I eventually got sick of dealing with it and got a tubal ligation.
I think your best bet might be condoms, but if you want a backup, sponge or diaphragm might be useful for you.
About the surgery: it was easy-peasy for mine. They did it laparascopically, and it was at a day surgery center, not a hospital. Went in in the morning, was home by noon. Tubes hurt but they gave me good pain meds, and I was able to transition to just OTC stuff pretty soon. Two small scars (one in the belly button, not noticeable at all), and some bruising and that was it. If you are 100% sure you will never want children, you might want to consider pushing for it if you can.
My situation is also different from yours - I am in the US, and I was 37 with one child when I got the surgery, so they didn't really try to talk me out of it. They did ask me about seven times "Are you sure? Are you really really sure?" which I understand is what they have to do.
I am bipolar as well, and I found that hormonal birth control made me miserable, to put it mildly. Pills were a nightmarish disaster and made me want to die. When I decided to try Nuvaring, I was reassured quite strongly that it had hormones that were "localized, so it won't cause you any mental issues" but that was dead wrong. I became horribly unhappy and downright bitchy, everything seemed set up to piss me off as much as possible.
So I would say trust yourself and your own impressions of your mental state, if you do decide to give anything hormonal another try. If you feel "off", there's probably something going on. I know it can be hard to navigate. Good luck.
posted by megafauna at 1:44 AM on March 15, 2015
I would not feel confident at all using a barrier method only.
In your situation, and ruling out the options you have, I would probably go with a doubled, non-hormonal protection. Depending on how much you don't want to get pregnant, you can double up just around ovulation, or you can double up all the time and, e.g., practice withdrawal or just not have PIV sex during ovulation.
Off the top of my head, the combos you use could be made up of:
condom
diaphragm
cervical cap
sponge
spermicide
withdrawal
periodic abstinence/"outercourse" based on fertility awareness
Here's a chart that might be helpful in determining what you'd like to use and how effective it would be.
posted by moira at 9:12 AM on March 15, 2015
In your situation, and ruling out the options you have, I would probably go with a doubled, non-hormonal protection. Depending on how much you don't want to get pregnant, you can double up just around ovulation, or you can double up all the time and, e.g., practice withdrawal or just not have PIV sex during ovulation.
Off the top of my head, the combos you use could be made up of:
condom
diaphragm
cervical cap
sponge
spermicide
withdrawal
periodic abstinence/"outercourse" based on fertility awareness
Here's a chart that might be helpful in determining what you'd like to use and how effective it would be.
posted by moira at 9:12 AM on March 15, 2015
This thread is closed to new comments.
posted by peacheater at 5:35 AM on March 14, 2015