first birth control to try: maybe Nuvaring?

March 23, 2008 4:45 AM

Deciding on a birth control option for the first time feels dizzying -- after much research on AskMe and all over the web -- due to all the conflicting anecdotal reports with people who love or hate every option. YANMD, but do you have any thoughts based on the facts I list inside? I'm leaning towards Nuvaring.

I've been sexually active for half my life, with absolutely religious condom usage (I've never had intercourse without a condom). Therefore sex just equals condoms in my mind and I'm surprisingly clueless about other forms of birth control.

I've finally decided I want to drop barriers with my partner so much that it's worth trying a different form of birth control, even if there are side effects. Neither of us is ready to choose permanent sterilization.


- I definitely don't want to take a daily pill.

- I've never smoked, I'm under 35, and I have no other risk factors for hormonal BC.

- I've never had a UTI or other vaginal infection/irritation -- maybe suggesting I'd be less prone to these effects I often see reported for Nuvaring??

- I virtually never have cramps, bloating or emotional effects from my period -- maybe suggesting I'd be less prone to hormonal BC's side effects??

- I'd be DELIGHTED to suppress my period with continuous hormonal BC, and that's a major attraction of hormonal BC.

- I'm uninsured (I'm in the U.S.) and money is a big concern, which suggests an IUD for the significant savings; however, 1) I haven't had a baby or been pregnant, and there are conflicting reports about how much of a problem this is with an IUD, both at insertion and long-term; and 2) Mirena, the only hormonal one, is much less likely to suppress periods than continuous use of other hormonal methods.


Based on all my searches so far, my best guess is that for a few months I should try out the Nuvaring (continuously inserted, a fresh one every four weeks) to see how it fits with my two main objectives of 1) no serious side effects and 2) period suppression as much as possible.

Thoughts on the method I should try, if not Nuvaring?

(keeping in mind that 1) we recently covered the topic of period suppression and debunked some persistent myths in that thread; and 2) I'm on top of STD testing, the HIV-test waiting period, etc.)

posted by sparrows to health & fitness (38 comments total)

I think Nuvaring is a perfectly fine way to start. It's dead simple and you can easily switch to something else if you choose. However, it won't be as cheap as the pill, because it doesn't come in a generic version. If cost is a major issue for you, you may want to try a pill first... if it doesn't give you any trouble, you're good!

Do note that if you insert a fresh Nuvaring every four weeks, you'll get a bit of a hormone drop during the fourth week. In my experience, that led to some emotional stuff and spotting. ymmv. (You can do a fresh one every three weeks, but that makes it even more expensive.)

About Mirena: quite a large fraction of women (70%, I believe) using it do have complete period suppression, and many others have significantly reduced period strength/duration. That 70% number may seem low to you, but remember that other hormonal methods aren't 100%, either; lots of women end up with spotting etc. even on continuous hormones, and some discontinue use due to various symptoms.

On boards etc I've seen people arguing that doctors who won't give Mirena to women that haven't had children are behind the times, but I don't know the basis for that. Perhaps just the insertion is a bit more painful. In any case, without insurance, the Mirena + insersion would likely cost you a bunch of money -- I'm guessing it might not be cost-effective. (For me it was; after insurance I only had a $10 co-pay!)

Finally: don't be too afraid. Hormones affect people in different way, and every method has some people complaining. But none of the side effects are likely to be horrible. You'll take it, you'll keep note for a few months (do I have more headaches than I used to? mood swings?), etc. And maybe you'll have to switch, maybe not. But it's not a huge deal either way.

Good luck!
posted by wyzewoman at 5:13 AM on March 23, 2008

Thanks for that 70% statistic about period suppression with Mirena; I'd thought it was much less but I bet I got it confused with something else!

I've read that childfree women have a greater likelihood of painful and/or unsuccessful IUD insertion, and a somewhat greater likelihood of an IUD shifting position or spontaneously coming out.

(As for cost, Mirena + insertion would cost a lot up front, but still way less than a supply of any monthly method for as many months as Mirena would last.)
posted by sparrows at 5:47 AM on March 23, 2008

Depo Provera. You get a shot once every 3 months and it's effective immediately. There is a generic available, but I don't know how much it costs with no coverage applied. Places like Planned Parenthood can work out a sliding scale charge based on your income. If you're lucky like I was for 9 years, you won't have a period at all.
posted by pieoverdone at 6:18 AM on March 23, 2008

I've heard of many, MANY more problems with Depo-Provera and Nuvaring than with Mirena. I asked about Mirena last time I was in and my clinician said that Mirena is a huge help for her; she has uterine polyps that would otherwise make her bleed a lot, and Mirena takes that away almost completely. In contrast, almost everyone I know who has had Nuvaring or Depo has complained of things like four-month nonstop bleeding. I am told that the hormonal effects of Mirena are limited to the uterus (so not affecting things like emotions, etc.) and are pretty predictable.

Nuvaring can also be annoying to get used to in terms of making sure it's in place, getting it dislodged, etc.

I haven't heard of people having issue with getting Mirena inserted when childless/childfree/young; I'm 28 and unmarried, and my friend was 25 and unmarried when she got hers.
posted by Madamina at 7:40 AM on March 23, 2008

I was in a similar place to you about a year ago — weighing my options and learning what's out there these days after years of defaulting to condoms.

Nuvaring can be a really great option, in my experience. I'm one of the women for whom it was 99% trouble-free, and vastly preferable to everything else currently available. I didn't use it to eliminate periods, so I cannot speak to that, but having three weeks of not thinking about a thing related to BC was wonderful. On another plus side, it helped regulate and lighten my periods, which had been a bit wonky for a while prior to Nuvaring. No apparent emotional effects. Insertion was easy, it stayed put, and as far as the other physical logistics, my boyfriend felt it only occasionally, to a minor degree. Nothing that was a big deal to him in the slightest. The one negative I experienced concerned infections, which you mentioned. I did find myself more prone to them, but then again, I've always been fairly sensitive in that department. On the flip side of my thoroughly positive experience, I do have to throw out the obligatory YMMV — I have a friend who swears Nuvaring is the stuff of the devil due to the awful emotional side effects and constant infections she experienced. I love it though. Absolutely love it.

For me, the pill would have likely required some trial & error to find the best type, as far as minimal emotional side effects. I had enough experiences with horrible mood swings years ago, from two different kinds, that I didn't care to give it another try... even though I think they all tend to use lower levels of hormones these days anyway (?). The other issue with the pill was forgetfulness. No matter how many alarms I set for myself, forgetting one would have been inevitable. I'm a flake, bottom line.

I don't know much about Mirena, but to echo the talk above, I've also heard it can be iffy finding a doc who will prescribe/fit one with a woman who hasn't had children (?). Maybe that's not the case so much anymore.

There's also the patch; I don't know if you've ruled that one out or not.

As a total wildcard, I'd also throw out the Fertility Awareness Method, which is not the rhythm method (which, as most people know, basically = babies). It's chemical-free, which is awesome, and highly reliable when done 100% correctly. But it's also 100% dependent on daily work (much like the pill, except even moreso — taking temperatures, checking cervical mucus, recording stats, etc. at generally the same time each morning). And even then there is still a window where you have to revert to condoms (or abstain). I went to a training session on it with friends a long time ago (there is also the bible on the subject, by Toni Weschler), and found it enlightening and incredibly educational, if not a practical solution for me.

All in all, I'd suggest getting a few month's worth of Nuvarings and giving it a try! If it works for you, great, and if not, there are plenty of other options. I had been going through Planned Parenthood and paying $36 a pop; recently I got a Px through my regular doc and am paying about the same price.

Whatever you ultimately decide, good luck!
posted by sixtyten at 7:49 AM on March 23, 2008

I've also heard that MDs won't insert IUDs into women who have never had children because of the risk of infection and infertility.

Mirena does sound like a good choice for you. It's such an individual decision and like wyzewoman said, you can always switch once you discover how it affects you personally.

In addition to Planned Parenthood being a good resource for the uninsured, federally-funded Title X clinics are a little-known secret in our county. Unlike Planned Parenthood, they have to slide the cost of their birth control supplies down to $0(!!), so depending on your income, this will probably be the cheapest place to go. However, I don't know where you are; you can find the closest clinic to you here.

Congrats on being so on top of your reproductive health!!
posted by crunchtopmuffin at 7:50 AM on March 23, 2008 [1 favorite]

i wouldn't rule out a pill--i never thought i would remember to take it every day either, but if you keep it next to something you need every day (like your toothbrush) you'll probably be fine. you might need to tape a note to your bathroom mirror every day for a month to remind yourself to take it, but you'll get used to it.

also, fwiw, wal-mart has added certain generic birth control pills to its $4 generic prescription program. (probably the only service to humanity wal-mart has ever provided, but whatever.)
posted by thinkingwoman at 7:59 AM on March 23, 2008

I hated all forms of hormones, and went with a copper IUD. No trouble for 10 years, got prg on my first try when I had it removed (you want to wait a few months before trying, discuss it w/ your doc.) Most of the world has had great success w/ IUDs, I highly recommend.
posted by DenOfSizer at 8:07 AM on March 23, 2008

(I should point out that I had never had children when I had my IUD inserted, and Planned Parenthood had no problem w/ that.)
posted by DenOfSizer at 8:08 AM on March 23, 2008

PS - you are going to LOVE condom-free sex! Have fun!
posted by DenOfSizer at 8:09 AM on March 23, 2008

I am a woman without children and I have an IUD and I had no problem finding a doctor to insert it. My understanding is the concern about fertility is primarily if you get an STD, the IUD can make it work. If you're not at risk for STDs (you're in a monogamous relationship) then it's not a concern.

It did hurt a lot going in, though -- I recommend painkillers in advance and a hot water bottle on your abdomen during the procedure. My cramps are worse and periods are heavier now too. However, I still prefer it to other methods because I don't have to remember to do anything and hormonal birth control always made me moody (I have the non-hormone IUD).
posted by Jacqueline at 8:15 AM on March 23, 2008

I would warn you against trying Depo Provera until you know how you react to other forms of hormonal birth control. Though its side effects can certainly differ from what you'd get while taking a pill, it would probably be a bad gamble to try Depo if pills give you negative side effects. (Based on my experience I'd highly recommend against Depo in general, but hey... Some people might be less sensitive.)

The thing with Depo is that you can't just stop taking it if you have bad side effects. It's in your system for a minimum of 3 months (when you would normally get your next shot), whereas you can stop taking pills pretty much at any time if you find the side effects too troublesome. To make matters worse with Depo, many women (including myself) find that its side effects persist long after they stop getting shots. I was warned of this before trying the shot, and figured the convenience of once-a-quarter birth control was worth a try. I definitely regret that decision.
posted by vytae at 8:17 AM on March 23, 2008

I was incredibly unhappy with the Nuvaring, actually. I have never been prone to UTIs/yeast infections/BV but on the ring my snatch was troubled all the time. No problems since I stopped.

I liked the patch until I found out there was a weight limit. That might not be an issue for you.
posted by sugarfish at 8:27 AM on March 23, 2008

you know, i doublechecked. wal-mart doesn't offer $4 birth control, just post-menopause hormone replacement and fertility drugs. sorry. wal-mart now sucks again.
posted by thinkingwoman at 8:35 AM on March 23, 2008

This lovely summary of birth control pills was posted on a previous askme about this subject. A couple of things to consider:

Hormonal options are generally either estrogen + a progestin or a progestin only. Estrogen and progesterone (progestin) are the two major female hormones. Think of the estrogen side effects as being like the worst period you ever had, and the progesterone side effects as being like menopause.

Mirena and depo-provera are progestin only.

Dose matters. The lower the dose, the fewer and lighter the side effects.

Some women prefer progesterone only birth control to avoid the breast tenderness, mood changes, etc that come with estrogen, but since you rarely have hormonal side effects from your period, I am guessing this won't be an issue for you. Progesterone only pills are a pain to take, since you have to take them at the same time every day for them to be effective. So in general the combos are more effective.

Nuvaring basically rocks if you're one of the women it works for. It's easy to insert and you don't have to think about it. It's a combination of estrogen and progesterone, and the dose is quite low. I couldn't deal with the estrogen part myself, so I stopped using it, but the only way to know how it will affect you is to try.
posted by selfmedicating at 8:36 AM on March 23, 2008 [1 favorite]

Great comments so far! selfmedicating, thank you for that excellent chart. DenOfSizer, you put a big smile on my face. All of this research may be confusing and time-consuming, but I just have to remember how excited I am about its ultimate object. :)

vytae, I agree that Depo would be too big a commitment (also, it's the only option I can easily say I've found more horror stories and warnings about than recommendations for).

But Mirena would be even more of a commitment in a way, especially financially, if I couldn't tolerate its side effects -- I would have paid for the insertion, the device, and the removal, AND gone through the pain of insertion (I have a low pain threshold).
posted by sparrows at 9:11 AM on March 23, 2008

I want to echo someone above about trying Depo- I would suggest trying something short term first. The problem with Depo is that it is a three month long commitment- if it doesn't work, you're stuck. I refused to give up on the whole no period thing and ended up with months of spotting. With the patch (which I now happily use) or the pill or the Nuvaring or whatever, you're making much less of a long term commitment.
posted by MadamM at 9:18 AM on March 23, 2008

As others have suggested, the growing body of scientific literature on Mirena is turning the tide regarding its use in nulliparous women. A few practitioners just don't want to deal with the issue and get up to date. Other practitioners do recommend testing for STDs prior to its placement which is probably reasonable regardless, and more and more women are opting for it. It's true that without having prior births, placement of the IUD can be more uncomfortable and a fraction of nulliparous women simply can't fit the devices comfortably in the uterus. That said, once you get over that hump if you're fortunate enough to do so, the Mirena offers lots of advantages. Including a fair likelyhood that you'll stop having periods entirely within several months, and if not, you'll have much less bleeding and milder cramping. Of course, there's no guarantee about which group you'll fall into. You also achieve demonstrably superior birth control efficacy short of perhaps vasectomy/tubal ligation, in the absence of higher doses of systemic hormones (things like blood clots are still a tiny risk with the pill even without smoking and such depending on your genetics). People above are referring to Mirena as a progesterone only method, but it's worth clarifying that there's a big difference between the local release of a small dose of progesterone to the endometrial lining and taking a much higher dose of systemic hormone.

As far as the costs, if Mirena and OCPs are compared from the standpoint of pure out-of-pocket price, the IUD wins easily over the long term (even moreso if you factor in the efficacy differences and the cost of unintended pregnancy). However in the US, depending on what state you're in there are a wide variety of state programs to supplement the cost of one or both (more commonly OCPs). The easiest way to find out is probably to head to your local Planned Parenthood if you have one. The folks there usually know about the funding resources for this sort of stuff inside and out.
posted by drpynchon at 9:28 AM on March 23, 2008

At some point I was really fed up with the side effects of ortho-tri-cyclen and went to my dr to convince her to give me an IUD. Instead she recommended that I start with the nuvaring, and I'm glad she did. The lower hormone dose got rid of the annoying side-effects I was seeing with orthotricyclen, and I otherwise have had no problems with it. The only reason I would think you wouldn't try the ring first for a few months is that you are uninsured, so would have to go back to the dr if you decided it wasn't working out. BTW, one nice thing about the ring is that it has 4 weeks worth of hormones in it. I never managed to get it to stop my period (constant spotting) but I do a 4 weeks on/one week off cycle, which can save you money if cost is an issue.
posted by ch1x0r at 9:40 AM on March 23, 2008

In fairness, to complete what I was saying before, the down-sides to the Mirena are for the most part up front -- pain with insertion, and the very small but real risk of a procedural complication. If it's successfully placed, a recent study demonstrated that expulsion rates were low and unaffected by parity, and the 1-year continuation rate was also similar in women with and without prior births (and better than combined oral contraceptives).

If you're interested in wading through the medical literature, there's a recent review article in Contraception specifically on Mirena in nulliparous women. A little birdy found the full article in PDF format here.
posted by drpynchon at 9:41 AM on March 23, 2008 [1 favorite]

depo worked great for me. I mean, if you like getting a continual dose of hormones; ultimately [3 years later] I realized I preferred the mood swings.
posted by salvia at 10:02 AM on March 23, 2008

I've been on the NuvaRing for years (it was my first experience with hormonal birth control, and I stuck with it). If it works for you it's definitely worth the money. No significant side-effects, and I use it for period suppression as well, and it works quite well for me.... every four or five months my body decides to start spotting and I have to just take it out and have a damned period, but that's much better than having one every month, and the ones I do have tend to be far less crampy. I work in a male-dominated field, and eventually it occurred to me that it just wasn't fair that I had to spend a quarter of my life feeling miserable and they didn't. Anyway, I'd highly suggest you try it out and see if it works for you, because if it does the rewards are great.
posted by you're a kitty! at 10:27 AM on March 23, 2008

Glamour magazine recently ran a pretty good, and pretty informative, overview of the major methods out there, here's the link to the article, the Nuvaring's pros and cons are run down on Page 2...
posted by acorn1515 at 11:01 AM on March 23, 2008

I haven't had kids and I found someone on my first try to give me a copper IUD. They do a sounding first to make sure that your uterus is big enough, so you should know pretty quickly if it's an option. I don't want to sugarcoat it for you since I didn't really know what I was getting into: the insertion was among the worst pain in my life and the first 4 months of cramps were horrible, though the pain dropped off in the next few months as I learned how to handle it (3 advil every 8 hours and those awesome heat pads). If you get the IUD be prepared for a rough couple months since some practitioners won't remove it during that time to make sure you've gotten over that initial rough patch. Despite all this I'd still recommend it; I love the price and low maintenance.

Your experience with merina might be different; I'm not sure how the cramping would be affected by the hormones. Also, I was told I have a pretty small uterus, so my experience might be outside the norm.
posted by lilac girl at 11:08 AM on March 23, 2008

I sent a private email to the asker, but here's a less detailed explanation of my answer here, as well as my thoughts on Mirena:

Two years ago, before hormonal birth control I was exactly like the asker: stable moods, no snatch troubles, no smoking, pretty healthy. After hormonal birth control, I had cravings, moodiness, depression, low libido, snatch troubles up the wazoo, and gained twenty pounds, probably from the food cravings. I tried both Ortho Tri-Cyclin and NuvaRing. About five months ago I stopped hormonal birth control altogether, and have seen like an 80% reduction in the side-effects, though I still have them to a greater degree than I used to.

I was considering Mirena. Two things have put me off: It's progesterone-only, and I have bad enough acne as it is (less acne was the only positive effects of OTC and NuvaRing). I've heard enough cystic acne nightmares from people who have had it to scare me off. Also, it's my impression it can take up to a few months for the poke-y string to soften enough for the dude to be comfortable during sex, and I'm in a monogamous relationship where we would both be unhappy if we were celibate for that long a time.
posted by schroedinger at 11:13 AM on March 23, 2008

Also, it's my impression it can take up to a few months for the poke-y string to soften enough for the dude to be comfortable during sex, and I'm in a monogamous relationship where we would both be unhappy if we were celibate for that long a time.

That was not at all my experience -- the strings should curl up and lay flat against you, not poke at all.

I went from no hormonal birth control to using Mirena, and I love it. I had no problem finding a doctor to do the insertion. The insertion hurt like hell, but an hour later I was feeling well enough to go to my kickboxing class. I did have some spotting, but that evened out after a few months.

Copper iuds do tend to increase bleeding and cramping, but Mirena won't. The statistics that I've read said that 20% stop bleeding by the end of the first year, and 80% stop by the end of the fifth.
posted by amarynth at 11:34 AM on March 23, 2008

I switched to FAM (the fertility awareness method, which sixtyten mentioned upthread) about a year ago to get off hormonal bc. (It was this thread that convinced me, actually.) Charting every day felt a little tedious at first, but once I got the hang of it, it's become pretty automatic. So FAM might also be an option for you and your partner to consider.
posted by scody at 11:43 AM on March 23, 2008

I love my Mirena. I've never been pregnant and got it inserted at Planned Parenthood in 2005. I haven't owned or used tampons, pads, pantiliners or any other blood-collecting device since about 3 months following insertion. The insertion was more painful that I expected. I ended up going home after the procedure. The crampy pain lessened over the course of a couple of weeks, but it was bad. The string isn't poke-y at all. From the beginning it wrapped right around my cervix


Couple of things:
1) The hormones in Mirena are released locally--i.e. in the uterus, to keep the endometrial lining thin and hostile to implantation of a fertilized egg. So don't compare it with Depo. The delivery is night and day (For that matter, Mirena uses Levonorgestrel whereas Depo uses medroxyprogesterone) I'd compare it to the difference between a topical antibiotic ointment versus an oral antibiotic.
2) One of the reasons why some clinicians won't do insertions with younger and/or single and/or without kids and/or unmarried women is that having an IUD puts you at greater risk for Pelvic Inflammatory Disease (PID). PID is basically what happens with gonorrhea or chlamydia when they're not treated/cured in a timely way. The infectionhas spread up into the uterus/fallopian tube area. PID can cause scarring in the fallopian tubes, which in turn ups the risk of tubal pregnancy and/or infertility problems.
3) If you do end up choosing Mirena, go with a practitioner that does many IUD insertions. Think Planned Parenthood rather than your regular doc. They'll be better at it as well as more likely to let you get it in the first place (and you can probably get a fab payment plan).
4) Another risk Mirena has is of developing ovarian cysts. So you need to make sure you get annual exams.
5) As far as effectiveness goes, another good thing about Mirena is that you don't have to ever worry about it. All contraceptive methods have to be used consistently (every time) and correctly (according to the specific directions) to get maximum effectiveness. An IUD takes that user error out of the picture.

/sex educator
posted by Stewriffic at 11:53 AM on March 23, 2008 [1 favorite]

Nuvaring destroyed my libido, made my periods longer (8-9 days!), made sex uncomfortable and it's expensive. I've previously tried everything except Mirena so I guess I'm trying that next. For reference, when I'm not on birth control I have very regular light periods, no cramps, a healthy libido and am mentally stable.
posted by fshgrl at 12:14 PM on March 23, 2008

I always jump in these threads to give a positive Depo review (since they're always filled with negatives). I have no idea why the horror stories outweigh the recommendations, except that on the Internet, people are always 90% more likely to complain about something than praise it. Anyway, just to offer a contrasting data point, I've been on Depo Provera now for eight years (with a short break in the middle). It's been great for me. I always had horribly painful periods before, with cramping to the point of vomiting. Now I don't have any. In Australia, a generic Depo shot costs about $20, and if I go to a doctor who bulk-bills I don't even have to pay for the office visit. (And in terms of economics, think how much I've saved by not having to buy tampons for EIGHT YEARS!) When I started it, I was at the top end of the weight range that is acceptable to use it, but I've had no problem losing weight while on it. My blood pressure's always been fine. When I went off it for a few months, my period started back pretty much immediately. (Which sucked; I'd been hoping that it might take a while to come back, as I'd been warned it could.)

The only, only negative I can even come up with is a slight loss of libido, but hey, that might also have to do with, you know, getting older. Besides, I never had much libido during those five days of agonizing period either. YMMV.
posted by web-goddess at 2:44 PM on March 23, 2008

Oh! I should add the the period-suppression didn't kick in right away; I seem to remember it taking six months or so to really kick in. There had been some random minor spotting before then. I wonder if that fact is responsible for some of the negative reviews. Maybe people who are trying it get freaked out by the spotting and quit before they get "stabilized" or something.
posted by web-goddess at 2:47 PM on March 23, 2008

I'm leaning towards Nuvaring.

I've been on Nuvaring for several years, and have been very pleased with it. I'm the kind of person who often was a little early or late (usually 30 minutes to an hour of variability) with my oral contraceptives, with a weekly or so mistake (took it 8 hours later, forgot about it for a day) and doctor says that that can dramatically decrease efficacy of the contraceptive.

I have citations from BMJ, Lancet, and JAMA, metamail me if you care and I can send them to you- the journals are a little bit startling.

Nuvaring is really great- you only have to think about it once a month. You don't have cramps, but a friend of mine that I got to try Nuvaring did and had them dramatically reduced and her flow reduced by more than half. I've gotten five friends to try it (I'm a believer) and all of us have had similar reductions in volume, not to be indelicate.

I stretch mine a week longer than recommended in the literature- my GYN suggested trying it- and that's worked just fine for me as well.

I'd suggest giving it a shot for a month and reassessing. You can always try something else.

Oh! The other thing I like is that it has a relatively small pulse of hormones- it gradually leeches out hormones over the entire month, rather than the pills which give you a big spike every day because they need to get enough absorbed to be effective.
posted by arnicae at 3:55 PM on March 23, 2008

Wow, thanks drpynchon for the link to that paper on Mirena and nulliparous women! Now I've got something to tell my new doctor the next time I see her. She was surprised to hear that I had the Mirena; apparently she'd seen an ad for it the night before on TV and it was advertised as being for women who'd had children.
posted by wyzewoman at 4:18 PM on March 23, 2008

If you are interested in a Mirena IUD and your main issue is the upfront cost, check out the ARCH foundation. They're a nonprofit established to assist low income patients who do not have insurance coverage for the Mirena intrauterine contraceptive system.
posted by Violet Hour at 6:19 PM on March 23, 2008

I chose Nuvaring as my first form of HBC because I knew I wouldn't remember a daily pill and I love it because it's so simple to use. I've never been able to skip periods with it though because I end up spotting for the last week or two of the second cycle. My first month on Nuvaring, I had HORRIBLE spotting and cramping (to the point I was ready to give up on it) but I stuck with it and am glad I did. I am considering switching to Mirena in the next month or two, but only because of the monthly cost of the Nuvaring. I can't say enough good things about Nuvaring.
posted by whatideserve at 7:50 PM on March 23, 2008

Just to add another anecdote to the pile...

I was on Depo Provera for the first 2.5 years (age 23-25), and I loved it. Periods disappeared, didn't notice mood swings or acne or anything. Got off of it because I started hearing a lot about bone density loss and I didn't want to risk that, not because I had experienced any of the horrible things you read about.

Switched to Nuvaring for 8 months, and experienced periods that were very heavy, but short (4 days, but the first day would overflow my menstrual cup in a few hours). Breast tenderness. Mood swings. Libido all over the place. Anxiety that disappeared when I got off the Nuvaring. Clearly estrogen/progesterone combined birth control is not for me! However, you may love it. It's the lowest form of estrogen/progesterone combined birth control, so it's probably a great place to start. I really liked the concept of the ring and how infrequently I had to think about it. Sadly, my body didn't agree.

Got a Mirena IUD (26 years old, no kids, no hassle about it, just a reminder that insertion would hurt more because of that). It hurt a lot going in, but I forget it's even there most of the time now, 3 months later. Periods have already gotten extremely light. Haven't noticed acne or anything. Before insertion, they tested me for chlamydia and gonorrhea because those STIs can travel up the string into your uterus and the rest of your reproductive system leading to pelvic inflammatory disease and that is Bad News. The string has never been pokey. My body is quite happy to be back on progesterone-only hormones.

Since you haven't had kids, if you are considering an IUD, I would recommend going to a doctor who has done a lot of insertions before. I went to the Bay Centre for Birth Control here in Toronto, and my doctor had done hundreds of IUD insertions and had had 3 of them herself. I'm sure Planned Parenthood, etc., would also be good resources for this. I think some of the caution about inserting them in nulliparous women is that insertion is more difficult, so I would recommend finding a doctor who's used to the procedure.
posted by heatherann at 8:55 AM on March 24, 2008

I don't have a Mirena, I have the copper IUD and I would heartily recommend an IUD. Definitely get the Mirena based on your wants/needs; finding a doctor that will give you an STD screening should not be too difficult. Finding one to give you a decent insertion price may be a little more difficult, but uninsured the Nuevaring should cost more than $500 over 5 years, and that's about what the Mirena + insertion would cost.

Go for it. Once it's in (and:ow) and you get past the first couple of months of cramps and spotting (hint: use ibuprofen preemptively, not reactively) it's the least thought and effort I've ever given towards birth control. Fantastic.
posted by 8dot3 at 10:18 AM on March 25, 2008

This is FlyingMonkey's fiancee posting as FlyingMonkey. I have a Mirena and I absolutely lovelovelove it. I have friends who have had excellent luck with NuvaRing; if you don't want to go with a Mirena immediately, NuvaRing is a good choice for hormonal BC. So, chances are you'll be reasonably happy with whatever method you pick.

Mirena is definitely more cost-effective in the long run, although the initial insertion fee can be a bitch. I didn't see if anyone has posted about this or not, but the ARCH Foundation does provide free Mirenas for people who cannot otherwise afford it (at least this was true in 2005-2006...) Also Planned Parenthood might be able to help you find other resources to help you afford one if you cannot. Depending on the area you find yourself in, you might have difficulty finding a practitioner willing to insert one (although I had no trouble getting a Mirena as a nulliparous 22-year-old unmarried woman, in relatively-conservative Pittsburgh). Also, my periods have completely vanished, which is a nice bonus; all my friends with Mirena IUDs also are amenorrheic (I know it's a bit anecdotal... but I read that 70-80% of women experience a diminishment of their menstrual flow, with up to half of that 70-80% having a total loss of menstrual flow.) However, it does take a few months for your body to get used to having had an IUD jammed into it, which can be a little unsettling at first.

One final caveat about hormonal BC methods: A lot of studies are coming out which show a significant decrease in the efficacy of hormonal BC, especially pills, in women weighing more than 165 pounds or so. If you're one of these women, you might want to consider an IUD more seriously.
posted by FlyingMonkey at 7:42 PM on April 5, 2008