FAM or IUD or baby but please god, no pill
May 2, 2012 6:56 AM   Subscribe

Hate the Pill -- IUD or FAM? If so, how so? Snow flurry inside.

Late 20s female in a committed relationship. I've been on a Pill of one kind or another for 10 or more years. My doctor switched me to Camila (progestin-only) in November of last year because of a history of (rare) migraines. I've gained twenty pounds and have only had one period -- I hate this pill.

My partner and I have discussed our options, which look to be a copper IUD or the fertility awareness method. Which way go we go?

My primary concern with an IUD is the expense -- we'd only need it for a year and a half or two years before trying for kids. (My insurance doesn't cover it.) I'm also a bit skwicky at the idea of foreign objects hanging out in my uterus and I'd hate to go from no periods at all to a monthly gully wash. TSS as a potential side effect doesn't sound fun, either.

I lean towards the fertility awareness method and I'm about halfway through TCOYF. My primary concern is, of course, my own ignorance and how to avoid pregnancy while figuring it out. Also, if you've gone from a Pill to FAM, how do you know when your cycles get back to normal or if you actually have anovulation or something?

We have an appointment on Monday to discuss an IUD with my doctor. I really don't want to take this pill anymore, even for the next six days. On the other hand -- what happens if you just stop?

I know YANM doctor or my doula, but please give me anecdotes or information to help me decide what to do. Bonus if you help me save my $30 copay by reassuring me that I'm smart enough for FAM starting now.
posted by mibo to Health & Fitness (43 answers total) 4 users marked this as a favorite
If you've been on a progestin-only pill (minipill) and have the self-discipline to take it at the same time every day, you will likely do fine with FAM.

Condoms would be a good suggestion if you think you need a backup method during your FAM learning curve.

FAM really is wonderful. I've used it to get pregnant, as opposed to trying to avoid pregnancy. I really loved the amount of data I got on myself. I didn't want to practice it now because I have an erratic schedule, my sleep is often disturbed (which is important to obtain a good basal temp) and I have ovarian cysts which really need some type of hormone-based control.

On another note, are you looking to avoid all hormonal birth control? I use Mirena now; I've had it about a year now. It has really improved my mood, I have lost weight and I just feel better. No hormonal headaches, either. My periods have lightened, and the cramps have let up, too.
posted by FergieBelle at 7:14 AM on May 2, 2012

Well, you did ask for anecdotes: I know two couples that used FAM, and one of them has 3 kids and the other has 2, and none of the kids were planned.

Have you looked into a Mirena IUD? From what I understand, the levels of hormones in your system are far lower with a Mirena than with a mini-pill (something like 1/10th or maybe even 1/100th - I can't remember how many zeros there were). The manufacturer offers a payment plan, and occasionally coupons.
posted by amarynth at 7:17 AM on May 2, 2012 [2 favorites]

On the other hand -- what happens if you just stop?

In general, nothing different than when you usually 'stop' - IE, when you take the inert pills at the end of the pack. But you would need to start using condoms or some other barrier method right away because, as I understand it, fertility-awareness takes a bit of time to get established.

Planned Parenthood has a good recommendation for those using FAM to prevent pregnancy (really, for anyone trying to prevent pregnancy) - keep some Plan B on hand as back-up in case there is a slip-up.
posted by muddgirl at 7:18 AM on May 2, 2012

May I suggest a third option? The Cervical Cap. It may not have been recommended to you solely because it's not a common means in the U.S., but it is FDA approved; you just may have to do some hunting.

But I looooooooove it; it's what I went with when I decided to go off the pill. It was more convenient than the diaphragm, it was removable so I didn't hae to worry about TSS, and I didn' t have to futz around with fertility awareness.

(Of course, if you did consider this and decided against, my apologies. Recommending it only because it's like the bastard stepchild of contraception, and it shouldn't be because it is teh awesome.)
posted by EmpressCallipygos at 7:18 AM on May 2, 2012 [1 favorite]

I know a few couples as well that were relying on FAM. One is currently 9 months pregant with their (unplanned) third child. The other has one that I don't believe was planned either.

I agree with amarynth, look in to Mirena.
posted by gwenlister at 7:19 AM on May 2, 2012

I think both of your options sound pretty lousy- an IUD is a big expense/commitment for only 1-2 years, and FAM is not foolproof. Any reason barrier methods are totally out? Condoms, sponges, diaphragms, cervical caps- hormone free, fairly cheap, you can pick 'em up and start using them without a doctor's help.
posted by ThePinkSuperhero at 7:25 AM on May 2, 2012

Are you willing to consider other options besides those two? Personally, I think the IUD sounds like a great option for you, but what matters is that you don't seem to be comfortable with it, and you're the one who has to live with it. You shouldn't do anything you're uncomfortable with. FAM is going to pose some problems for you because you've been on the pill. None of us can tell you how long it will take your body to settle into a regular, chartable cycle, because it varies from body to body. For me, it took almost a year, though I'm told that I'm unusual and that most people's bodies readjust much faster. But until it does, and until you figure out what it's doing, you're going to need to use condoms or another barrier method every time you have sex. And even with perfect use, the failure rate is much higher than with other methods.

But those aren't your only two options. Condoms are the obvious method, and you'll likely end up using them as a backup method, probably most of the time at the beginning and then sporadically thereafter, if you choose FAM. But I can understand if you or your partner would prefer not to have to use them all the time. But there are other barrier methods. Diaphragms and cervical caps have a better success rate at preventing pregnancy than FAM.

You might also consider other, localized hormonal methods. A lot of women who have had miserable side effects from the pill have had no side effects from Nuvaring, the theory being that the hormones stay localized rather than circulating through your entire body. Similarly, Mirena causes fewer side effects than other hormonal methods, both because the dose is lower and because of how the hormones are released.

The point is that you have tons of options, many of which seem to address some of your concerns about the three you're currently thinking about. If I were you, I'd make an appointment at your local Planned Parenthood. They seem to know more about more different methods than most other gynecologists, and they may be able to help talk you through all the possible options and weighing the pros and cons of each for your unique situation. Good luck!
posted by decathecting at 7:25 AM on May 2, 2012 [1 favorite]

2nding cervical cap or diaphragm. If you are looking down the road at having kids, both of these methods allow you to just go for it when you're ready and not worry about clearing your system or uterus of anything.
posted by apparently at 7:26 AM on May 2, 2012

I've had the copper IUD for 5 years now and I've decided if I had to do it over again I'd go for the Mirena. Just too much damn bleeding every month, after all this time still not a month goes by without an accident. Plus it's depleted my iron reserves so much I lost lots of hair and am only now regaining it back with substantial iron supplementation over the course of the past year.
posted by Dragonness at 7:29 AM on May 2, 2012

Yet another option to consider is Implanon. It's a plastic rod about the size of a match that goes in your arm and releases progesterone. It should be somewhat cheaper than an IUD, and it's only designed for 3 years, so you'd get more of your money's worth. Since it's a really low dose (though not as low as Mirena) you might not have the side effects you're getting with the mini-pill.
posted by zeptoweasel at 7:33 AM on May 2, 2012 [1 favorite]

FAM is an excellent way to get pregnant. If you're not too worried about having babies in 9 months, go ahead.
posted by roomthreeseventeen at 7:35 AM on May 2, 2012 [1 favorite]

decathecting said: A lot of women who have had miserable side effects from the pill have had no side effects from Nuvaring, the theory being that the hormones stay localized rather than circulating through your entire body.

I'm finding this to be true right now. I've just started on Nuvaring, so it's too soon to say for sure, but with all the pills I've tried I knew immediately that they didn't agree with me. Not only are the hormones localized, it's an extremely low dose, and they're released constantly, so there's no ups-and-downs throughout the day like there can be with a pill. So far my only side effect is being SO HUNGRY, which is actually a plus for me.

(You can see my extreme adverse effects on the pill in my posting history. Sadface.)

If nothing else, Nuvaring is much easier and cheaper to give a try to than something like Mirena or Implanon, because you can take it out yourself whenever you want.
posted by fiercecupcake at 7:58 AM on May 2, 2012

Mirena is like 10X as expensive as a copper IUD, though. I have one and think it's the best decision I've ever made, but... not cheap (mine was covered).
posted by AmandaA at 8:00 AM on May 2, 2012

Ask your doctor for a pill that is lower in estrogen than most. Assure him that you will report any leg cramps or migraines.

I passionately hate the mini-pill and recently stopped taking it. I feel so much better now. Best thing that came out of my break up.

I have suffered from migraines since I was 16 years old and was on estrogen based pills, off and on, for 15 years with no heart problems. It probably helps that I have never smoked, never been heavy and I have no family history of heart problems.

You could always switch doctors and not tell the new one about the migraines.
posted by myselfasme at 8:03 AM on May 2, 2012

I've never used hormonal birth control. I started gung-ho on FAM to avoid pregnancy but I just rely on condoms now (fingers crossed). They say FAM takes just a few minutes to do every day but I found it didn't work for me based on my lifestyle--I can work strange hours, I stay out late and I don't wake up the same time every morning. If you do, or if you're very disciplined, FAM could work for you.
posted by girlmightlive at 8:09 AM on May 2, 2012

The only couple I know who tried FAM as a method to prevent pregnancy has two kids now.

I really like my Mirena (but luckily the expense was covered by my insurance). For my purposes, the expense would have been worth it if I had to pay because the time and effort it takes to fill pill prescriptions, pick up the pill from the pharmacy, and remember to take a pill every day has a life-cost that adds up. If you were to use condoms, I'd calculate how much money you'd be spending on two years' worth of condoms and see if that comes close to the cost of the IUD. It's a big up-front cost but it might equal out to all other options (other than FAM, which is obviously free... but babies, expected or unexpected, are EXPENSIVE). I love that I don't have to think about or pay for birth control for five years.
posted by banjo_and_the_pork at 8:36 AM on May 2, 2012 [2 favorites]

+1 for the Copper (Paragard) IUD. Insertion is not very comfortable, but I've had very positive experiences with it (using it since Dec 2011, so what, 16 months?).

I would argue that the worry-about-getting-pregnant to cost/investment ratio still tips highly in favor of getting one. IUD's are one of THE most effective methods of contraception, in large part because there's not much risk of user failure (like there is with any barrier method and most hormonal methods, i.e. not implanon or Mirena, but all others).

Planned Parenthood offers IUDs at a HIGHLY subsidized rate (as in, I was eligible for the Paragard at about $40 based on my reported - not verified! - income). Also, which state are you in? Minnesota, for example, has a program called MFPP which provides contraception FOR FREE if you qualify.
posted by Betty's Table at 8:42 AM on May 2, 2012 [1 favorite]

Not sure if you will encounter this, but if you have never had children, some medical professionals are very hesitant to implant an IUD. Personally, I'm not a fan of IUDs, but I've never had one. While FAM is a perfectly valid method, as mentioned above, it is far from foolproof and is prone to surprise pregnancies. If that's a problem, I wouldn't rely upon that alone as birth control and would ask my partner to use a condom. I totally understand wanting to go pill-free, and that may be the best option for you, but there are many different formulations with the pill and people respond to them differently. For example, Levora turned me into a human zit, but I have no issues with Yasmin/Safryal, and my overall health seems better when I am on it. IANAD but it does sound like the level of estrogen in your pill is too high if you are not getting periods. So, if you're up to experimenting with pills, I would definitely ask about a low estrogen formula as myselfasme suggested. You definitely have options, and, if you want to go pill & device free, I'd just go the condom route with FAM as a supporting method for extra assurance.

As for just stopping, nothing will happen really, but I would no longer consider myself protected by the pill. I stop and start every few years, and the only thing to keep in mind is that in can take a few cycles for everything to level out and get back to "normal." Good luck!
posted by katemcd at 8:43 AM on May 2, 2012

An IUD is awesome, but they are quite expensive without insurance. I was never able to take pills and had terrible luck with Paragard, but the Mirena has worked out amazingly well since the hormones are localized. No period, no side effects, no kids -- no wonder they are the most common form of birth control in the world.

I seem to remember a thread (either here or at IUD Divas) where someone who didn't have insurance bought a Mirena through a Canadian pharmacy, and then just brought it along to the appointment (obviously she gave the doc a heads up beforehand). I've never bought anything this way, but this site lists them at $225 and I bet PP would provide a sliding scale insertion, perhaps that would work with your budget?

FWIW, I have no experience with fertility awareness, but I have seen data that especially once you're over 30, the pullout method is nearly as effective as condoms.
posted by susanvance at 8:53 AM on May 2, 2012

Just nthing Nuvaring for your plans. After that . . .check out the Mirena. It's a five year commitment, and it's expensive, but good gravy. It's the biz. I'm on my 2nd one. Yeah it cost up front (how much depends on your insurance - I just had a copay) but you never pay per month for pills or for "feminine supplies" ever again. Well, I don't, and I understand that is pretty common side effect. Pretty effing posh.
posted by Medieval Maven at 9:10 AM on May 2, 2012

I used FAM to prevent pregnancy for about nine months before deliberately trying to conceive But my pre-pregnancy cycle was very, very regular and predictable, and we actually enjoy using condoms when necessary. (I could not trust myself to be abstinent during my most fertile times -- which should perhaps be obvious, but TCOYF makes it sound easy and it's not. Condoms, man.) I haven't used it since having my child, because it's basically impossible to do while you're breast feeding.

If you're planning to start trying to get pregnant in a year or so, I think FAM combined with a barrier method is a good bet. It'll allow you to get to know your cycles well ("awareness"). The humble condom is a useful tool, one you can use the way you want to. If, like me, your cycles are predictable, you can just use them during your fertile periods. If that makes you nervous, use them all the time. I personally found benefit from getting familiar with my menstrual cycles prior to trying to conceive, although a close friend got knocked up the month after removing her IUD, so YMMV.

But condoms are freaking awesome. Contrary to what pop culture says, they can be made sexy, they keep you from having unwanted babies (when used properly, etc.), you can easily decide not to use them, and they don't mess with your hormones. Yay, condoms!
posted by linettasky at 9:12 AM on May 2, 2012 [1 favorite]

Ive been using FAM and uh, pull-out method for 5 years.
No babies, but a couple of scares. I tried the NuvaRing but it grossed me out. I'm thinking about IUD since getting scared every other month is not fun.
My periods have been messed up since I stopped using birth control5 years ago (after 10 years of use).
I should mention I do not want children and I take a medication that reduces effects of bc pills.
posted by KogeLiz at 9:28 AM on May 2, 2012

Ditto, the only couple I know who used FAM had two kids while using that method.

I was in a similar situation a few years ago. Came thisclose to getting an IUD, but I just wasn't comfortable with it. Tried to get a cap or diaphragm and couldn't find a doctor who would.

We've been using condoms consistently (and correctly) for three years now and have had no accidents. I really kind of love it and wish I'd never bothered with the pill. YMMV.
posted by PhoBWanKenobi at 10:00 AM on May 2, 2012

Contraceptive films are easy and cheap and immediately reversible; I'd recommend the nuvaring as well except that without insurance covering it, it's not cheap, and while it's a much more manageable delivery system, it's still a hormonal form of birth control. But I used the films for a good few years and never had a problem. If you can't find them locally, you can get them on amazon.
posted by lemniskate at 10:00 AM on May 2, 2012

Diaphragm is actually not such a big deal, and if you're comfortable and careful about using it, as good protection as the hormonal methods (but without weight, bad moods, or loss of libido! yay!!).

But yeah, all forms of rhythm method are a slim statistical protection. As though that and your irregular cycles were'nt bad enough, you can actually spontaneously ovulate during sex -- your body wants a baby! So, I'd look to barriers to back you up.
posted by acm at 10:15 AM on May 2, 2012

I would certainly back FAM up with contraceptive sponges or film. I also don't know anyone who used FAM for more than six months without an unplanned pregnancy resulting. I know that the published stats suggest decent success rates, but apparently my circle of friends (including one professional sexual health educator) didn't succeed in "perfect use."
posted by Sidhedevil at 10:21 AM on May 2, 2012

Nthing I looooooove my Mirena. The hormones are localized, so you're unlikely to have problems from them. And I haven't had a real period in years, which is a huge plus for me. I'll be getting my second Mirena this month.

FAM sounds like a baaaad idea to me if you don't want kids right now.
posted by catatethebird at 10:31 AM on May 2, 2012

Had the issues you had with oral hormonal birth control. Have been using the NuvaRing for 3.5 years without any issues. I love it and have found it to be really easy to put in and take out.
posted by OsoMeaty at 10:32 AM on May 2, 2012

Also, I got my Mirena free at Planned Parenthood. You don't have to tell them about your insurance, and can get it free or reduced cost.
posted by catatethebird at 10:36 AM on May 2, 2012

I can answer any copper IUD questions you have. I too was worried about the torrential downpour, and it was bad, but only for 3 months. I know that's a long time, but for me it was worth it. My periods are heavier than when I was on the pill (also for 10+ years - I wanted to be hormone-free) but after a few months they are pretty normal.

Do the math on two years of another method vs Paragard, it might work out. Also, shop around. I didn't have any insurance when I got it and managed to get the device, and insertion for around $250 total. That works out to $20.83/month if I only used it a year or $2.08/month over the 10 years it's good for. I make too much to qualify for assistance, so although it was through a clinic I didn't need to qualify for any special discounts.
posted by Bunglegirl at 10:42 AM on May 2, 2012

I used FAM to avoid and to plan my pregnancies, no scares in the approximate decade we used it. Used with films or condoms, never got the hang of my lifeboat (diaphragm).

If you do find someone who will put in an IUD, just be advised that if manual dilation starts to hurt, make them stop and use more anesthetic. You will still need to be aware of your cycle, as IUDs to up the chances on tubal pregnancies (has happened thrice in my circle of over 30s age friends).
posted by tilde at 10:55 AM on May 2, 2012

Planned Parenthood also has a note on their birth control comparison chart about how to increase the effectiveness of some methods, including FAM.
posted by amarynth at 11:03 AM on May 2, 2012

I know plenty of people who have used FAM to avoid pregnancies with great success. However, it is very easy to screw up. If getting pregnant would be a horrifying catastrophe, I would absolutely not recommend it.

I have a Mirena IUD and I LOOOOOOVE it. It is expensive, but as I like to tell people, it's about the same cost as an abortion or the first-trimester prenatal care and screening. I had side effects from birth control pills that I do not have on the Mirena. And it's more effective than a tubal ligation.
posted by KathrynT at 11:38 AM on May 2, 2012

We had no problem avoiding pregnancy using FAM. It's obviously riskier than other methods. We were ok with the risk.
posted by sudama at 12:41 PM on May 2, 2012

You do know you need a backup method with fam if you don't want to abstsin half the month, right?

I used a combination of FAM and withdrawal, and it worked fine, but only because we always withdrew well before orgasm during fertile times, no waiting til the last minute. Also, I was only comfortable using FAM because I had been off the pill for many years and had been informally tracking my cycles, so I really knew myself. I can't recommend you jump right into it.
posted by mrs. sock at 12:54 PM on May 2, 2012

I am in love with my Mirena! I want to marry it! You should talk to PP or look into other options for getting it subsidized... I'm on my second one and haven't had my period in years. *dances*
posted by désoeuvrée at 1:36 PM on May 2, 2012

I add to the clamor regarding my love of Nuvaring and Mirena. But I definitely think of your two options, copper IUD is the better way to go. Unless you are sort of ambivalent about getting pregnant, then FAM is probably OK.
posted by treehorn+bunny at 2:11 PM on May 2, 2012

I tried to get an IUD but I had the problem mentioned upthread - I have not had kids yet. Apparently it can be very difficult and painful to get it to "take" unless you've had children already. I was discouraged from getting it.

So I use the Nuvaring. I was hesitant because the pill messed my mood terribly, but apart from the whole "not getting pregnant" bonus I have also experienced a significant reduction in acne, elimination of cramps, shorter, lighter periods, and a leveling-out of cycle-related mood swings. And people have been experimenting with skipping periods completely, so I'm sure you could talk to your doctor about that.
posted by newg at 2:42 PM on May 2, 2012

I've used FAM for 10 years now and have only gotten pregnant when I want to. However, my cycles are very VERY regular, even post-partum. We use condoms or abstain during my fertile period. I don't think I'd do an IUD when you're planning for kids that soon.
posted by chiababe at 3:01 PM on May 2, 2012

I tried to get an IUD but I had the problem mentioned upthread - I have not had kids yet. Apparently it can be very difficult and painful to get it to "take" unless you've had children already. I was discouraged from getting it.

I haven't had kids and neither have a couple of my friends who also have the Mirena. None of us has had problems, and my current OB/Gyn told me that the belief that IUDs are problematic for women who haven't given birth is basically outdated and based on misinformation. So to anyone having trouble getting one from their current provider--it's nonsense. Go see someone else.
posted by désoeuvrée at 4:20 PM on May 2, 2012 [2 favorites]

As a medical student currently studying contraception- I came to say exactly what desoeuvree said.
Anyone with a uterus can get an IUD. It is safe, easy, low risk, etc, etc.
On the other hand, if you don't want the full 5-10-12 years of coverage it is pretty expensive- do try the Nuvaring- as you can see upthread, many people who don't tolerate hormones well love it!
posted by aint broke at 4:44 PM on May 2, 2012

I also had a lot of problems with the various types of pills I tried--and even the Nuvaring, like headaches, lack of libido, and emotional issues.

I have used FAM for about 5 years now and only got pregnant (on our first try!) when I wanted to. We used condoms or did, um, non-PIV activities during the week or so I was fertile. I did chart my temperatures for the first year or so, but after that my other signs of fertility (cervical mucus) were clear enough that I could just go off of those. I also was lucky enough to take part in a study that provided me with a Clearblue Fertility Monitor, so I had that to back up my other observations. (I have since had a miscarriage and my system is still all wonky, but that's another story.)

It might take you a while to get the hang of FAM, but you can always use condoms until you figure it out. It's a really nice feeling to know what is going on with your body, and empowering to keep yourself out of the medical industrial complex.
posted by apricot at 5:15 PM on May 2, 2012 [2 favorites]

My copper IUD was about $700. Over 18 months, that works out to about $38 a month, or not much more than my hormonal birth control cost. Keep it for two years, and it'll basically be a wash.

For me, the heavy periods subsided after a few months, maybe five or so, and now, about 2 years in, they are as light as ever. I do occasionally get a menstrual cramp now when before I never cramped, but they are annoying, not debilitating.

The plus side of an IUD (for me) is that I don't have to worry about using it correctly, I don't have to track my periods with any rigor (mine can be so erratic that it would take me two or three years just to get enough repeatable data to draw any conclusions from) beyond making sure I've got tampons in my purse when the day is getting close, I have no hormonal side effects, and it's completely reversible.

You're thinking of getting pregnant in the next year and a half. That's great! But you don't know where you'll be in a year and a half. So having some kind of ongoing protection in place until you KNOW you want to start making babies NOW is a convenience and a reassurance that is hard to beat.

Another thing you can do is get the IUD and practice FAM at the same time. So maybe when you're ready to take the IUD out, you will already have a good, strong FAM practice in place to take you into the next stage of your fertility.

If you think you have the discipline for FAM and can roll with the possibility that you might be starting your family a lot sooner than you planned, then that might be a good idea. I don't have that discipline--IUD for me, for now. Good luck!
posted by elizeh at 8:02 PM on May 2, 2012

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