Birth control woes!
May 15, 2010 11:07 AM   Subscribe

Birth control woes! My girlfriend suffers from migraines with auras, has rather heavy periods that sometimes leave her anaemic and require opiate painkillers, which means she is basically screwed for all the birth control options I can find. Ladies in this situation, have any tips?

Condoms work fine for us, but their efficacy makes me a little nervous. I've made sure I know exactly what I'm doing, but mistakes still happen. The big issue is we pretty much can't have kids until a few years from now if that's what we decide, assuming we're still together (all metrics point to a solid yes =D).

Anyway, she tried the Nuva Ring, but pulled it out after two weeks of horrible side effects. It exacerbated other conditions, especially gastroinestinal stuff, it was bad news. It was also an NP who gave her the Nuva Ring, but when her gyn caught wind of this, told her NOT to use hormonal birth control again since she could have a stroke. IAMNAD, but her gyn is extremely old (late 70s) and might have out dated information. Or not, just checking all sides.

That leaves IUDs. A copper one will make her periods worse, which is a no no considering how bad they are now, and I have no clue about the Merina IUD. I know the hormones are supposedly localized, not sure what that means for migraines and stroke risk.

Though, even then, that is probably out. I mentioned IUDs to her before, and she said she didn't want one because she wasn't comfortable with something she couldn't remove herself. I'm certainly not questioning this, it is her call and while it seems a little extreme to me (considering you can have it out pretty quick with an NP or gyn's help), I also don't have a uteris that would have foreign objects shoved into it, so.

I admit that I somewhat selfishly was/am hoping for a solution that allowed me to stop using condoms, but that no longer seems to be an option. I'm now considering condoms + some other mechanical birth control method, no clue about those though. All sorts of crazy membranes and caps and stuff, I need a cheat sheet =D.

I am also considering just getting a vasectomy and having some sperm frozen (not too expensive for 3 samples, will probably double up at least). I was also considering getting one before I met her, so this isn't a result of being sexually active.

Note, I am leaning towards not wanting kids, but I options are nice.

So, men and women who are in a similar situation, what do YOU do? Also, if the Merina is viable, some thoughts from ladies using it would be nice. I'm not going to nag her or anything, I just want her to have all the information and some anecdotes (positive or negative) to go on. Probably won't make her any more comfortable with it, but just in case, I'll deliver the information to her with the disclaimer that I'm not trying to 'get' her to use it - just making sure she's sure, but let's just say I've mostly written the Merina off.
posted by anonymous to Health & Fitness (39 answers total) 2 users marked this as a favorite
An ex of mine who had hormone problems with all BC had no issues at all with Mirena, save occasional and unpredictable (but light) spotting. This killed oral sex for me, but it's an option.
posted by rhizome at 11:19 AM on May 15, 2010 [1 favorite]

I've never heard that migraines are a contraindication for hormonal birth control- some googling tells me that some doctors won't prescribe them because of a slight increase in stroke risk. In any case, she should consider getting a second opinion from another gynecologist. From what I understand, and from my experience, getting birth control right is a matter of trial and error. Hormones are a complicated business and vary wildly from person to person- if she wants to try hormonal BC, she should be ready to try a variety of options before she finds the right thing.

One thing: I hope that this is obvious, but if she decides that she doesn't want to go on BC for whatever reason, don't pressure her. Her right to decide what to do with her body trumps your desire to not use condoms. You seem to be aware of this, but make sure you aren't accidentally putting pressure on her by getting involved in the research process.

And one more thing, sorry: a lot of people on Mefi have had awesome experiences with the Mirena, but I am one of those people (like your girlfriend) who is seriously squicked out by the idea of having something implanted in my body. If she is really, really opposed to the idea, any number of positive anecdotes are not going to convince her.
posted by MadamM at 11:28 AM on May 15, 2010

I'm dealing with the same thing right now, except I don't have auras, which makes things more flexible for me. Basically, she shouldn't take anything with estrogen in it, which rules out the NuvaRing and most hormonal birth control options. However, I believe she can take progestin-based birth control. I think that includes the Depo shot and Implanon, as well as a few brands of pills. She could also go for a diaphragm.
posted by emilyd22222 at 11:29 AM on May 15, 2010

I am a former semi-regular hormonal migraine person who has had the Mirena for 3 years. I really can't express to anyone who will listen how much I love it. Aside from what I would call semi-quarterly breast tenderness, it's like I don't have periods anymore at all. In three years I have gone from missing work about four times a year due to migraines to one that I can remember.

Prior to the Mirena, I had been on oral BC for close to 10 years. I'd been pleading with my GYN for another option, and due to one reason or another (don't get me started, but I thought about a lawsuit) got the Mirena after a shake up at the practice and a new young fresh out of school GYN saw me. She was horrified (as was my new GYN) at how long I'd been on the pill with migraines and confirmed the increased stroke risk.

Other notes - they occasionally balk of you haven't had kids, but I never have nor do I plan to. In fact, I'm hoping that the day they remove mine they'll just be putting a new one back in. I really am that happy with it that I wouldn't plan on swapping out until I go through menopause. And as for having something put inside me, there are weeks that go by that I completely and totally forget it's there. As in "oh hey, maybe I'd better check and see if I can still find the strings" forget. It's really gone from a monthly "OMG I'm dying" to that much of a forgotten part of life.

I know that I'm a random stranger on the internet, but if anyone ever has any questions about it that they're not comfortable putting online, feel free to me-mail me. Really - LOVE IT.
posted by librarianamy at 11:42 AM on May 15, 2010 [2 favorites]

Well, I feel for you.

It took me eight years of use to figure out that birth control was making me bloated, depressed, and giving me high blood pressure (in a nutshell). My doctor has encouraged me to try other kinds of hormonal birth control, but I've been on five or six at this point and am pretty much sick of the whole pill switch side effects rigmarole, and so we're just using condoms.

There's already tremendous pressure on women in our society to rely on hormonal birth control. I didn't full realize this until I tried researching alternatives. I looked into IUDs, but my insurance wouldn't cover it and my doctor would only insert a Mirena (and then only if I were married--uck. I was engaged at the time, but still.) I was more interested in a Paragard, but that wasn't even an option she'd consider. It doesn't sound like it's an option for your girlfriend, either.

So I asked about cervical caps, and found that there's only one brand available in the US and it can be difficult to find doctors who will prescribe it or pharmacies that carry them. Ditto for diaphragm; I visited two doctors to ask about barrier methods, and neither do fittings or prescribe them any more because "women are fine with the pill." Ugh. There's also the Today sponge. I haven't tried it because the website warns that those who are allergic to sulfa drugs (me!) can't, although people on metafilter have questioned the validity of that. All of these methods should be combined with spermicides for maximum efficacy (the sponge has a spermicide built in)--usually nonoxynol 9 for the diaphragm or the cap. Many people are sensitive to this spermicide, myself included. Anyway, I pretty much gave up and resigned myself to condoms after that. However, I know some women who have been very happy with barrier methods, particularly when combined with condoms. Your girlfriend sounds like she might be one. I'd consider visiting Planned Parenthood to discuss options with them. From what I've heard, they're better about prescribing alternative methods to pills than other doctors.

My husband and I have been much happier since we've found a condom brand that we really like. For us, it's all about Lifestyles Lubricated Ultra Sensitive. You should try many brands to make sure you're using one that's comfortable and fits you well. This will help with compliance (actually getting yourself to put them on) and effectiveness (using a condom that's too big or two small increases chances of slippage and breakage). Your girlfriend also might consider combining condoms with charting. Taking Charge of Your Fertility is pretty much the bible of charting. If I were in your position, I'd probably choose to abstain from vaginal intercourse during my girlfriend's most fertile period, and use condoms the rest of the time, since you really don't want to get pregnant right now.

When it comes down to it, though, you really do need to respect her comfort level. If she's reacted strongly to hormonal birth control in the past, and wants a minimally invasive type of birth control that she can choose to stop using herself, an IUD probably isn't the right choice for her, even if you might want it to be.
posted by PhoBWanKenobi at 11:45 AM on May 15, 2010 [7 favorites]

The mirena rocks, and it might actually help with her anemia issues (I use the mirena, and have a friend whose gyn recommended it because of her heavy periods/anemia). I hate the pill because of the side effects but haven't had any of same with the mirena.

This doesn't help at all with her resistance to a method she can't remove herself; that's something she needs to work out with her doctor (and you). With lots of methods (except barrier) there may be some lag time after going off it before you can get pregnant, so maybe that's something to think about. As in, it's not like these things all have an on/off switch. The question is why she'd be resistant to a visit to the doctor if she decides to go off a certain form of birth control. (Which you said you wouldn't harass her about, and that's right, but I think it's fair to have a non-demanding conversation about it.)

IANAD and feel somewhat hesitant about chiming in here, as the mirena IS hormonal BC and if stroke is really a possibility for her, and this would exacerbate the risk, that's obviously something to consider. She might just want to get a second opinion, though, as the hormonal effects of the mirena are very small.

How does she feel about the efficacy of condoms? Have you talked about what she would do if condoms failed? All forms of birth control have pros and cons, so maybe you could sit down with her and just make a list of those. For me, the cons of the mirena have been just about zero, but that's going to vary from person to person I suppose.

Good luck to you.
posted by torticat at 11:47 AM on May 15, 2010 [1 favorite]

Anecdotally, both the combined Pill and the minpill gave me epic auras... but the minipill only did it after I accidentally took two one day, after which I reliably got a migraine *every night* within an hour of taking it.

It sucked, we went back to condoms, and Mr. F got a vasectomy-- which I can't recommend for you, as you do appear to want biological children. You can't be 100% sure that your sperm samples will hold up (shit happens, technicians are human). You need to be very certain that the chance of not making your own babies, ever, is OK for you and any longterm partner you have.
posted by fairytale of los angeles at 11:55 AM on May 15, 2010

I think you should get that vasectomy - that is the only way you can be sure and not put the burden of birth control on her. Not to be cynical, but I would also look at her problems finding birth control vs her desire to have children and check you're on the same page.
posted by meepmeow at 11:59 AM on May 15, 2010

Nthing the Mirena, I love it and haven't had an actual period in years (I'm the happiest girl in the world)! I'd say it's definitely worth looking into.
posted by That's Numberwang! at 12:00 PM on May 15, 2010 [1 favorite]

Hormonal birth control need not be completely ruled out based just on a history of migraines. In some women, like me, hormone fluctuations can trigger migraines. My gynecologist prescribed Seasonique for me, not for birth control, but as a way to get my migraines under control. Unlike most versions of the pill, which have 3 weeks of hormones and then a week of sugar pills, Seasonique has 3 months of hormone pills with one week of pills with a lower dose of hormone. This decreases the hormone swing that comes with traditional BCPs, and has helped to keep my hormone levels more consistent, which has nearly eliminated my migraines. I think it's worth asking her OB/GYN about this option, however, it is not a common use for the drug and if you suspect he isn't keeping up on new information, he may think you are crazy for even suggesting it. A second opinion might be worth it, if it will give you a reliable birth control option which would also keep her migraines in check! Good luck!
posted by pupperduck at 12:30 PM on May 15, 2010

Arrrgh. Your GF needs a new GYN; when she's in a position to need the latest and somewhat specialist advice on birth control, why is she seeing an old-school healthcare provider?

Also, if you're worried about condoms being an effective enough form of birth control, you should not be ditching condoms for the pill, you should be using the condom AND the pill (or condoms and another form of birth control.) Really, look at the effectiveness stats and do the math.
posted by DarlingBri at 12:31 PM on May 15, 2010 [1 favorite]

I gave up on hormonal birth control about four years ago due to side effects, and for some reason just viscerally didn't want an IUD, so my boyfriend have used the Fertility Awareness Method ever since (Taking Charge of Your Fertility is the go-to book on the subject). It takes a little time to learn (and requires daily commitment on her part to chart her fertility signs), and you will either have to use a backup method of birth control or not have vaginal intercourse during her fertile "window," but if you're both willing to make it work, it can be a great option.
posted by scody at 12:36 PM on May 15, 2010 [2 favorites]

Estrogens have been implicated in stroke and other cardiac risk more than progestins, from what I have heard and read. She should not rule out Mirena or Implanon (which are progestin-only) until she's sure that it's not just the estrogens giving her trouble. I would have her talk to a neurologist or cardiologist if she can about what birth control would best minimize her risk of migraine and stroke.

Here is what I would do if I were her- I would request the lowest dose progestin pill available, and try it for a couple weeks to see if the side effects are less than combined hormones like those in Nuvaring. She should chart her migraine symptoms at the same time. If it doesn't work, she knows she will have control and she can stop any time. If the progestin-only pill worked, I would ask about either Implanon or Mirena, because their efficacy is superior to just about anything else on the market, on par with surgical sterilization. I understand that she's afraid of not being able to stop the side effects with an implant, but doing the pill trial first should help her know in advance if it's going to work, and she can also get reassurance from her doctor that she can get the implant out with an emergency appointment if she needs to. Mirena and Implanon are lower dose than any pill, patch, or other hormonal method out there, and they should have the least side effects.

Barrier methods like caps and diaphragms are not that much better than condoms when you take user error into account. If you have a backup plan that you talk about as a couple for unintended pregnancy, and you can tolerate the risk and hassle of barrier methods, go for it. Yes, you should not pressure her, but she should not be forcing you to live with a higher risk of pregnancy than you are comfortable with until she has ruled out every option for her for a good medical reason, not just squick factor.

So someone needs to compromise here. Trying an implant involves some risk on her part. A vasectomy involves some risk on your part. An abortion would be alot more risk than either of those. You need to decide together what you're comfortable with.
posted by slow graffiti at 1:08 PM on May 15, 2010

Also, her physician is not just an old, outdated fogey. By warning her about Nuvaring and stroke, he is in fact in line with current recommendations by the World Health Organization. From a meta-analysis:

The use of oral contraceptives (OCs) confers an increased risk for ischaemic stroke (IS). This risk slightly decreases, but remains significant, if low-dose formulations are used, particularly if other risk factors, such as hypertension or smoking, are associated. Some inherited prothrombotic conditions (e.g., Factor V Leiden, G20210A prothrombin or methylenetetrahydrofolate reductase C677T polymorphism) could also greatly increase the IS risk if present in OC users. Migraine, particularly with aura, is an independent risk factor for IS, and the patient's IS risk is probably affected by other individual risk factors (e.g., age, genetic predisposition to thrombosis, presence of patent foramen ovale or enhanced platelet aggregation) which seem to be over-represented in migraine patients. IS risk among migraineurs is further increased when OCs are currently used and can become very high if associated with smoking. Consequently, in 2004 the WHO stated in its 'Medical Eligibility Criteria for Contraceptive Use' that women suffering from migraine with aura at any age should never use OCs. Moreover, since the exposure to the effects of OCs may greatly increase the IS risk in some migraine subpopulations with specific personal characteristic, testing for these risk factors may allow for more accurate stratification of the population at risk before long-term use of OCs is prescribed.

However, this was a letter submitted to the British Medical Journal saying that Implanon and Mirena are acceptable alternatives:

In her editorial on migraine with aura and increased risk of ischaemic stroke, Loder suggests that a blanket ban on oestrogen-progestin is hard to justify because they are the most effective forms of birth control, including for women with migraine with aura.1 Guidance from the UK Faculty of Sexual and Reproductive Health Care has advised that this method of contraception presents an unacceptable risk to a woman’s health since 2006. Several other highly (and more) effective methods are available to women with a reduced risk of user failure—namely, the progesterone implant (Implanon), the levonorgestrel containing intrauterine system (Mirena), and copper containing intrauterine devices. These should be offered to women with migraine with aura, and combined hormonal contraceptives should be avoided.
posted by slow graffiti at 1:36 PM on May 15, 2010 [2 favorites]

She should talk to a neurologist about what the increased stroke risk really means and then make her own decision. If the OB-Gyn flat out won't prescribe her birth control, a note from the neurologist will take care of it.

That being said, I personally suffer from migraine with aura and - like your gf - horrible debilitating periods that require opiate painkillers (for the menstrual migraine though, not for cramps). I had a mirena for 7 years. I had it removed because I was freaked out that it could be making my migraines even WORSE (they were already bad and making them worse is a common side effect of hormonal BC).

Having it removed was a mistake. When I had it in, my periods were incredibly light, lasting like seriously just one day. Additionally, I suffered no PMS/cramps and NO menstrual migraines at all. I didn't even realize I got menstrual migraines until I had the damn thing removed. Now I am resorting to using condoms with my HUSBAND of all people - which seems like a shitty and cruel joke. I actually intend to get a new Mirena next month.

Anyhow, to address some of your gf's concerns: I'm not going to lie. Having the Mirena inserted is an incredibly painful experience. It easily will outrank even the worst migraine pain you have experienced. HOWEVER it only lasts for about 20 seconds and then it is over, and you don't have to think about BC again for 5 years. Having the Mirena taken out is a piece of cake! No, you cannot remove it yourself, but all it requires is literally a 5 minute office visit. It's kind of reminiscient of removing a tampon: they just go in there, grab the string and yank it out. And then you are on your merry way.
posted by sickinthehead at 1:59 PM on May 15, 2010

Different birth control pills may or may not cause migraines. I get migraines and got many more on Nordette. The doctor switched me to Levora and I hardly get them anymore; they're usually stress induced when I do get them.
posted by IndigoRain at 2:29 PM on May 15, 2010

(Pardon, that was supposed to be Mircette, not Nordette.)
posted by IndigoRain at 2:29 PM on May 15, 2010

I'm with Darling Bri about doubling up on birth control methods if you're worried about condom efficacy. Diaphragms are still available, you just have to find a gyn willing to fit your gf with one and prescribe it. Using a diaphragm in conjunction with condoms should decrease her likelihood of pregnancy by quite a bit. Cervical caps are out there too, they're just harder to find.

And yes, the migraines with aura pretty much makes progesterone forms of birth control a bad idea, specially for women over 30. Mirena is an improved version of the old IUDs which also uses an extremely low dose of progesterone, (delivering it directly to the uterus). Gyns will frequently prescribe mirena anyway for women with visual auras because the progesterone dose is so low. But, again if that's not something she's into then yes, you are stuck with physical barrier methods. Everything else (short of surgery) involves either estrogen or progesterone.
posted by Iggley at 3:10 PM on May 15, 2010

posted by Iggley at 3:11 PM on May 15, 2010

You mention she's afraid that a cooper IUD would increase menstrual bleeding; I've had one for over a year and have seen a shortening of my bleeding days. The only difference is I'll get mild cramps a few days before the beginning of my cycle, instead after the bleeding has started. Just throwing out some anecdotal data.
posted by lizjohn at 3:30 PM on May 15, 2010

I have several friends who won't stop talking about how Fabulous their IUDs - both hormonal and non - are. To the extent that though I've been completely happy with hormonal birth control pills I've been tempted to switch, as they swoon about less heavy periods and almost never having to think about birth control.

That said, a vasectomy would also give you guys a similar assurance of not having to worry.
posted by ldthomps at 4:02 PM on May 15, 2010

If slow graffiti is right that Implanon could be acceptable, that would be a great alternative. They last three years, I'm on my second one now and it's not possible to explain just how fantastic it is to not have periods or cramps any more. The insertion was quick and pretty much painless both times.
posted by emilyw at 4:05 PM on May 15, 2010

Just chiming in against Depo. My migraines turned into a 3.5 month long headache.

As someone in a similar spot as your gf, I've tried almost everything for the last 20 years. Condoms and a calendar combined have given me pregnancies only when I wanted them.
posted by Gucky at 4:16 PM on May 15, 2010

Once again, PhoBWan speaks so much truth!

A couple other tactics to think about -- your girlfriend could chart her cycle and see how regular things are. You guys could avoid sex entirely when she ovulating and before and after. Get the bible on this, Taking Charge of Your Fertility. Your girlfriend should talk to her (new) gynecologist about getting a prescription for Plan B that she can fill and keep on hand for an emergency, like a broken condom. (I definitely echo other's comments that she needs a new gyno -- get recommendations from friends.)

Look, condoms don't have to be all "bleh" all the time. Try different brands. Order a pack of different kinds from Good Vibrations or Babeland and have fun trying them out. Condoms force you to get creative in your sexytime and not just rush for the goal posts. And they are way better than whatever crap your girlfriend has to go through in order to have a happy sex life.
posted by amanda at 5:43 PM on May 15, 2010

emilyw: If slow graffiti is right that Implanon could be acceptable, that would be a great alternative. They last three years, I'm on my second one now and it's not possible to explain just how fantastic it is to not have periods or cramps any more. The insertion was quick and pretty much painless both times.

Yup. I had mine for 6 years until I took it out to start trying to get pregnant (got pregnant within 12 months of taking it out, 4 months of trying). No period at all during that time, so no cramping/anaemia/hormonal swings. I did find my weight shifted slightly. I would really avoid depo since there's no way at all to stop any effects from it, but once the Implanon is out, it's gone.
posted by geek anachronism at 5:54 PM on May 15, 2010

I've had my Mirena about 18 months and I love it but for the first year, I really think it made my periods longer and more painful. I think that's pretty abnormal - when I asked my GP about it, she just shrugged and and wouldn't discuss it with me. (I'm now looking for a new GP.) I still love my Mirena but wanted to share the other side of the experience.
posted by whatideserve at 6:51 PM on May 15, 2010

Risk of stroke is only increased for women who have aura with migraines, not just migraines by themselves, as some posters seem to think. There is some consistent and published research to back this up and the WHO recommends that women who have migraines with aura (and it doesn't matter how often nor how severe) do not use estrogen-based hormonal birth control (i.e. the Pill). The Mirena IUD is acceptable for this group. Experiences on the Mirena vary wildly. IUD Divas on LiveJournal is a good discussion group for this issue. I have a lot of personal experience with this problem as I was on the Pill for many years before I learned about the increased stroke risk, and I have migraines with aura. I tried the Mirena IUD and had a very unpleasant experience, and had it removed, and now have to resort to condoms. It can be difficult to get doctors to place an IUD in women who have not had children previously, as that is "off label" use, but they will do it at Planned Parenthood.
posted by Dilemma at 6:58 PM on May 15, 2010

From where I see your problem, I see following things
1. Migraine with aura (whats frequency and medication she is taking?)
2. Heavy periods
3. Inability to use hormonal birth control options.

What I don't find here is her age. From my knowledge, I see 2 different cases, #1 solely and #2+#3 together. If she is taking any medication for migraine, have you checked if it is the cause of any of her issue? If she is taking any triptan derivative like Zomig or something and if hormonal pills are messing up story, I won't be surprised at all.

My feeling is, you are bit deviating from your actual problem.
(and you have already recd. plethora of advice for birth control issue)
posted by zaxour at 11:05 PM on May 15, 2010

n-thing Taking Charge of Your Fertility. Yes, it takes some reading and some commitment, but I have not found it to be a huge burden. And of course, there's the added benefit of no side effects whatsoever. YMMV.
posted by bardophile at 12:23 AM on May 16, 2010

Also, if your GF has never seen a specialist in migraine, it's worth a shot. My migraine specialist is a god damned ninja with the meds and the data gathering, and I really feel like we're making progress stopping me from ending up like several of my female relatives and their "three migraines a week is a good week" resignation.

Migraine specialists will also be able to advise on the birth control issue, and possibly refer your GF to a better GP. The best my old GP would offer me was ergotamine for the migraines-- my migraine doc had a complete fit about "this is the 21st century, we have science," prescribed a daily prophylactic med, handed out rescue meds for aborting a migraine in progress, and referred me to a vastly more experienced GP who's been great.
posted by fairytale of los angeles at 12:37 AM on May 16, 2010

Chiming in for the diapraghm; if her gyn doesn't want to fit her for one, find one that does. They're out there. And they're cheap; 75.00 for one that lasts you, oh 2-3 years at least.

Yes, as with condoms "user error" can be an issue, but if you're consistently careful, it's fine. No accidents for us after 12 years (I can't tolerate hormonal BC at all). Which is better than some of the people I know who use the pill.

The good thing about it is that she can try it and see if it works for her w/out having to go through a painful insertion, or worry about hormonal reactions.

I don't like the sponge, personally; it's kind of a pain in the ass and felt weird to me, but that's me. She can get one OTC and see how she likes it.
posted by emjaybee at 8:14 AM on May 16, 2010 [1 favorite]

I had debilitating migraines with Ortho-tricyclen (same hormones as in Nuva ring), but no issues at all on Yaz.

Doubling up on barrier / physical methods (and if you're afraid, some foams and/or gels) might be a good option for you.

IANAD, but if your gf is still in her early 20s then her issues aren't that uncommon, but if she's older, those symptoms sounds pretty intense and prolly should get treated for it. Regardless, if she's going to a gyn (or any other doctor) who's advice she does not trust, then it's time to find another one.
posted by Neekee at 9:06 AM on May 16, 2010

i had horrible migraines for years before ditching b.c. pills. minera has good for me, tho i've only had it a few months. it supposedly gets better with time. i'm not gonna lie - it was unbelievably painful to have inserted. feel free to mefi mail me for more info!
posted by fillsthepews at 10:43 AM on May 16, 2010

As a female who has had a Mirena for a year now, I can wholeheartedly recommend it. My periods are almost completely gone (starting from about the second month). I am like a proselytizer to all of my friends who don't have one yet. It was painful to get inserted (like a long, painful cramp) but since then my abdominal pain has decreased 90% during the time that I should be getting my period.

However, if she is not comfortable with it, I wouldn't push it too hard. But hopefully you can show her some of the testimonials of other ladies who have had it put in, and she'll reconsider!
posted by amicamentis at 5:21 PM on May 16, 2010

Everyone will be different, but I also have "migraines with auras, rather heavy periods that sometimes leave [me] anemic and require opiate painkillers" and I have taken Mircette on an off for about 10 years, with the blessing of three different neurologists. I think my migraine frequency is about the same as before (I've been getting them since I was a child), or maybe a little less.

You mention what her GYN said, but what does her neurologist have to say about it?
posted by Pax at 6:43 AM on May 17, 2010

I really love the Mirena. I had to go off hormonal BC due to estrogen-induced migraine with aura and borderline high blood pressure. (Plus, I'm allergic to latex and had bad luck getting the non-rubber condoms to not just fall off.) For me, the Mirena was a last resort before having to choose between abstinence, having kids, or sterilization.

I had no trouble finding a doctor who would give me the Mirena, despite the fact that I was 23, had never given birth, and was unmarried. Insertion hurt more than anything else I have ever experienced in my life, I'm not going to lie (and it's not like I have lived a life unaccustomed to pain and injury). But I started feeling better within a few days, now I don't notice that the thing's there at all, and my previously-evil periods that used to make me cramp until I threw up have now disappeared entirely, which is awesome. I've had the Mirena for going on four years and, if I'm not ready to have kids in 2011, I will get another one with no reservations.

The one thing about the Mirena is that not only does it not provide any form of protection against sexually transmitted infections, but if you contract a bacterial STI while you're using it, you're at a much greater risk for pelvic inflammatory disease. PID is really nasty and can lead to chronic, intractable pain and also infertility. So... for this reason, current guidelines suggest that only monogamous couples should use the Mirena. I'm not trying to insinuate that either of you guys are cheating or anything like that, but if you happen to have an open relationship or something, it will be more difficult for you to find someone who is willing to insert a Mirena.

But please, please, please don't pressure your girlfriend into getting the Mirena. Be really careful -- even if you aren't intending to make her feel pressured, it's super-easy for these types of discussions to get interpreted as "My boyfriend wants me to get the Mirena." I was really terrified when I found out I had to get the Mirena, and it took a lot of soul-searching to be brave enough to do it. It's really scary to know that there's going to be a random piece of plastic stuck inside your body for the next five years, and that there are going to be random strings hanging around that you need to feel for with your fingers, and that in order for this to happen, you need to have a really unpleasant visit to the gyno's office. I lucked out and have had a really good experience so far. But I could imagine being really, really bitter if I had gone through that horrible experience of insertion and then had the Mirena get expelled, or get embedded in my uterus, or some other horrible thing like that.
posted by kataclysm at 7:44 AM on May 17, 2010

Although IUDs can't be removed yourself, you don't have to go to a GYN. I was told by my GYN that any doctor should be able to remove it as long as there are no complications (e.g. embedding). This might make your girlfriend be less nervous about getting one.

Another personal experience here of bad experience with a Nuva ring. I have had both a copper IUD and the Mirena and they have been great.
posted by Gor-ella at 9:53 AM on May 17, 2010

Yup, love the Mirena. No periods, no maintenance, no worry BC. Had the first one in five years, stopped getting periods / any hormonal stuff a few months in... got a second one, same thing, then 2 years later decided I wanted kids after all. Had it removed in January and got pregnant in February. Best of both worlds.
posted by rabbitrabbit at 10:37 AM on May 17, 2010

This reply is far too late to be of any use to the original poster, but I'm in the same situation as your gf and was just put on Micronor. It's the minipill, a progestin-only pill so it's okay to take if you have auras. Estrogen is contraindicated by the World Health Organization for people with auras but progestin (like the kind in the Mirena) is fine. If she's freaked out by the concept of an IUD (I am too!) then the mini pill seems like a good option for her. I can't say whether it will be a good or bad or idea since everyone responds to BC pills differently, but it's worth a try.
posted by Zoeymonster at 12:22 AM on December 13, 2010

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