Would prefer to not lose my mind. Again.
November 3, 2011 4:17 PM   Subscribe

Accutane. HBC intolerance. IUD. Anxiety about all of the above. Here we go.

If it matters, I'm 32, pregnant once, long ago, terminated.

Ok. There are a few factors at play here:

1. I am not on birth control, currently, because...

2. All, yes, all forms of HBC make me crazytown. Or exacerbates the crazytown, if you'd prefer.

3. I have a history of depression both in myself and my family. It's A Thing.

4. I now have a boyfriend. Hooray! But that means birth control. Boo. Scary.

5. I am nervous as hell about installing an IUD. I've read previous questions about it here, and even the level-headed MeFites seemed to say that they basically bled, had terrible cramps, and exhibited PMS behavior for so long that they just gave up and had it removed.

6. My lovely cystic acne has gotten way worse in the last year. I'm actually in real, physical pain because of it. My really great dermatologist has tried all of the things. We're doing one more round of prescription face washes, creams, and pills, and if it's still no dice, he's pushing Accutane. Hard.

On top of this, Accutane has gotten all kinds of bad press lately. My dermatologist was adamant that it is all basically scare tactics.

When I went for my appointment tonight, he made me sign the IPledge paperwork and I all but had an anxiety attack, initialing each line that I'm basically cool with "suicidal tendencies, depression, etc" and the "may cause serious birth defects." I know they *have* to keep you apprised of the risks, but I've never been on a medication that seems this severe.

He even went so far as to try to put me on the pill TONIGHT, so that a month from now, if this round of topical/pill treatments fail, I would be ready to go on Accutane.

I, of course, panicked and balked, basically yelling I NEED TO TALK TO A GYNO FIRST AND MAYBE A PSYCHIATRIST. He relented.

Ok, level-headed Mefites, my questions:

1. Should I get a second opinion? I felt all kinds of anxious that he was pushing something that looks, well, horrible.

2. If overreacting in my anxiety over Accutane, can anybody give me data/anecdata that could make me change my mind?

3. I'm going on the birth control anyway, because of said boyfriend, but considering HBC is basically out, can anyone help me feel better about an IUD? I'm truly scared. If it's really that bad, PMS-symptom-wise, should I even consider trying HBC again? (With a real sit-down talk with the boyfriend, of course.)

4. Is there any course of action that I haven't thought of?

Sorry - my head is swimming with anxiety, and Things I Need To Do In The Next Month and Decisions I Have To Make. My goals are simple: get rid of the painful acne, not get pregnant, and not go crazy in the process. What are the easiest way to do these things?

posted by hubble to Health & Fitness (21 answers total) 2 users marked this as a favorite
So, on one hand, I am a dude. So I'm not going to pretend I have a lot of authority here. But I've got a lot of not-shy-about-lady-parts female friends, and I know for a fact that at least a half-dozen of them cannot stop raving about their IUDs whenever the topic comes up.

Also, I myself took Accutane, and I turned out fine. Granted, I was about sixteen, and a boy, so less concern about birth defects. Yeah, it has a higher-than-normally-okay level of really bad side effects, but if you're ok with, say, tracking your moods and pushing the panic button if you find yourself in depressive states - maybe with your boyfriend's help? - it does do a pretty impressive job of making all the acne go away forever.

I could say more, but I think that's about as far as I feel I can, what-with only having dangly boy-parts myself.
posted by Tomorrowful at 4:24 PM on November 3, 2011

There was a recent anecdata-filled question about Accutane, that might help you a little.
posted by brainmouse at 4:24 PM on November 3, 2011 [2 favorites]

I have a Mirena IUD. I'm due to have it replaced in about five months and definitely will. I love it! I have no kids, never pregnant; I did not find insertion bad at all. I didn't find it painful, I would say uncomfortable or "wrong" feeling for a minute or so during the procedure. I think I took a Percocet or Tylenol 3 for the procedure, which helped a lot, and ibuprofen the next few days after. Shortly after insertion I had mild cramps, not a bad as my worst periods, and some spotting. Probably lasted three days. Not bad at all, and now I don't get periods, just minuscule spotting occasionally that reassures me I'm not pregnant. I haven't had any side effects from the hormones..since they don't really enter your bloodstream and stay localized, there is little risk of that.
posted by catatethebird at 4:30 PM on November 3, 2011 [2 favorites]

I can't speak to the Accutane, but I completely feel you on the HBC. I'm giving it a big ol' try AGAIN right now and it's truly horrible.

Practically every one of my friends has an IUD and loves it (about half and half Paragard and Mirena). I'm the only one who it didn't work for -- my tiny retrograde uterus wasn't having it. I hear nothing but great things about it, honestly. It was my Last Great Hope before sterilization, which I can't afford yet, and I'm still sad the IUD didn't work out.

Give it a go -- it could be the best thing ever. If not, trust me, it's still not as bad as HBC, even with a near perforation. :/
posted by fiercecupcake at 4:31 PM on November 3, 2011

There are two kinds of IUD: Mirena, which has progesterone, and Paragard, which does not.

You should not experience any mood swings or other hormonal side effects from Paragard (I mean, you'll still probably get PMS and period-related acne and all that loveliness, but it shouldn't be any different than it normally is). If you are not interested in hormonal birth control, do not get Mirena.

It will be painful to insert if you've never given birth, but the pain is brief and manageable. You will feel a bit crampy and bleed for a few days afterward, and your periods will be heavier than usual for a few months.

I have had a Paragard for about a year and a half now and it's been great. I totally recommend it.
posted by elizeh at 4:45 PM on November 3, 2011 [1 favorite]

I am nervous as hell about installing an IUD. I've read previous questions about it here, and even the level-headed MeFites seemed to say that they basically bled, had terrible cramps, and exhibited PMS behavior for so long that they just gave up and had it removed.

What? There are a lot of us on here that love love LOVE our IUDs. I'm on my third Mirena and it is the best thing ever. There tends to be an adjustment period during which there's a little bleeding but after that no periods, no cramps, no PMS. It is awesome. And I am far from being alone in my experience.
posted by rabbitrabbit at 4:55 PM on November 3, 2011 [4 favorites]

I love love love love love my IUD. I have a Mirena, which has hormones. The hormone doses are so small that it is a totally different animal than the pill as regards my own personal physiology, but I would understand if you didn't want to take the chance, particularly if your insurance doesn't cover the whole thing. I have a couple friends who have Paraguards, and they love them as much as I love my Mirena.

Of the 13 women I know well who have IUDs, ten have a Mirena, three have a Paraguard. 3 of the women with Mirenas reported ongoing spotting / breakthrough bleeding for several months, one of them for a year, though there were no PMS symptoms. One woman expelled both her initial Mirena and the replacement within a couple months. Two of the women with Paraguards reported having their periods get moderately heavier, and said it was totally worth it.

I'm on my second Mirena; I had one in between the births of my two children, and I use it now for birth control. I love it so much. I have no period -- well, I'm also breastfeeding my son, but he's a year old so you'd think it would have come back by now. My skin is GREAT. My husband plans to get a vasectomy sometime soon, and I'm going to see if I can get my insurance to pay for a replacement IUD even after he gets the snip because I just love it so much.
posted by KathrynT at 4:58 PM on November 3, 2011

my head is swimming with anxiety, and Things I Need To Do In The Next Month and Decisions I Have To Make.

But you DON'T have to make all these decisions within the next month. That's a false and somewhat arbitrary timeframe placed on you by yourself, and reinforced by your doctor's behavior.

Talk to a gyno, weigh your options, and then go from there with the Accutane question. In the meantime, use condoms or abstinence with your boyfriend, and keep breathing.
posted by runningwithscissors at 5:02 PM on November 3, 2011 [2 favorites]

I'm 32. I have an IUD. I was scared and anxious for the insertion. (I have given birth. But the baby was not term--she was 32 weeks.)

Turns out I was scared over nothing. I literally didn't even know my doctor had done the insertion until I asked her. I didn't feel anything at all. I know she used lidocane gel (like the kind they rub on your gums prior to getting a shot for a cavity at the dentist) and that numbed my cervix. There was no pinch. I could not feel the measuring of my uterus. The insertion was made and that was it. I would say the most uncomfortable part was the speculum smashing everything (as speculums do).

With my doctor's permission, I took 600 mg of ibuprofen prior to the insertion, as well as an Ativan. But I think I would have been fine without either one.

Afterwards I was expecting to just go home and sleep... but, I felt fine. No cramps, and just a little bit of spotting.

It's been 5 months since I had it placed, and I have definitely noticed a very positive change in my mood. I went off HBC to have a Mirena placed. I do notice PMS, but this is very minor compared to the constant anger and even rage I had on HBC. My periods have been longer, but I have been told it is very possible that they will go away completely due to Mirena. It usually levels off and you find your new normal between 6 months and 12 months of having it inserted.

I recently had the option to go on some sort of dangerous medication that my endocrinologist was being very cautious about: she told me if I got pregnant on it, I'd have to terminate the pregnancy due to the chance of severe birth defects. Even though I have an IUD, and even though I don't want another baby and am trying my best not to have one, I ultimately decided not to risk the medication. That risk, coupled with some other issues I would have with the medication, made it not worth it for me.

Having said that, I have acne as an adult, too, and although it is not cystic in nature, it is still enough of a bother, nuisance and confidence killer for me that I definitely feel like the risk posed by Accutane is worth the benefit of the medication. Were I in your shoes, I would do it. My brother took it when he was in high school and did very well on it. As I understand it, the medication is something you do once, maybe twice and perhaps three times, under the auspices of an experienced physician. If you follow the directions of the iPledge program--you have your IUD and you use a backup method--you will be fine. Another thing you can do, if you are so inclined, is chart your basal body temps to see when you are ovulating, and you can abstain from sex during that time, so you have extra assurance you will not be pregnant.

I have tried a wide variety of topical medications and oral medications for my acne, which is hormonally driven. The things that have worked the best for me in controlling my acne, aside from HBC which really was the best, has been Solodyn and Aczone. Ziana was good too. I have also tried sulphur washes, Metrogel and Finacea.

I would encourage you to at least give the IUD a try. Let your doctor know your thoughts about it. And give Accutane a try--and follow the directions for the support/compliance program. It is a great medication, when used properly. Best of luck to you!
posted by FergieBelle at 5:03 PM on November 3, 2011 [1 favorite]

Hormonal birth control in pill form have ALWAYS made me go crazytown. I also have anxiety and depression issues. I started the NuvaRing about a month ago, and it's going really well and I have no side effects. I would highly recommend you check out the NuvaRing before trying the Mirena. I've heard amazing things about IUDs, too, but they are really expensive and a long-term commitment. I literally walked into a PP and got a NuvaRing the same day. And I can take it out and stop using it whenever I want. You can also use it to skip your periods if you so desire.

I would also find a new derm if possible.
posted by two lights above the sea at 5:05 PM on November 3, 2011

I love my Mirena IUD. I have another friend who loves it too. The insertion was not comfortable, and I had cramps for a few hours afterwards. I did the insertion at lunch and went back to work for several hours, then out to dinner (which, afterwards, I've found is not really recommended, but it was fine if not totally comfortable). The first month to six weeks I had some spotting (but nothing that was out of control). Since then (2 1/2 years ago) it has been wonderful. I do still get my period, but incredibly light and for 1-2 days only. My friend doesn't get hers at all. When my 5 years with this Mirena is up I plan on replacing it with another one.

However, my dermatologist explained to me that the Mirena does not help with acne the way HBC often does because of the difference in hormones. I can't remember if it was because the Mirena is less hormones and they're localized or because the Mirena only has one (I think?) type of hormone. But either way, I don't know that the Mirena will help with the acne the way HBC does for some people.
posted by Caz721 at 5:26 PM on November 3, 2011

You don't have to do anything right away. There is NOTHING you need to do immediately. You sound like you're very, very anxious about the timeframe, and I want to encourage you to breathe, and take all the time you need to make these important decisions about your health.

You have a boyfriend, but you can have lots of fun sexy times without PIV sex, so you don't need to worry about birth control ASAP.

You want to take care of your skin, but another month isn't going to change anything.

Take your time.
posted by insectosaurus at 6:37 PM on November 3, 2011

I adored my Mirena IUD before it expelled (twice -- but not painful at all either time). I have depression and had been totally crazytown on HBC before, but the Mirena was absolutely perfect for me because it did nothing to mess with my mood AND totally made my skin better. Since I've been off it, even in the last couple of months when I've been on NuvaRing, my skin has just not been the same.

I know at least three or four other people with the same situation: avoid other types of HBC, have depression and were wary, but love their IUD. Nobody I know has had any bleeding problems; most have gone down to very low levels of flow or stopped having a period altogether.
posted by Madamina at 6:43 PM on November 3, 2011

I took a course of Accutane, despite the fact that I have depression (and infact, eventually, it DID make the depression worse). I ended up taking a lower dose of the Accutane and thus spreading the course of treatment out over like six months.

1) The Accutane really, really, really, really helped. My skin is normal now. It was worth all the horribleness. Quite frankly, my life changed for the better. (I was even a mini bit ticked that no doctor had suggested//offered it to me sooner.)

2) There was a LOT of scary precautionary stuff around Accutane in general just due to the birth defect risk. Insane fussy scary stuff (and I didn't even want kids and I was with a guy who'd had a vasectomy and blah blah blah). They STILL made me watch a video and sign a million things and state the TWO forms of birth control I would be using (even though one was, you know, a VASECTOMY) -- and I still had to get monthly pregnancy tests!!! So I think all that stuff is *designed* to be intimidating and scary and heavy-handed (for the people who would say "oh, I totally didn't read any of the things I signed or watch the video or see any of the handouts or realize that going for monthly pregnancy tests had any important reason"). If horrible birth defects are preventable, then they are going to go super-overboard to try and prevent them.

3) I also can't take birth control pills due to the depression side effects etc., so I don't have smart advice on this part of the question.

4) Like two lights above the sea's answer above, I would say that you will want to feel like you trust your dermatologist, especially in this process. If anything is off or scary or icky . . . yes, possibly consider finding another doc. Feeling pressured isn't good. But also maybe you can sit with the decision -- like insectosaurus said -- take as much time as you need.

Good luck to you!!
posted by oldtimey at 6:57 PM on November 3, 2011

I had an IUD installed last year and it was quite uncomfortable when it was first put in and in the hours after I got it. By that night, I was perfectly comfortable with minor cramps. I bled more during the periods I had for the first three months but I have about 1 or 2 days of spotting now, with no cramps. It is so wonderful. I love my IUD so much and when this one runs out, I plan on getting another, if I don't go for something permanent.

Also, I was in the same boat as you with the painful cystic acne and being made all sorts of crazy by HBC. I was lucky that I didn't have to go the Accutane route. I was put on spirolactone as the step between antibiotics and Accutane. My skin reacted immediately and cleared up in a little over a week. I don't want to tout it as a miracle drug but my issues were hormone imbalances and its definately helped them. You don't mention that it was one of the pills you were put on but I figured I'd put it out there. It does require blood tests before starting and during to watch potassium levels. There are side effects. That said, IANYD or AD.

Also, I wanted to echo that you don't have to make a decision RIGHT NOW about anything. Do your research, perhaps get a second opinion, think it over and then make a decision. Take your time, if you feel you need to.
posted by godshomemovies at 7:07 PM on November 3, 2011

1. Between the acne and the crazypants reaction to hormones, I would NOT get a Mirena if I were you. I'd get a Paragard.
(Full disclosure: I have had both, and like the Paragard better. The Mirena broke me out like gangbusters.)

2. I got my first IUD (Paragard) before I was ever pregnant. This was in 2001, and I had to beg for it. Things have changed now. Ask your gyno for Flexeril before you go in, to help relax your uterus. Ask for Cervadil to help dilate your cervix. Ask for Vicodin for the after party.

3. If you get a Paragard, be aware that it will probably increase your periods in length, volume, or both. Consider buying a menstrual cup. This is how I cope. I like using a diaphragm, because you can have sex with it in without making a mess.

IUDs are the best ever. They are so worth it.

Can't speak about the Accutane, but I'd get the IUD first, because it is super effective, set-it-and-forget-it birth control.

Best of luck. Don't freak out, you don't need to.
posted by Leta at 7:35 PM on November 3, 2011

Just chiming in to say I'm another one who loves (LOVES!) her IUD. The discomfort of having it put in was not bad, even though I had to have that done twice because it wasn't positioned correctly the first time, and although my periods were significantly heavier for the first four to six months, they then went back to what they'd been before, or possibly even lighter. I have another four or five years left on this copper-T, at which time I intend to have the doc pull the old one and replace it with another.

(It's interesting what catches one's attention. The accounts of people who had bad IUD experiences seem not to have stuck with me. My own impression is that AskMe has a resident "Rah, rah, IUD!" cheering section (of which I'm a member, of course), several of whom speak up in any related thread to say how happy we are with our IUDs.)
posted by Lexica at 9:32 PM on November 3, 2011

There are people for whom HBC is dangerous (as in life-threatening) due to other medical conditions, and WHO recommends Mirena for them if they have conditions like dysmenorrhea that would indicate it. If you don't need Mirena's nice effects like getting rid of menstrual problems, look into the copper one. Talk to your gyno and get a full description of the drawbacks and problems--that's his/her job!

A lot of people said here and elsewhere online that it hurt at first and then it was OK. That seems accurate in my estimation. YMMV, like with all things in life.
posted by wintersweet at 10:22 PM on November 3, 2011

I'm two-for-three of your concerns; I have a Mirena IUD and I'm currently taking Accutane. I don't have a history of depression.

I LOVE my Mirena; insertion was unpleasant, but when mine expires next month I'm getting another one. This varies from woman to woman, but I haven't had a period in four and a half years! Some months I'll spot a bit, but rarely enough to need a panty liner. Mirena releases a tiny amount of hormone but it's unlikely to be enough to trip you up. Talk to your gyno to be sure.

I also LOVE what Accutane is doing for my skin. I had a bit of cystic acne but my real problem was massive overproduction of oil. I'm in my fourth month (of what will probably be a five month course.) My face got dry and flaky at first; that has gotten better the longer I take Accutane. My lips are really dry but they're manageable as long as I apply lanolin regularly. Keep in mind that your acne may get worse for a while when you start Accutane before it gets better.

Accutane does cause very severe birth defects. The way you prevent this is by not getting pregnant while you're taking it. Mirena is a great way to do that.
posted by workerant at 7:51 AM on November 4, 2011

My dermatologist was adamant that it is all basically scare tactics.

He is partly right. The depression scare stories on Accutane are probably that. It is difficult to argue with people who are sure that Accutane made their depression worse, but anecdotes do not a proven connection make. But just having painful scarring cystic acne, usually at an age when you are most senstive to appearance, seems to me to be a recipe for depression right there. And as someone who took Accutane twice, to me it is a depression cure since the acne that made me feel like a freak/elephant man/leper was gone! Other reported side effects I had were zero - absolute zero for me, but of course YMMV.

A true wonder drug!!

The very, very, real possibility, neigh likelihood of birth defects are real. I think nowadays because of the iPledge thing, even Sister Maria Teresa at the Convent of the Immaculate Conception has to be on two forms of birth control.

Being an XY, I am ignorant on XX birth control but the XX's I've talked to tell me that IUDs today are not your mother's IUD. I think the general consensus is one of high satisfaction. Seems the consensus on this thread.

The most important thing, though is how you feel about this since it is your body. And if you feel rushed for a solution, then don't do it. A few weeks wait isn't so terrible. Good to clear your head for a bit to assess your options.
posted by xetere at 2:06 PM on November 4, 2011

Just like you, I tried every other acne treatment in the book before taking Accutane and nothing worked at all. I had to take THREE courses of Accutane because I had such severe cystic acne from ages 12-22. But, that third run (which was the last one I'd be allowed to take) cleared it up totally and was seriously the best thing I could have done.

Echoing what others have said above, taking Accutane is worth most of the side effects considering how much it helps your state of mind afterward. I only recall super dry skin as the main side effect for me actually. I didn't experience ANY depressive side effects at all -- but I have no history of depression in my family. My boyfriend's brother, however, had to take it, and they do have a history of depression - but he is well and clear-skinned! What's depressing is not wanting to go out in public for 10 years.

The warning about birth defects is if you get pregnant while taking Accutane. Each pill even has a big red line through a pregnant silhouette to remind you not to get pregnant. Also you have to get blood tests while you're on it to make sure your cholesterol levels are fine - and to double-check that you're not having a kid.

Anyway, I would highly recommend it. Yes, it's a harsh treatment but some of us are unlucky enough to be born with harsh, deep-rooted acne. Good luck!
posted by thebots at 1:20 PM on November 5, 2011

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