What's my best option for birth control?

April 29, 2015 2:27 PM

My doctor wants to put me on hormonal birth control to help with some health issues I've been having, but I have concerns about the side effects. I'm scared and in pain. Please help me figure out my options (special snowflakes aplenty below)...

I have had two ovarian cysts rupture in the last seven months. The first time I had a cyst rupture, I was hospitalized for three days while they figured out what was going on. This time I was incapacitated for the past two days from the pain, but didn't go to the hospital because I am already in the hole $6000 for my last trip, thanks to a high-deductible insurance (I have slightly better insurance now). I currently have a copper (non-hormonal) IUD that's been there for five years. It works great, but since my first cyst my periods have been so heavy and long I've become anemic. My periods were just starting to renormalize when the second rupture happened. The ultrasounds I have had do not indicate PCOS, but recurrent cysts are likely. I'm 36, and I've never been pregnant. No plans for kids right now, but not ruling it out for later.

My doctor is suggesting a hormonal IUD like Mirena, but I am concerned that I will be one of the unlucky ones that have terrible side effects from it. I used to take birth control pills for years (Yaz), and I was a crazy, super-hormonal mess the whole time. I know with IUDs it's a lower dose, but I really don't want to risk going through that again, especially with something that is difficult and painful to remove. I also do not want to have another cyst rupture -- it's so painful and recovery takes so long for me. I'm in a very healthy monogamous relationship, and maintaining the "very healthy" part of that is important to me. Birth control side-effects were a contributing factor in ruining a long term relationship in my past.

I've checked out IUD Divas and I still feel torn. Do I have any other options? Condoms are not the answer, it's just too risky if they break or slip off (had one pregnancy scare too many to want to try that again). Barrier methods in general are not reliable enough for me. How do I make a decision? I feel like I'm backed into a corner. Do I really have to choose between having recurring cysts, awful hormonal side-effects, or unreliable barrier methods? Please tell me there is a solution I haven't thought of here.

I'm overwhelmed, scared, and in pain. I just don't know what to do. All advice appreciated. YANMD, etc. I have an appointment with my primary doctor on Monday to go over options, but I want to feel more informed when I go in, and not stress over this until then. Thank you, MeFi.

posted by ananci to Health & Fitness (18 answers total)

I just want to say that there are tons and tons of women (like me) who have used hormonal birth control (me: Loestrin) for years and years and years without trouble or side effects. It's always much easier to see/hear the folks who are complaining, and their complaints are valid, but it's not everybody. It did what I wanted it to do, I never had side effects or an accidental pregnancy, and then when I wanted to get pregnant I stopped taking them, and was pregnant two cycles later. YMMV, of course.
posted by BlahLaLa at 2:49 PM on April 29, 2015

Nuvaring is an option. It's still hormonal but you can remove it at any time. I'd ask to try something you can stop/remove quickly if you have more bad reactions before using something you need an appointment to remove. Using a different HBC may result in a different experience completely. You should still allow 2-3 cycles to get used to it and let your partner know.
posted by soelo at 2:54 PM on April 29, 2015 [2 favorites]

Yasmin gave me a blood clot, but after a ton of research, my doctor and ob/gyn agreed that even though I needed to avoid hormonal birth control, Mirena was the best choice. It's very uncomfortable going in, but it's been GREAT since then. If you don't like it or you have bad side effects, it can be removed.

MeMail me if you have more questions about it. :)
posted by wintersweet at 2:55 PM on April 29, 2015 [3 favorites]

I've been told that removing an IUD is actually easy, quick and relatively painless. (Have I been lied to yet again about another female thing?) My understanding is that the Mirena is MAGNITUDES less hormones than even the lowest dose hormonal pill. If, in fact, removing an IUD is not anywhere near as horrible as having it put in, why not try it?

Monitor your emotions closely and have a set a date and/or emotional metrics ahead of time for when you would pull it out if it's not working for you. (Metrics like "I've been crying for three days straight" or "One month to settle in to the hormonal changes" but the crying thing would override the month deadline... Whatever your limits are.) If you do try it, get your partner on board. Let them know you don't want this to harm your relationship and that you need their help and support.

Another thought: was Yaz one of those pills where the levels of hormones in it vary by the week? Those seem particularly awful to me for hormonal experiences. In contrast, the Mirena would be a steady continual dose, so there would never be a hormonal rollercoaster other than the one your body brings to the table.

I'm sorry you're suffering. It's so much harder to make these sorts of decisions when you're already in pain and scared.
posted by purple_bird at 2:58 PM on April 29, 2015 [1 favorite]

I'm not sure if (a) the IUD is causing the cysts so you need to find different birth control for that reason, or (b) the IUD is irrelevant to the cysts but your doctor wants you to try hormones to prevent the cysts.

If (b), then trying Morena and finding out how it goes would be a good idea. If (a), if you're with a regular trustworthy partner, withdrawal works pretty darn well. I used a combination of condoms and withdrawal (depending on our moods) successfully for ten years.
posted by metasarah at 3:02 PM on April 29, 2015

Response by poster: Wow, thanks for all the support and advice! Your experiences are really good to hear as well. This is helping so much to calm me down. I'm looking forward to seeing what everyone's take on this is.

Metasarah: The current IUD is not directly causing the cysts. However, as I still ovulate, it does nothing to prevent cysts from forming. Cysts happen when you release eggs, so hormonal BC that prevents ovulation would stop or reduce the risk greatly for a cyst from happening again.
posted by ananci at 3:10 PM on April 29, 2015

Mirena doesn't stop ovulation though. Which was the main reason I chose it, trying to preserve my hormonal cycle in some fashion. 12 months of spotting, occasional horrorwshow periods, then a cervical infection leading to a 'sensitive' cervix, I got it taken out. I'm on the pill now, and skipping periods since I was getting hormonal migraines around my period.

The reason we chose the pill was because it would stop ovulation and thus settle the endometriosis issues. So far so good, but it's still a bit of a crapshoot. I'll probably switch to a lower dose in the future I think.
posted by geek anachronism at 3:27 PM on April 29, 2015 [1 favorite]

I had two month long episodes of bleeding while on my copper IUD, probably from burst cysts, it gave me mild anaemia, which made me eligible for a funded Mirena. I feel kind of like I won a small lotto prize, because it had been great, my period almost completely stopped, and without the side effects I experienced on the pill (depression, loss of sex drive, etc).
From my understanding, the Mirena releases about 1/10th the hormones of the lowest dose pill, it is just better targeted.
posted by Elysum at 3:29 PM on April 29, 2015

There's a whole pile of different pills out there. Yaz wasn't for you. Definitely tell your doc Yaz wasn't for you, and why. Ask specifically how likely Mirena is to cause moodiness (I don't know. It doesn't for me, when some other HBC has, but that's anecdata). You might also ask about cost; if it's totally covered then it seems wise.

If your doc doesn't listen to you about the side effects you're worried about, then I'd be concerned about the lack of listening. Finding good HBC for you can be a pain in the ass (and may not be possible), and having a doc that listens to your side effect concerns, and explains to you how the particular pill/IUD/ring/whatever they're suggesting will help or is unlikely to cause the thing you're worried about, is priceless. Especially because it can take a few months to know about how a new method is for you, be sure to have a doc who listens to you and can be a partner in finding a good method for you.

Lastly, especially if you're worried about moodiness, I'd suggest that a trusted friend/partner/relative can help you by watching for it from the outside. My ex (who is an ex for unrelated reasons) was really helpful for me when I was trying to find a method that also let me be sane. (For me: Ortho Tricyclen was the pits, Nordette was ok for moods but not so good otherwise, Nuvaring was pretty great, but my Mirena is awesomesauce. For me, no periods, wish I coulda had that all my life.)
posted by nat at 3:33 PM on April 29, 2015

I love my Mirena as I've never loved any other hormonal birth control. But one of its known side effects -- documented in the very insert that comes with it -- is that, in some women, it can cause ovarian cysts. So I'm a little puzzled that it was suggested to you.
posted by artemisia at 4:36 PM on April 29, 2015

I got a Mirena to control endometriosis and it's awesome. I don't have to worry about taking a pill at the same time every day (or forgetting them when I travel!), and the hormone dose is a lot lower (the particular pills I was on previously were gradually turning me into a moody crazy lady; on the Mirena I feel like my normal self).
posted by Blue Jello Elf at 5:08 PM on April 29, 2015

Just to speak to the removal on the Mirena -- I have taken EARPLUGS out with more pain then I had removing my Mirena. I barely felt it. It took ten seconds, and seven of those were my doctor asking me three different ways if I was sure I understood that I would return to fertility the instant that thing was out of my body.
posted by KathrynT at 5:32 PM on April 29, 2015

I actually just had my Mirena removed because I didn't like it. (It caused a year of every-other-day spotting for me, which I finally got fed up with, but it definitely didn't cause any mood symptoms, for what it's worth.) I didn't even notice when they actually pulled it out. I've had a child, which might make things slightly different, but there you have it - it was so painless I literally felt nothing. Fast, too - I think it took all of 3 minutes from getting undressed to getting dressed again.

So having it removed if it doesn't work for you is totally an option. I really wanted to love it, but it just didn't get along with my uterus, I guess. (It did reduce my formerly heavy periods to nothing but every-other-day spotting, though.)
posted by Cygnet at 5:32 PM on April 29, 2015

It's not painful or difficult to remove the Mirena, just to add to the chorus on that. Mirena is quite different from Yaz. Yaz contains two hormones, drospirenone and ethinyl estradiol - basically a progestin and an estrogen. Mirena only contains a progestin, called levonorgestrel. The two have very different side effect profiles because of containing different hormones. For example, estrogen carries the low risk of blood clot, but progestins do not, so Mirena is a good choice for someone who has other risk factors for clots. There is also a new IUD on the market called Skyla - it's a lower dose hormonal IUD.

I can't guarantee you anything about your reaction to a different hormonal contraceptive, but I would say that it is likely that you would not have the same mood side effects if you were using a different kind of hormone. Of course some people do have side effects, but the potential benefits for many people of a birth control you never have to worry about/remember make it worth trying out.

I personally loved Nuvaring, but at the time when I switched to Mirena from Nuvaring, Nuvaring was costing me $70/month and the Mirena was free, completely covered by my insurance. So you might want to also look at your coverage since it sounds like it might not be great, but you might be surprised to find that they would cover a long acting contraceptive.
posted by treehorn+bunny at 6:21 PM on April 29, 2015

If you want a birth control that will also reduce your chance of getting more cysts, you'll want to combination oral contraception. If, however, you're concerned about the potential emotional/libido side effects, those might not be your best options.

I really like my Mirena, though I have friends who had unpleasant experiences with it. What about the Nexplanon implant? Or Skyla, which is like Mirena but lower in hormones. None of these methods will help prevent cysts, but they are highly effective, long acting, and easily reversible.

If you want to read about ALL birth control options, Bedsider is an excellent resource (though it's loading slowly for me this evening).
posted by cowboy_sally at 6:55 PM on April 29, 2015 [1 favorite]

Mirena has been a big win for me (and I had it inserted when I was knocked out for an endometriosis related laprascopy so skipped what I hear is an unpleasant insertion). I have had it for one year and have had no funky hormonal side effects although the spotting and related weirdness lasted longer than I thought. (6 months or so - not too bad, just annoying).

While I tend not to have super strong reactions to contraception, I have had hormone-induced emotional and libido swings on some previous birth control methods, and zero of either on Mirena.
posted by oneaday at 3:33 AM on April 30, 2015

Sorry to hear of your circumstances. I actually just had a 4 cm cyst rupture on Saturday and I am still recovering--I hate this. I have Mirena IUD. I also have a history of migraine headache with my periods and my gynecologist is not willing to put me back on oral contraceptives. In the past, I've been on Loestrin, Yaz, and Yasmin--and ovulated anyway, and developed cysts anyway. (And was terribly rage-y.) I'm also 36 (and have one child).

At a visit on Monday with my endocrinologist, she suggested we might try metformin, which is a drug commonly used to treat patients with PCOS--on some women, it regulates hormones and controls and/or eliminates ovarian cysts.

I do have a diagnosis of PCOS, and I have found that I really needed to see an endocrinologist to get an appropriate workup and treatment plan that went beyond birth control pills. I have other symptoms from my PCOS which the endo has treated very successfully.

Anyway, I've been super happy with Mirena. My periods have lightened, but I'm not one of the lucky ones who has them disappear altogether. My cramps are better. My skin is clear. I feel level-headed and like my normal self--on birth control pills, I felt like I had reactions that were totally out of proportion to the problem at hand, I constantly snapped at my husband, etc. Insertion was not an issue whatsoever and I anticipate that removal will be super quick and painless, too--my gynecologist is very skilled at IUDs. (That makes a big difference.)

Best of luck to you. I hope you find some relief.
posted by FergieBelle at 5:40 AM on April 30, 2015

IUDs actually do work by stopping ovulation. I read one study that looked at eggs found when flushing the tubes (or something...) and was fairly clear on that. It makes sense for the hormonal ones but i recall it was true for even the copper ones.

If you need corroborating evidence, rates of egg implantation in the fallopian tubes (ectopic pregnancy) are also reduced on IUDs which only makes sense if the eggs aren't being released to get fertilized.

If you are still ovulating (as opposed to "still having a hormone cycle, which is then interrupted in another way for real eggs but not for cysts") then that would mean the IUD isnt working for you at all, which seems odd. I'd double check if the cysts you're having are really caused by ovulation or if the idea is just to suppress them with hormones due to some other perhaps-not-understood mechanism.
posted by Lady Li at 9:41 PM on May 1, 2015