Are any of these three options more likely than Nuvaring to suppress periods?
March 22, 2011 1:12 PM   Subscribe

Continuous Nuvaring is not working for period suppression. Of Depo-Provera, Mirena, and continuous Ortho Evra (only those three options), is any significantly MORE likely than Nuvaring to completely or mostly suppress periods?

I'm very grateful for any input, and happy to hear either anecdotal evidence or clinical/percentage evidence. Thank you.

--- The basic question:
Last year my doctor agreed with me that I should try to suppress my periods, because they had become intensely painful and I can't take any normal pain relievers. I also can't usefully take oral medications, so my only period-suppression choices were these: continuous Nuvaring, continuous Ortho Evra (the patch), or Depo-Provera shots (or possibly a Mirena IUD, though of course that would be the most involved/painful to both start and stop using, of these options).

Continuous Nuvaring is what I've been trying for half a year. It's clearly not working for period suppression (which I know means my response to it is atypical). But it has changed my cramps from excruciating to just bad, which is very valuable and might make it still my best option if none of the other options are much more likely to suppress periods. Now I'm seeking any YANMD opinions or advice re. my other options, while I remain on continuous Nuvaring and wait for my insurance to be reinstated (unclear when that will happen).

--- More details if you want them:
I'm in my early 30s and for only the last few years, I've been having excruciating menstrual cramps along with fairly heavy/clotty, irregularly timed periods. Cause is as-yet-unknown (long and thorough pelvic+vaginal ultrasounds a few months ago showed only perfectly healthy looking organs with no detectable cysts/fibroids/etc., and I don't have any apparent endometriosis symptoms or any pain that isn't clearly uterine cramping).

I'd never used hormonal BC before last summer when I started Nuvaring, and I've never been pregnant (although I do want to maintain my possible fertility for now, so options like endometrial ablation are out).

I also was diagnosed 14 months ago with an unrelated chronic condition that means, among other things:
1) I must not take any kind of aspirin (ibuprofen/Motrin/Aleve/etc.), so the only pain reliever I can use is acetaminophen (Tylenol); and
2) I can't usefully take any standard oral medication, because I often wouldn't absorb it correctly; this rules out all oral birth control.

Nuvaring is at least a partial fail for me. Initially, I tried regular non-continuous use of Nuvaring (three weeks in, one week out, then new ring), but during each of the fake-period fourth weeks, my cramps were just as excruciating and my bleeding was just heavy as before. For the last half year, I've been trying continuous Nuvaring (new ring for three weeks, then immediately another new ring for the next three weeks, etc.). This has resulted in a repeating pattern: 5 or 6 weeks with virtually no bleeding, then 3 or 4 weeks of continuous moderate bleeding with clots and, at the heaviest peaks of the bleeding, bad (but NOT excruciating) uterine cramps.

The several-week blocks of continuous bleeding are unnerving (and this time around [three weeks into the current block], I think I clearly have some degree of anemia -- some clear sustained weakness and fatigue -- which I'm hoping I can correct with iron supplements).

You are not my doctor, but currently I'm waiting for my insurance to be reinstated (hopefully by next month, but maybe later). So your advice will just help me with research and help me not feel so discouraged. In case you want to share anything with me privately, is the throwaway email I used for a previous anon-question (which I don't mind associating with this one). Thank you.
posted by anonymous to Health & Fitness (22 answers total) 2 users marked this as a favorite
I have a Mirena. I love it. I haven't had a real period in almost two years.

I sometimes have light cramps but it was nowhere near as bad as they used to be pre-Mirena.
posted by amicamentis at 1:14 PM on March 22, 2011

Depo is supposed to have the most hormones out of any of the continuous products, however only 75% of people are period free after a year. It can work once you use it long term but you can have breakthrough bleeding or continuous periods for months.
posted by boobjob at 1:24 PM on March 22, 2011

Just as a data point, I've been on Depo for the past 3 years and while I did have periods for the first few shots, they are definitely gone now. I really love it--you go in once every 13 weeks or so, get a quick shot, and then you don't have to worry about periods or babies!

It should be noted, however, my doctor tells me that Depo can lead to low calcium, so she suggested I take supplements.
posted by chatongriffes at 1:26 PM on March 22, 2011

Although I don't face the sort of experience you do, I did have heavy, long periods and really hated them - I never understood women who found a way to "appreciate" their periods. I tried period suppression on the NuvaRing, but after about two months I'd start spotting and would have to take it out and have a proper period to get it to stop.

I got the Mirena about a year ago, and good god, it's the best thing I've ever done. It's not only insanely effective as birth control, but it also pretty quickly decreased my period to a couple of days of spotting, and then eliminated it altogether. It did kinda hurt to have it put in (felt like a really bad cramp), but I went back to work after and felt fine by the next day. It was also mostly covered by my insurance, and saves me a lot of money on birth control; it lasts for five years.

It definitely doesn't eliminate periods in all women, but I believe it'll at least improve the monthly slog. If you're at all interested, please have a chat with a doctor who's up to date on it (not all are).

One of my best friends had a really terrible experience with Depo, but of course it's different for everyone. She was told that she never should have been put on it with her migranes, so that's something to consider if you get them.
posted by you're a kitty! at 1:29 PM on March 22, 2011 [1 favorite]

Mirena IUD, though of course that would be the most involved/painful

I literally didn't feel mine being inserted, so don't worry that it'll necessarily be painful. It was about as uncomfortable as a pap smear.
posted by The corpse in the library at 1:33 PM on March 22, 2011

Have you taken a look at the Implanon device? It's a matchstick-sized plastic rod which is inserted (more-or-less painlessly) under the skin on the inside of your upper bicep. It lasts for three years and it's more than 99% effective, and if you happen to disagree with it, your body goes back to normal four days after it's taken out. It's also progesterin-based, so it generally has less nasty side-effects than most pills and Depo.

However, one thing I'd bear in mind if you consider Implanon is that the main side-effect is messing up your cycle. Some women never experience periods with it, some women bleed for two out of every four weeks, some only have occasional irregular spotting.

For what it's worth, I had one inserted just over a week ago, after going back-and-forth for a long time. I, too, have problems with oral medication and I figured that this was a good halfway point to start with: more reliable than Depo, but less invasive than an IUD.
posted by fight or flight at 1:43 PM on March 22, 2011

Another one chiming in to say how much I love my Mirena IUD. I've had it for about a year and half now - had some occasional light spotting the first three months and since then nothing. I've never been pregnant and insertion was quick and just felt like bad menstrual cramping. My understanding is that it's relatively easy and painless to have it removed as well. Having to go to the doctor's for insertion and then removal or another insertion five years later definitely beats quarterly Depo shots, at least for me.
posted by radiomayonnaise at 1:47 PM on March 22, 2011

I'm about to get my 2nd Mirena in May. Love. It. I haven't had a real period (or even anything like one, honestly) in five years. Insurance covered it, but even if it didn't I can't imagine you don't make it back in just not participating in the Feminine Hygiene Economy.
posted by Medieval Maven at 1:50 PM on March 22, 2011

Love the Mirena! I'm getting my third put in this Friday. The first was in for five years, and I did not have a single period for 4.75 of those years; my second was in for two years, most of which was period-free, before I decided I wanted to try for a baby. (Had it taken out January 2010; baby was conceived in Feb 2010, and is four months old now.)

though of course that would be the most involved/painful to both start and stop using

I will say: insertion is painful, but having it removed does not hurt one bit.

Get the Mirena. It is awesome.
posted by rabbitrabbit at 2:05 PM on March 22, 2011

wow, rabbitrabbit, sounds like you're a lady who's got her birth control options figured out. You'd delight a whole cohort of old women who fought for research and access to birth control back in the day :)
posted by you're a kitty! at 2:13 PM on March 22, 2011

Believe me, not a day goes by that I am not grateful to be living in these modern times. And I hope like hell that the generations to come are as lucky as I have been.
posted by rabbitrabbit at 2:23 PM on March 22, 2011 [1 favorite]

First I'll say that I too adore my mirena,

Second I'll suggest that since you've already tried an estrogen option and found it ineffective, it might really make sense to try a non-estrogen option.

Finally I'll say that insertion is unpleasant but it's five minutes for five years. And that's awesome.
posted by Salamandrous at 2:27 PM on March 22, 2011

I just got my Mirena for exactly the same reasons you cite after trying Nuvaring. I can't advise you as to which option would be best for you, but I think it was the right choice for me. I haven't had it long enough to comment on long-term performance, but even if you consider how much less expensive it is than Nuvaring (if covered by insurance), it comes out ahead. As an additional anecdote, several female OBGYNs at the research hospital gyn clinic where I go have the Mirena and enthusiastically recommended it to me, which made me feel better about trying it.

The only thing I would warn you about is the potential pain of insertion, especially if you haven't had kids (like me). My doctor was honest with me about this part, and prescribed me a couple of medications to take before the procedure, including a pain killer. While I'm sure they made it better, it still hurt like hell. I spent the rest of the day with a heating pad on the couch, and it was fine. I would still do it again. I like having my fertility control on autopilot, as it were, and knowing that one day of ouch can save me from debilitating period cramps for a few years. Good luck!

(I am not a doctor, this is not medical advice, etc. etc.)
posted by anonnymoose at 2:46 PM on March 22, 2011

Another anecdote that while Depo eventually led to period suppression, getting there is miserable. I had period-heavy spotting for a year. Then five years of nothing whatsoever, so ultimately it was worth it but that year was awful.
posted by peanut_mcgillicuty at 2:53 PM on March 22, 2011

I love my Mirena so much I'm trying to write a fan song with the lyrics "LOOOOOOOVE My Mirena!" to the tune of the Macarena.

Insertion varies a lot -- for me, it was like "hm, that's kind of odd, I -- SQUEAK -- wait, that's it?" But I've had two kids. My next door neighbor had one put in after her second caesarian delivery (no vaginal births) and she was white-knuckling it on the exam table. But your doc will usually write you a scrip for some painkillers and maybe a wee spot of lorazepam beforehand, and even if they don't, it's over in less than the time occupied by one bad menstrual cramp. As for taking it out? I've taken out earplugs with more pain than I felt upon removing the Mirena. Not kidding.
posted by KathrynT at 3:09 PM on March 22, 2011 [1 favorite]

I had really terrible periods until I was 19, when I got my first Depo-Provera shot. It was near-miraculous: the (constant) bleeding and cramping stopped dead. It probably wasn't instant, but I remember it was quite soon after the shot; maybe a few weeks or a month? I was on it for ten years and never had even spotting. It was wonderful.

I went off it onto continuous Nuva-Ring use, because we thought I was having some of the long-term side effects. Since I've been on the ring, I have occasional cramping and spotting. I'm going back on depo this spring; it was just more effective at keeping away the beast with the razor claws that shreds my insides.

I've been told that I'm problematic enough in said insides that I probably could not tolerate a Mirena. My response to the (depth?) test before insertion was pretty unfortunate.
posted by galadriel at 3:36 PM on March 22, 2011

Depo made me bleed for 3 months straight and helped me to spiral into a nasty depression. I did not take the second dose, and would never recommend it to anyone but my worst enemy.
posted by Logic Sheep at 3:37 PM on March 22, 2011

Mirena stopped my periods cold. Depo left me bleeding for three months. Continuous Nuvaring left me spotting at odd times. YMMV.
posted by wyzewoman at 4:25 PM on March 22, 2011

I had Implanon and loved loved loved it, for six months. I did not bleed or spot at all, then suddenly, bam, a full period that came out of nowhere and stuck around for the better part of five months before I said enough (and damn I spent so much money on tampons I don't even want to think about it). I did my research about what causes breakthrough bleeding, and the answers according to PubMed are few. One clinical trial suggested that mifisteprone would stop breakthrough bleeding in Implanon users, but my MD was not okay with giving me an abortion drug for non abortion purposes because this is Texas and it was 'too experimental and probably wouldn't work.'

I had to get the thing taken out, and now my options are Depo or condoms, so I'm not exactly a happy camper.

I used to be a candidate for Nuvaring, but not anymore due to history of hypertension. When I was on it, I could definitely suppress my periods more often than not, but if I got breakthrough bleeding I had to take the ring out for a few days, let my hormones rebalance then go for another ring. A study backs me up on this that taking the ring out for a few days once you seem to have developed persistent bleeding/spotting is better than just leaving the ring in place and waiting for it to get better. Frankly, you might not be able to suppress your periods 100% through any means if the biochemistry of your endometrial tissue doesn't want to work with that. Some percentage of women in all the trials of Nuvaring, Mirena, Depo and other contraceptives have irregular or continuous bleeding like I did, and for us, continuous contraceptive hormones throw off the process that signals healing in the capillaries of the endomentrium, so they just bleed without stopping. You may or may not be one of those people.

If you are, you may just want to do the best you can with Nuvaring, which is at least under your control, as opposed to the others where the result may still be weeks on end of bleeding or spotting that you can't do anything about without medical intervention. It sounds like Mirena might be different, but for Implanon and Depo I bet the likelihood of bleeding is about the same.

I'm going to go sulk in my corner now, hating on all you people who haven't had a period in years.
posted by slow graffiti at 5:05 PM on March 22, 2011 [1 favorite]

I love my Mirena, haven't had a period for 3 1/2 years. (I did, however, have fairly continuous spotting for 6 months after it was put in; that obviously stopped.)
posted by saveyoursanity at 6:14 PM on March 22, 2011

I've got to go against the crown vote for Mirena here. Obv YMMV, but I had a not great experience with my Mirena. My periods were slightly lighter, but they were less regular than they'd been on the pill (not shocking there) and I had more spotting. Inconvenient but hardly the end of the world.

But: I started getting bad cramps - my gyno was surprised by this, but I got moderate to occasionally bad cramps when I had never had cramps before, on birth control or not. Also, while I admit to being a wimp about pain, getting it in was the most painful thing I have ever experienced. Does not make me look forward to childbirth, I will tell you that. Getting it out was no big deal at all, at least. I got it out after two years because I was tired of the cramps, and there were no pluses to it except not worrying about taking a pill every say, which is why I'm now trying the Nuvaring.

I know a lot of people have great experiences with the Mirena, and the local hormones are supposed to help with cramps for some people, so it might work for you, but I had to give you the negative acecdatum.
posted by hatsforbats at 7:52 PM on March 22, 2011

Depo stopped my periods for about 8 months (I think I had two shots) but also made birth control kinda unnecessary as I didn't ever want to have any sex while on it. Not ever. YMMV.
posted by artychoke at 9:33 PM on March 22, 2011

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