Oral BC hack, to predict my sensitivity to Mirena?

July 14, 2010 10:43 AM

If I've never tried hormonal birth control, is it illogical to have my first try be a Mirena IUD?

Is there a way I could experiment with taking an oral medication that delivers the same levels Mirena does (in order to see how I respond to them, before going through a full IUD insertion)?

I know Mirena's levels are extremely low relative to other hormonal methods. So, could I get a prescription for the lowest-dose oral BC of a type most similar to Mirena's, and then just physically split up each of those pills, taking a few fragments a day to approximate Mirena's continuous tiny dose?

I've had enough experiences of being sensitiive to smells and chemicals and stuff that I'm concerned I might be one of those people who have emotional and/or libido-compromising effects from Mirena.

(I'm very specifically interested in non-condom BC -- and I'm not ready for permanent sterilization -- so I do definitely want to at least test hormonal BC, because I really want it to work for me if it can.)

(And of course I know if I were trying a non-standard oral BC dose, I would still need to use condoms because that wouldn't work yet as BC.)

posted by sparrows to Health & Fitness (40 answers total)

Have you considered a Paragard? It's a copper IUD, no hormones. I had mine inserted about three months ago, and it's been great.
posted by roomthreeseventeen at 10:46 AM on July 14, 2010

Your reaction may be different with oral birth control, since Mirena delivers the dose directly into your uterus, where, as I understand it, most of it stays. So the amount in your bloodstream is minimal, which may not be the case no matter how small you break up the pills. Just a thought.
posted by torisaur at 10:49 AM on July 14, 2010

Nuvaring might be a closer cognate than pills.
posted by chesty_a_arthur at 10:52 AM on July 14, 2010 [1 favorite]

I also have a copper IUD (no hormones) and while I can't say it's been "great" (I got anemic for a while and have to take iron supplements now), it is certainly convenient to not have to worry about birth control OR extra hormones. Personally, hormones mess with me enough that it's totally worth some extra cramps and bleeding to avoid being on that emotional rollercoaster.
posted by Jacqueline at 10:54 AM on July 14, 2010

Mirena delivers the dose directly into your uterus, where, as I understand it, most of it stays.

This. The effects are going to be different because Mirena delivers the hormones, well, topically, basically, and the oral contraceptive pill delivers them via the bloodstream. Have you talked to your doctor about your concerns? The copper IUD is a good solution if you are really concerned about the hormones, but it does have some drawbacks, such as heavier, longer periods with more cramping. (Indeed, Mirena was developed partially to deal with some of those side effects as well as provide additional protections -- Mirena actually inhibits ovulation because of the progesterone while I believe the Paragard, and any other non-hormonal IUD is not known to do so and may only inhibit implantation.)

Anyway, the point is that Mirena delivers a very low, localized dose of hormones via a completely different mechanism than BC. If you want to test out the hormone levels, check with your doctor and see what s/he thinks is the best way to do so. And if you want to avoid hormones altogether, consider the copper IUD.
posted by devinemissk at 11:02 AM on July 14, 2010 [1 favorite]

This doesn't really sound like a thing you can do, to be honest. In any case I was made crazier by low-dose oral BC than anything else I ever tried over the years, and yet my Mirena has treated me A-OK.

I would second the idea of trying Nuvaring, as it's removable, but I have no personal experience with it myself.
posted by padraigin at 11:03 AM on July 14, 2010

Response by poster: I did consider the non-hormonal Paragard. I prefer the idea of Mirena, because the point of the very small hormone dose in Mirena is to combat the relatively common bad effects of Paragard (heavy periods and bad cramps, which I already have sometimes).

In other words, I'm estimating I would be even more likely to react badly to Paragard (enough to need to have it taken out) than I would be to react badly to Mirena (enough to have it taken out).
posted by sparrows at 11:06 AM on July 14, 2010

Response by poster: (Thanks devinemissk, I missed your reply before posting mine.)
posted by sparrows at 11:07 AM on July 14, 2010

Some anecdata about the Paragard: I was worried about the possibility of more-intense cramps when I got mine, because both of those were pretty bad for me already. The first three months or so, I had a day of pretty awful cramps each month. It's now been another year, though, and I haven't had a cramp I've noticed in the last twelve months (and I am now the biggest cheerleader for Paragard ever). So whatever you choose, realize that you should really wait about 6 months to give your body time to adjust, before you decide to have it removed.
posted by amelioration at 11:13 AM on July 14, 2010

Seconding the Paragard, which is fantastic, nonhormonal, and good for birth control up to 12 years. Their advertising campaign is not nearly as strong as Mirena's, but their devices are amazing and they also donate their devices to family planning clinics, so I think their hearts are in the right place.

Something to bear in mind with Mirena (and something their ubiquitous ad campaigns gloss over) is that they're really expensive little devices, so--although many people do decide they don't want to put up with the cramping that is a standard effect of IUD insertion for the first few months--you may want to consider whether you want to test h.b.c. with a $1000+ device. If you're looking for non-oral hormonal birth control, the Nuvaring is a pretty good option, though it has different hormones than the Mirena.
posted by verbyournouns at 11:16 AM on July 14, 2010

Please try Nuvaring first before you plunk down a huge chunk of change on IUD insertion. Then again, all formulations are different, so your reaction to Nuvaring may or may not be similar to your reaction to Mirena.

Mirena is effective with a small amount of hormones because, as torisaur said, the hormones are released close to the relevant organs. Orally taking the same amount of hormone as in Mirena would most likely leave you unprotected. So that is not a good option.

Data point: I had the copper IUD and I had it removed because my periods became heavy and a nuisance. I'd argue that I was more emotional with the copper IUD than I was using hormonal BC but I'm not sure if that was chemical or circumstantial.
posted by emkelley at 11:19 AM on July 14, 2010

As others have said, nuvaring is much closer to this than pills. When I asked my doc about an IUD our compromise was only if I would give nuvaring a try (since she was iffy on an IUD for anyone who hasn't had a kid). I ended up loving it. Half my friends are on it now, too.
posted by Kellydamnit at 11:21 AM on July 14, 2010

Also! Check what your insurance covers first: there are companies that will cover the paragard but not a mirena, vice versa, or will only cover either if you've been pregnant in the past.
posted by dinty_moore at 11:23 AM on July 14, 2010

Anecdotal evidence, but I was another birth control virgin who just jumped straight into the Mirena and I've had no regrets.

I don't know if I'm as chemically sensitive as you are but the experiences I've had with prescription pills-throwing up constantly on Haldol, going to the hospital with an allergic reaction to Paxil, passing out drooling on Risperdal, not being able to orgasm on Zoloft-were what made me avoid hormonal birth control pills.
posted by Juliet Banana at 11:41 AM on July 14, 2010

FWIW, I can't tolerate pills at all and I absolutely love the Mirena -- no probs whatsoever. I don't think you can test how you'd react to the Mirena by taking any level of oral BC.
posted by rabbitrabbit at 11:45 AM on July 14, 2010

You don't mention how old you are. If you are in your 20's/30's and are still considering having children I think an IUD is an illogical choice. When I researched IUD's the two doctor's I spoke to both recommended the IUD for women who already had children and were not ready for sterilization, or women who were pretty sure they didn't want children and were not ready for sterilization. In fact they were kind of pushing the IUD instead of sterilization because it is far less invasive, has the same BC effectiveness and lasts a long time.

I was also informed that the hormones in Mirena would probably have little effect on me because the levels are so low. (I react badly to hormonal birth control so this was a major concern). I have heard really good things about Mirena.

I also looked into the Nuvaring but again was told by two doctors that the way the hormones get into my body will not change my reaction to them.

I'm in Canada FWIW.
posted by sadtomato at 11:46 AM on July 14, 2010

You may find this Livejournal community helpful.

Supposedly, the Mirena IUD has fewer side effects than other types of hormonal birth control, but many people find they still experience side effects. I have very bad cramps naturally and I have been quite happy with my Paragard IUD. Everyone's experiences are different and you can't predict how you will react.
posted by Lobster Garden at 11:48 AM on July 14, 2010

I can't speak for the Mirena experience, but I'm another hormonal-BC-virgin in serious L-O-V-E with my Paragard. I chose the Paragard because I'm already dealing with libido-killing side effects from other medications I'm taking, and I didn't want to add anything else into the mix. It's been a year and a half since I had my IUD installed, and despite Paragard's reputation for causing heavier/longer periods, mine have actually become slightly shorter and lighter. Bonus!

If you do decide to go the IUD route, I strongly suggest going to Planned Parenthood to have it done. They're kind, knowledgeable, they install IUDs all the time, and they won't give you grief about it if you haven't yet had a child.

(on preview, YES YES YES to IUD Divas. It's a marvelously helpful community.)
posted by Vervain at 11:50 AM on July 14, 2010

When I researched IUD's the two doctor's I spoke to both recommended the IUD for women who already had children and were not ready for sterilization, or women who were pretty sure they didn't want children and were not ready for sterilization

This is a really strange comment, IMHO. My doctor had no problem prescribing an IUD for me, and I'm an NP woman who is unsure about children.
posted by roomthreeseventeen at 11:51 AM on July 14, 2010 [1 favorite]

You don't mention how old you are. If you are in your 20's/30's and are still considering having children I think an IUD is an illogical choice. When I researched IUD's the two doctor's I spoke to both recommended the IUD for women who already had children and were not ready for sterilization, or women who were pretty sure they didn't want children and were not ready for sterilization. In fact they were kind of pushing the IUD instead of sterilization because it is far less invasive, has the same BC effectiveness and lasts a long time.

There's nothing illogical about getting an IUD if you're young and have not had children. It does have an effective rate on the same level as female sterilization, but is easily removed if and when you do decide to become pregnant.
posted by donajo at 11:57 AM on July 14, 2010 [4 favorites]

This is great! I'm also considering an IUD because oral BC makes me insane/fat.

It's a little scary because so many bad experiences are posted on the web but so little good ones are.

Thanks for the LJ community link. So helpful.
posted by two lights above the sea at 12:05 PM on July 14, 2010

I've been told the reason some doctors don't prescribe IUDs for women who don't have children is that it's physically more painful and much more challenging to insert.

As far as hormones... my wife was a raving rollercoaster of loonyness while she was on orthotricycline low, but has been just peachy with mirena. Some cramping and spotting for the first ~4 months but nothing at all since.
posted by Quack at 12:09 PM on July 14, 2010

This is a really strange comment

The doctors would have prescribed it for me and in fact did (I just decided to go with something else) but they were very thorough in explaining the risks. Perhaps they were too good at emphasizing the risks to me?
posted by sadtomato at 12:10 PM on July 14, 2010

sadtomato, the latest research suggests that IUDs are actually ideal for young women (whether they have had children before or not) because they are low-risk and low-maintenance. See this short article on the Planned Parenthood website.
posted by Lobster Garden at 12:29 PM on July 14, 2010

You don't mention how old you are. If you are in your 20's/30's and are still considering having children I think an IUD is an illogical choice.

I don't understand why. I got a Mirena inserted 8 weeks after my son's birth because it was so taxing I couldn't imagine ever doing it again. One year later, I decided I really did want a second child. I was pregnant again within 3 cycles.

I will get another Mirena after this child, because even though I have never, ever wanted more than 2 children, replacing the Mirena every 5 years is much less risky than sterilization. A friend of mine's daycare provider had another child's mother die during a routine tubal ligation a few months ago. Yikes.
posted by kpht at 12:33 PM on July 14, 2010

Oh, and keep in mind, if you haven't had kids, THE MIRENA REALLY EFFING HURTS TO INSERT. People kept coming to me asking if it hurt and I did it after the baby, so I'm like "not for me, it was mildly uncomfortable, like a pap smear." The few girls I know who've gotten it without children have been laid up in bed with terrible cramps for the rest of the day.

Worth it, for sure, but be aware that it'll hurt.
posted by kpht at 12:35 PM on July 14, 2010

Response by poster: Wow, this is definitely complicated. :/ I really appreciate both the personal anecdata and the broader points. It's a while until my ob/gyn appt (maybe I should just drop into a planned parenthood branch).

Little more info:
- I haven't had a child
- I might want to have a child
- I do have insurance coverage for Mirena and for Paragard
- I'm in my early 30s
- Although I've never smoked, I do have a mildly increased risk of blood clots for an unrelated reason, so I don't feel totally safe trying regular strength (as opposed to Mirena) hormonal BC
posted by sparrows at 12:39 PM on July 14, 2010

the latest research suggests that IUDs are actually ideal for young women (whether they have had children before or not) because they are low-risk and low-maintenance. See this short article on the Planned Parenthood website.

Ok, I stand corrected, please disregard my comments.
posted by sadtomato at 12:39 PM on July 14, 2010

Modern IUDs do NOT impede fertility as long as you don't let an sti go untreated.

The Nuvaring is NOT a cognate for the Mirena. It uses a totally different hormone!

The closest thing is progesterin only bc pills. They have a higher dose than Mirena and are less localized, so if you can tolerate them, you can definitely tolerate the Mirena, though that doesn't go the other way around.

Depending on what kind of coverage you get for birth control, you might try the Mirena and then have it yanked if it doesn't work out for you.
posted by Salamandrous at 12:51 PM on July 14, 2010

I had Mirena for 4.5 years. I had it inserted a few years after the birth of my daughter. I really, really loved it. I had problems on BC pills (decreased libido, general malaise) and I was bad a remembering to take them. I didn't have any of the side effects commonly blamed on Mirena (low libido, weight gain, etc.).

However, I did have an ectopic pregnancy about two weeks ago. Ectopic pregnancy is a known side effect of Mirena.

From the package insert via RxList: Up to half of pregnancies that occur with Mirena in place are ectopic. The incidence of ectopic pregnancy in clinical trials that excluded women with risk factors for ectopic pregnancy was approximately 0.1% per year.

In my case, my Fallopian tube ruptured and I had internal bleeding (and A LOT of pain). I was rushed into emergency surgery and after a failed laparoscopy (too much blood in my abdominal cavity for the surgeon to see through the scope). I had open abdominal surgery to remove the right tube entirely. I did not have a history of ectopic pregnancy or any risk factors (except for the Mirena itself).

Your risk of this happening to you while you are on Mirena is really, really low. But if it does happen, it sucketh.

Fortunately for me, my husband and I feel our family is complete so the prospect of diminished fertility is not a big deal. Obviously, YMMV here. The prospect of being at higher risk for ectopic pregnancies in the future is a bigger deal, at least for me. I also have to figure out a new approach to birth control, since having a history of ectopic pregnancy now makes me a not a good candidate for Mirena.

Even with this experience, I think Mirena is great for most people. The best way to figure out how you tolerate it, though, is to have it inserted. There's probably not real hack or workaround for just seeing how it goes.
posted by jeoc at 1:20 PM on July 14, 2010

- I haven't had a child
- I might want to have a child
- I'm in my early 30s

This is me and I decided on Paragard. I didn't have horrible side effects on pills but they sneak up on you until one day you realize why ____ has changed over the last 5 years. Sure, it hurt but a few sharp pains for 12 years of hormone-free protection is worth it. Most reports I read online about Paragard the person usually evens out after 6 months of heavier bleeding or they give up before that. Every pill I took had different effects and I'm sorry to say that you really can't predict how you will react until you get a Mirena put in. Since you have insurance it shouldn't hurt (your bank account) too much if it doesn't work out.
posted by Bunglegirl at 2:09 PM on July 14, 2010

You don't mention how old you are. If you are in your 20's/30's and are still considering having children I think an IUD is an illogical choice. When I researched IUD's the two doctor's I spoke to both recommended the IUD for women who already had children and were not ready for sterilization, or women who were pretty sure they didn't want children and were not ready for sterilization. In fact they were kind of pushing the IUD instead of sterilization because it is far less invasive, has the same BC effectiveness and lasts a long time.

Illogical? Not so much, sorry. Your doctors probably overestimated the risks to you. IUDs are a completely reversible form of birth control, and the issues with nulliparous women getting them is the somewhat higher possibility of expulsion and the increased pain of insertion. Neither of these issues have any effect on one's future fertility.
posted by thisjax at 2:30 PM on July 14, 2010

...she was iffy on an IUD for anyone who hasn't had a kid

farbeit from me to call aspersion on a medical professional, but I am pretty certain this is pure unadulterated bullshit. I know plenty of practicioners (in this state, anyhow) who will willingly insert IUDs regardless of your pregnancy (or not) history.

To answer the question, the Pill won't help you make this decision at all, and furthermore, any BCP at that low of a systemic dose would likely not be efficacious. Go with the Nuvaring, try it first, see what you think.

I also wonder how/why these are so expensive for some of us? I had a Mirena inserted last February and it cost me $500 total for insertion at Planned Parenthood - this was full pay, no insurance, and I don't qualify for hardship discount because I'm fairly well off.
posted by lonefrontranger at 3:05 PM on July 14, 2010

on preview: what thisjax said about "nulliparous" women. I've never been pregnant, for the record, it didn't hurt much going in, and I've never had a problem with it staying put.
posted by lonefrontranger at 3:07 PM on July 14, 2010

About doctors not wanting to give IUDs to nulliparous women: this was a reaction to the Dalkon Shield, an IUD used in the 70's, which was poorly designed and led to sterility-causing infections in some women. For a while afterwards, the thought was that a women who hadn't had children would be much more upset about losing her fertility than a women who already had her kids, so it was best not to take the risk with them.

Now, however, the IUDs are better designed, and they test for infection before they give them to you, so they're considered safe. Not all doctors have gotten the message, however.
posted by wyzewoman at 3:31 PM on July 14, 2010

I have a Paragard IUD, so I can't comment on the effectiveness of the Mirena device. I am mid-twenties, have never had children, and dislike hormonal BC. I tried it for about six months before I realized it made me crazy. The lighter periods just weren't enough of a payoff.

When I consulted my doctor about an IUD, she recommended the Mirena, because the low dose of hormonal BC does counter the possible side effects of an IUD, such as heavy periods or cramping. I still went with the Paragard, because I just didn't want any synthetic hormones.

I will say that it hurt pretty bad to have it placed, and even with some Advil I was basically in bed for the rest of the day. My first period post-Paragard was about the same in terms of flow and length, but I had cramps that far exceeded anything I'd experienced before. After that, things basically went back to normal in terms of cramping, though I do notice that some months my periods last a little longer and/or are a little heavier. Still, I'm really pleased with my choice. It's exceedingly low maintenance, highly effective, and I don't have to worry about any side-effects from hormones. Maybe the initial placement sucked, but I got over it quite quickly.

I'm not a health professional, but since you say that you are concerned about high hormone levels in pills and don't want to exacerbate your already heavy periods, the Mirena sounds like a great choice for you. I really can't say enough about the convenience factor -- not to mention the peace-of-mind factor -- of an IUD.
posted by redfishbluefish at 4:05 PM on July 14, 2010

Nuvaring is NOT a comprabale form of birth control to Mirena, not at all. The closest thing chemically is a progestin-only mini pill, so you can ask your doctor for a trial of those, but careful because they're incredibly timing sensitive (can't miss a dose by more than half an hour) and the risk of accidental pregnancy is so high than some providers will not prescribe them at all. People are hung up on the idea that the vaginal/uterine administration makes Nuvaring and Mirena the same, but chemically they are totally different.

Nuvaring has a whole category of hormones in it that do not exist in Mirena. That's the ethinyl estradiol, a synthetic estrogen. Mirena only contains a progestin which is also in Nuvaring, and as far as your body is concerned those two progestins are nearly identical. It's the estrogen that gives many women side effects, including cardiovascular effects. Currently guidelines by the World Health Organization do NOT approve any combination birth control containing an estrogen for women at risk for stroke, but they do approve Mirena and Implanon, the progestin-only implants currently available. My doctor told me that Nuvaring could not possibly raise my blood pressure considerably, but as soon as I switched to Implanon, my blood pressure dropped nearly 10 points to normal, when I had been hypertensive. The cardiovascular risks of long term estrogen use are something to worry about if you are at high risk of clots so I encourage you to stay away from combination pills and Nuvaring unless you get a cardiologist telling you they're okay.

You should consider Implanon if you're freaked out about pain and reversability; it's quick and no more painful than a blood draw.
posted by slow graffiti at 4:45 PM on July 14, 2010

Oral contraceptives mess with my body so much I can't use them. I had my first Mirena in at 27, out after five years (the max) and a new one put in because I loved it so much, no periods, no side effects, totally awesome. Two years into the second one I decided I wanted a baby, had it taken out in January and got pregnant in February. Once my son is born, I will be getting another Mirena. They are the best.

Oh, and keep in mind, if you haven't had kids, THE MIRENA REALLY EFFING HURTS TO INSERT. People kept coming to me asking if it hurt and I did it after the baby, so I'm like "not for me, it was mildly uncomfortable, like a pap smear." The few girls I know who've gotten it without children have been laid up in bed with terrible cramps for the rest of the day.

I've never had kids and had my second Mirena inserted on my lunch hour, then went back to work. A little pain during insertion, but no big deal.
posted by rabbitrabbit at 6:47 PM on July 14, 2010

Just to clarify the ectopic pregnancy thing:
IUD's do not make you more likely to have ectopic pregnancies, but they are less effective at preventing them, if that makes sense?

I'm cribbing numbers from wiki, but for example, a Mirena IUD might protect you from 99.98% of normal uterus-based pregnancies (probably higher, but I think that includes ectopic), but only blocks about 90% of the rarer ectopic pregnancies.

God, I wish I could afford a Mirena, it sounds awesome! I got a normal copper IUD, insertion wasn't much worse than a pap smear, though more nerve-wracking inducing (I didn't realise I might *bleed*). Slightly heavier periods, but the tradeoff for the safety and security has been well, well worth it.
My sister who had heavier periods to start with, more fervently wishes she could have a Mirena, and I'm gonna suggest she gets her iron levels checked, and if they're on the low side, convince the Dr's it's necessary.

Good luck!
posted by Elysum at 11:43 PM on July 16, 2010

Response by poster: Followup: I decided to try Nuvaring first and miraculously I am completely without any side effects so far. Thanks for all your help here!
posted by sparrows at 10:29 PM on September 9, 2010