Got on the pill, but can't get off
September 4, 2011 7:12 AM   Subscribe

Hormonal birth control is screwing up the sexy time. Alternatives?

I'm 25-year-old female and have been on the combined pill (Gildess) for about five weeks and was on the mini-pill (Jolivette) for a few months before that. I only have one complaint: all of a sudden it has become super difficult to have an orgasm. The formerly tried-and-true solo methods either don't work or take forever, long enough that I get bored and give up on what used to be an enjoyable nightly routine. Sex with the boyfriend is mighty fun and I get really turned on by him, but he and I are both a bit frustrated with the one missing piece.

Any suggestions on alternatives? (The progestin-only pill was nearly as bad, but had the added benefit of breakthrough bleeding, so that guy's out.) You are not my doctor, but I want to have an idea of what I want before I see her. The possibilities I'm considering:

--> Today Sponge - bit pricey, but maybe try it for a few months to see if things get better sans hormones?
--> NuvaRing - still has hormones, so might not solve things. Costs a bit, but, hell, it would be worth it if it works. Seems less scary than IUDs.
--> Mirena IUD - again still has hormones so might still mess things up. Insertion doesn't sound fun and it's a hunk of change to put out initially.
--> Paraguard copper IUD - No hormones, but potentially awful periods.

All of those would be accompanied by condom usage, since I'm paranoid and fond of my current non-pregnant condition. I'm just looking for a backup. Any thoughts? I'm leaning towards trying out the sponge+condom for a spell and then jumping onto one of the latter three methods. Is the failure rate of the sponge-condom combo low enough to be a responsible option? I'd appreciate any testimonials, especially from anybody who has had a similar issue. Thanks in advance.
posted by anonymous to Health & Fitness (26 answers total) 2 users marked this as a favorite

Sponge has spermicide in it, which I wouldn't use because of potential irritation, which can lead to the body being more easily infected with an STI. Also, it's not great as to the failure rate, which puts it right out, in my mind.

Nuvaring won't be any different than your oral contraceptives.

Mirena would be my choice for you. It's long-acting, reversible, and the hormones are used locally, not systemically. In my case at least, it also resulted in no periods.

Copper T is just as you say. Awful periods.

So. As to the insertion. Yes, it hurts, but the pain is gone by the next day, and you can get a cervix-softening medicine to help out. I'd also recommend going to a provider that has a lot of experience. Planned Parenthood is ideal.

Money: Yes it's a lot of money, but it's not in the long run, because the IUD lasts at least 5 years (my provider said there's some research that it's more like 7 years, but that's not to be counted on for now. Insurance if you have it, also usually covers it. So.

Other considerations: any IUD will put you more at risk for Pelvic Inflammatory Disease if you get certain STIs. It's good that you use a condom and will continue to.

Anyway, that's my two cents. FWIW, I am a health educator that specializes in reproductive health.
posted by Stewriffic at 7:30 AM on September 4, 2011 [2 favorites]

I've been using the Paragard IUD for about a year. I've never been happier with my birth control. YMMV, but I've found that my periods started out CRAZY HEAVY but then have mellowed back down the longer I'm using the Paragard. I'm pretty in love with it, and I can't recommend it enough.

Insertion was probably one of the more painful things I've ever been through (I think some people faint), but the pain was mostly gone by the next day. Totally worthwhile.
posted by superlibby at 7:35 AM on September 4, 2011

I also vote Mirena. I didn't find insertion that bad, and the no periods thing is a huge plus.

Also if you are in the US, I believe there is new legislation that BC is soon to be fully covered, including IUD's. I don't know the details, but check into it if the $ factor is a huge deterrent.
posted by mazienh at 7:35 AM on September 4, 2011

I had a lot of problems with both the pill and the ring. I had a more painful than usual insertion and recovery, but I don't regret getting a Mirena for a second -- it's made a HUGE difference.
posted by Narrative Priorities at 7:35 AM on September 4, 2011

(Also, I used to use Nuvaring and found the hormones messed everything up for me. Paragard has been a revelation.)
posted by superlibby at 7:36 AM on September 4, 2011

Seconding being in love with the Paragard. No hormones, and yes, the first few periods were bad, but I've had it over a year now and everything's just peachy. And, I paid about $75 for mine; not bad considering I would pay $40 a month for pills. (my insurance covers visits and procedures, but not prescriptions.)
posted by Made of Star Stuff at 7:56 AM on September 4, 2011 [1 favorite]

I hate my Paragard. Do not recommend. Maybe Mirena, although insertion is super painful.
posted by roomthreeseventeen at 7:59 AM on September 4, 2011

I'm a happy NuvaRing user. I've been on it about 3-4 years, after several years of trying various types of pills. All of the pills I tried had horrible side effects: zero sex drive, horrendous mood swings, crippling depression. I've had none of that on the NuvaRing and have no problems with dryness or orgasming. Several friends also use it and love it. It's a much lower dose of hormones than most pills, and the hormones are delivered via a constant "stream," so to speak, rather than in one big dose once a day. As always, YMMV, but I recommend trying out the NuvaRing first before you look into an IUD.
posted by pecanpies at 8:05 AM on September 4, 2011

I went through the same dilemma a few years ago. My husband and I ended up relying on condoms alone. Of course, we're ridiculous about condom use. We use them perfectly every single time, which drops the failure rate down to 2 to 3 percent. My sex life is better than it ever was on hormonal methods (and I tried about . . . five, over 8 years, including the NuvaRing). I was scared out of my wits at first, but now it's become like second nature.
posted by PhoBWanKenobi at 8:11 AM on September 4, 2011 [2 favorites]

I have had bad reactions to hormonal contraceptives (decreased sex drive on the pill, depression on progesterone only injections) and I loved the Mirena/IUS I had (IUD with hormone). The amount of hormone is substantially less. The insertion hurt about as much as stubbing my toe badly, with mild cramps on and off for a week - but after that, I was cramp-free for the next 5 years (which was so often - even on the pill I had cramps).

That said, it is expensive. Neuvaring has less hormone than pills and may have less effect; you can always try it for a month and see what happens, whereas the Mirena is much more of commitment.
posted by jb at 8:23 AM on September 4, 2011

What about a condom + diaphragm combo? 2 barriers + spermicide would be pretty darn reliable.
posted by belladonna at 8:25 AM on September 4, 2011 [4 favorites]

I've used all of the methods you outline above (as my only method with a LT partner - did not get pregnant); here are my experiences:

1. Today sponge: easy to use but I found I needed a day of ... rest ... in between usages since I did have some irritation. They were sometimes tough to find (this may've changed in the past few years) and I didn't like feeling stressed about running out.

2. NuvaRing: Tried it for three months and even with the lower hormones I still had pill-like side effects (slight depression, slight anorgasmia, not being in the mood, etc.)

3. Paraguard copper IUD: Despite the warnings from my doctor (better if you've had a kid - I hadn't) I wanted to try it anyway since I was terrified of hormones. I hated it -- my periods were horrendous and extremely painful (like, have to take Vicodin for three days painful) in addition to having almost as painful cramps or general achiness for the two weeks prior.

4. I just got the Mirena IUD put in about a month ago and so far I love it! Insertion was not any more painful (albeit about 30 seconds longer) than a normal yearly exam. (If you go this route take 3 ibuprofen prior.) I don't feel any of the hormonal side effects and while I haven't had it long enough to know how my periods will be I can tell you that this period was about half as awful as they normally are, so I'm feeling optimistic.

Hope this is helpful -- good luck with whatever you choose!
posted by hapax_legomenon at 8:28 AM on September 4, 2011

My SO and I have been using condoms only for three years and never had any problems... shouldn't that be an option?
posted by greenish at 9:58 AM on September 4, 2011

Nthing Mirena. I've tried nearly everything else: 3 different kinds of the pill made me crazy and/or my sex-drive bottomed out, diaphragm and sponge caused irritation, and relying on (disciplined) condom use made me anxious.

With the Mirena, I literally never think about birth control. It's hard to remember what a source of anxiety, stress, and physical discomfort this part of my life used to be. Caveat: I've had it in for 5 months and I spotted continuously for about 3.5 of those, which was extremely annoying. I've finally stopped spotting, but I still have regular periods; they are only slightly less mild, but I'm okay with that.

Do you have insurance? Mirena/Paragard insertion may be covered. Also, try Planned Parenthood if you think you might be eligible for sliding scale services. If you're below a certain income level your state may subsidize reproductive health services. That's how I got mine when I was between jobs.
posted by swingbraid at 10:08 AM on September 4, 2011

Another Paraguard user here - I love it! My periods were a bit heavier for the first few months, but now (6 yrs later), they are lighter than before I had the IUD. Insertion wasn't painful for me as I had it done shortly after giving birth. I absolutely love the certainty of my IUD - I never worry about birth control, ever!
posted by yawper at 10:15 AM on September 4, 2011

Another vote for Paraguard. At first my periods were the same (they were already pretty heavy), but then they started shortening. Two years later, and I maybe have three days of bleeding and a day of spotting. My cramps have changed, as well. I used to have three days needing to be on a constant supply of aleve, but now I just have a mild twinge now and again. I no longer need to carry around emergency painkillers! I'm super-duper regular! Sexy time is awesome!

I was 23 and nulliparous at the time of insertion. The dr. at planned parenthood said she placed them all the time, and it's one of her top recommendations for birth control. The insertion was like having one of the worse cramps of my life for about 3 minutes. I am more than willing to put up with that pain if it means no kids, no worries, no hormones and better periods (for me) for up to 10 years.
posted by lizjohn at 10:29 AM on September 4, 2011 [1 favorite]

From my experience, the Nuvaring won't help you here.
I've been using the Nuvaring, and while it is extremely convenient and makes me feel secure, it diminished my sex drive to the point that I stopped using it. I actually have the lowest sex drive of my life and other problems such as inadequate self-lubrication, which I never had a problem with before. It took about 3 months of using it before this problem started. I haven't used any other method of birth control for that long, so I don't know if it has a greater or lesser effect that the pill would. You could try OrthoTriCyclenLite (I think that's the name) -- it is basically a half-dose, so hormonal effects are severely diminished. When I was taking normal birth control, I was switched to this because of other hormonal side effects I was experiencing on the full dose.
I would actually suggest looking into IUDs (I've been thinking about this myself). There used to be problems with them such as construction and insertion issues, but they are becoming more popular recently and have much better construction. They are easy (since you don't have to remember to take a pill every day or anything) and apparently quite effective. And I've heard that even the hormonal one has only a minimal effect on sex drive.
posted by DoubleLune at 11:12 AM on September 4, 2011

Mirena is awesome. Awesome awesome. Like lizjohn says, insertion sucks but eh, it's over soon, and you get to legitimately take the day off work. Take lots of NSAIDs and you'll be fine. No worries about birth control ever ever.

I've had all kinds of hormonal BC and this is by far the best. However, my periods are not regular (still lighter than they were without BC), and cramps are pretty much super horrible. I'm part of that 1% of the population who apparently doesn't get to enjoy the no-period no-cramps thing on Mirena. Yet, the birth control aspect far outweighs the period aspect. Cannot recommend it highly enough.
posted by ArgyleGargoyle at 11:21 AM on September 4, 2011

If you are having these problems with the Pill hormones, it's entirely likely you could have the same problems with the Mirena hormones. It's awesome in theory, but there is a percentage of women who is sensitive to those hormones no matter how localized they are. Paragard would be the better option, and like others say, give it 6-8 months to settle in before you give up on it due to the periods.
posted by Addlepated at 11:23 AM on September 4, 2011

I'd also like to point out that failure rates for IUDs are extremely low, laughably low, and lower than any other method you described above. IUDs even fare better than sterilization (depending on method--I think laparoscopy was analyzed but not Essene). (Caveat that I don't know the methods for comparing rates and how "failure" is assessed).

I am super paranoid about being pregnant and plan on never, ever having children. You might consider sterilization, but an equally excellent and less invasive way is to get the IUD.
posted by ArgyleGargoyle at 11:24 AM on September 4, 2011

I love my Mirena! I was basically a crying, crampy, angry mess on all of the pills I've tried. Since getting the Mirena, my periods have stopped, along with almost all mood swings and cramping. Don't let the word "hormones" scare you, they're localized. Mine was covered, but I've probably saved enough in condoms and tampons to make up the potential out of pocket cost, and fully plan to get another one when this one comes out.
posted by almostmanda at 12:19 PM on September 4, 2011

I used Mirena for about 3 years and loved it. I continued to have fairly robust periods (just somewhat less heavy and slightly shorter than usual, but still regular and very present), but this wasn't a big deal to me. I LOVED not having to think about birth control ever. Insertion wasn't too bad (definitely not in fainting territory), but I had already had a vaginal birth which I believe makes insertion easier.

Unfortunately, I had an ectopic pregnancy about a year ago. Any IUD increases your chance of having an ectopic pregnancy, and if you have had one before it is probably not the best choice for you. I ended up having emergency surgery, and it sucked. I actually liked Mirena enough to ask the GYN if I could get another one, and she felt that was a bad idea. Not a firm no, but she felt my chances of a second ectopic would be greatly increased with the IUD.

The increased risk of ectopic pregnancy alone is not a compelling reason to not get one (at least in my opinion). It is RARE, and many many women never have this issue.

However, once the IUD was removed I found that I had some side effects that I wasn't even aware of. After a couple of months, my sex drive came back in a big way. I had been so habituated to a lower sex drive I didn't even realize I had a problem. The difference (as my husband can attest) has been huge. I also effortlessly dropped 10 pounds, and my skin got clearer and just nicer looking (luminous? people started telling me ALL THE TIME that I looked much younger than my actual age). People talk about the hormones in Mirena not being systemic, but really that's not true. The hormones enter your bloodstream, alter your hormonal balance and have systemic effects. Whether those systemic effects are noticible or negative seems to be very individual.

On the downside, I now get discernably PMS-y and birth control is more of an effort (condoms and fertility awareness).

So after my experience, I think that Mirena can be an excellent choice, but it is not the perfect solution. My younger (childless) sister had Mirena inserted just before my ectopic pregnancy, and she has been very happy with it. But there is no perfect solution and Mirena has trade-offs like any other birth control.
posted by jeoc at 4:42 PM on September 4, 2011

Another pleased condom user here. Ten years, eight with my current partner. I had one come off mid use during a particularly long session but we sorted that out with Plan B.
posted by Jilder at 6:29 PM on September 4, 2011

Haven't read all the comments, but enough to want to chime in and say I love my Paragard Copper-T. Birth control pills killed my libido, as well as pushing the depression I struggle with normally into suicidal levels.

Although my periods got heavier for the first four to six months after having the IUD inserted, they've since gone back down to their previous fairly light level. I feel much more in touch with my body's cycle (understandably, since the hormonal birth control was pretty much squashing said cycle flat), and these days find that paying attention to my libido's level helps me know where I am in my cycle. (When my libido abruptly goes to sleep, I know my period will arrive in a day and a half or so; mid-cycle, when I assume I must be ovulating, it definitely surges, which my husband appreciates.)
posted by Lexica at 9:18 PM on September 4, 2011

Condoms. Obsessively careful condom use. And there's a reason that emergency contraception is known in some places as 'Plan B' (I haven't had to use it for several years, despite being in sexual relationships).

I did have a copper IUD for a year, and yes it was nice to be able to relax a bit mentally, but the negative physical side effects outweighed that - YMMV, obviously some people are very happy with theirs. I got longer, heavier periods AND spotting around the time of ovulation AND spotting after sex; my theory was that the main contraceptive effect of the IUD was to make me feel smelly and unsexy.
posted by Lebannen at 1:43 AM on September 5, 2011

I am allergic to spermicide, hate condoms, and went through many types of hormonal BC over the years without finding one that didn't cause intolerable side effects. Some highlights included month-long spotting, constant migraines, rage, and weepiness. The one that seemed to be least malevolent ended up causing suicidal depression after I was on it for a number of years. That realization was it for me. I didn't want to mess with my hormones ever again.

So when I was 28 I got a tubal ligation. They did it via laparoscopy, so I was back home the same day and the scars are almost invisible. It was literally the best thing I ever did for myself. I never have to think about, worry about, purchase, or deal with side effects from contraception again. I am a happier person with a much-improved sex life. It was a bit of an investment, but so very worth it.
posted by heatvision at 8:42 AM on September 6, 2011

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