Birth control in the Darkest Timeline
November 9, 2016 11:34 AM   Subscribe

So, I have some questions about how I should handle my birth control now that it looks like 2016 is Just Not A Good Year. I'm in the US; more after the jump.

Hey all. I'm a 33 year old cis lady that likes to have naked fun times with men-types. I had a Paraguard inserted in 2009, and it has been amazing as I've never reacted well to hormonal birth control. I have had the same cis male partner for many years; because of life issues, we may not be together much longer. Previous this current arrangement, my partners and I always used condoms. However, I am anxious and prone to worry and have absolutely no interest in being a human parent (ever. Really.) and my current partner has 2 grown kids and is not interested in adding to that total. If I end up single, I may end up in another relationship. I *really, really, really* am not interested in pregnancy and do not want to find my reproductive situation limited after Obama leaves office. My orgininal plan was to just keep getting Paraguards every 10 years until I was through with menopause, but was open to Essure (although the potential side effects look awful) or tubal ligation. I have expressed interest in sterlilization with my gynecologist before (a few years ago), and she was supportive but wanted me to wait until I was closer to my mid-thirties.
I do not plan on getting remarried. A deal breaker would be a partner who is interested in starting a family with me (I have absolutely no issue with kids from past relationships and am not biased against parents).
I am in excellent physical health and have decent health coverage.
What is the best course of options to discuss with my GP and GYN?
posted by sara is disenchanted to Health & Fitness (12 answers total) 9 users marked this as a favorite
In your shoes I would opt for a new Paraguard. Soon.

I am hoping there will be some replies from Mefites that know more about how the process of repealing the ACA (and the provisions like covering birth control that are in employer sponsored healthcare) will work and how long it will take to go into effect. Someone I was speaking to today thought it would go into effect until 2018 since those of us with employer sponsored healthcare are going through open enrollment now, the coverage will extend through 2017. I am due for a new Mirena in mid-2017 but I'm going to push for it to happen Jan 1-20 just to be safe.
posted by CoffeeHikeNapWine at 11:40 AM on November 9, 2016

Not sure what the current best options are, in terms of birth control. However, I looked at Essure a few years ago, and the side effects looked really, really awful. I would absolutely not go in that direction.
posted by needlegrrl at 11:42 AM on November 9, 2016

I had this conversation with my awesome Obgyn a few weeks ago.

Essure: No! Lots of side effects. Lots of follow up surgery and failure. May be pulled from the market.

Sterilization Option: She recommended fellopian tube removal. Apparently a lot of oviarian cancer starts here. Could reduce your lifetime cancer risk by 2%, plus no babies ever.
posted by Kalmya at 11:46 AM on November 9, 2016 [4 favorites]

There is pretty good evidence that Paraguard is effective for up to 12 years, and it is probably effective for much longer. Realistically, your current Paraguard will probably carry you through the darkest of times. Short of outlawing the method, Paraguards themselves are pretty inexpensive. This doesn't take into account the insertion, which, who knows.

If permanent sterilization is what you want, I would suggest bringing it up again with your current gyn, and if he or she still isn't supporting your choices, I would suggest finding a new doctor. Our new government is likely not to have your health, safety, and choices in mind, but your doctor should.
posted by i_am_a_fiesta at 11:48 AM on November 9, 2016

This isn't Gilead (yet).

I don't have knowledge beyond what google can give about where sterilization techniques are now as far as safety/side effects/etc. But I think your IUD replacement schedule should still be workable.

My feeling is that the worst that will happen between now and 2019 is that insurance companies will not be mandated to cover IUDs in the future. Maybe I'm being overly optimistic, but even in an Evangelical theocracy, the chances of IUDs non-hormonal being outlawed seem low, and would not come without warning.

If you keep your "decent health coverage" until 2019 you might even still be with an insurance company that covers it. Even if you don't, Planned Parenthood quotes $1,000 for IUD insertion right now, I'd budget $2,000, and start saving up.

That being said, a few years ago, your gyno wanted you to wait until you were closer to your mid-thirties before sterilization. Now you're in your mid-thirties. There's a good chance that if you have the conversation now, you'll get a different answer.
posted by sparklemotion at 11:51 AM on November 9, 2016 [2 favorites]

If it ain't broke, don't fix it. I'm on my second Paraguard and very happy and comfortable. The first one lasted 12 years. If need be there will be a third one until menopause. FYI, back in the day when I was pregnant, a lady in my stress test group was pregnant after a tubal ligation. I know everything is not 100% but that kind of gave me pause when I was talking to her.
posted by PJMoore at 11:57 AM on November 9, 2016

If you can afford surgery and are fine with the recovery, do that if you feel that strongly.

Otherwise, I myself am going to keep with the IUD I have which will get me through the next 5 years and by then I should be able to afford just getting another one outright or sterilization myself.
posted by Medieval Maven at 12:47 PM on November 9, 2016

sparklemotion -- Paraguard has been previously a source of controversy, and anti-choice politicians and groups have made the (scientifically false) assertion that copper IUDs are abortifacients. To think that it may be the target of anti-choice legislation is not paranoia.
posted by i_am_a_fiesta at 12:52 PM on November 9, 2016 [4 favorites]

To think that it may be the target of anti-choice legislation is not paranoia.

To expand my answer, I absolutely agree that IUDs will be a target. But, in the same way that a Democratic legislative trifecta could never hope to ban all guns, I don't think that the Republican trifecta will be able to ban non-abortifacient birth control. I think the best that they will be able to do is make it an out-of-pocket expense.

The reasoning that allows the Hobby Lobbies of the world to avoid paying for birth control is based on the fact that the Court sees "IUDs are abortifacients" as a valid religious belief, scientific fact was never considered. Even if/when the Republicans get a ban on abortion passed, Kennedy is on board with the opinion that the government needs more than bullshit fairy stories in order to restrict medical procedures. Trump's replacement for Scalia would only make that a 5-4.

That being said, when Trump gets a chance at a second appointment, that's when to start worrying. But even assuming a fast-tracked, no-filibuster appointment, legislation would still need to be passed and come into effect (with Bayer and Duramed lobbying heavily against it). Which is why my original comment stated that a ban on IUDs would not come without warning.

So, OP, if you are, medically speaking, happy with Paragard and would have stuck with your planned schedule in a happier government environment, I'd say stick with that plan unless Ginsburg or Breyer kicks it before 2019.
posted by sparklemotion at 1:27 PM on November 9, 2016 [1 favorite]

Birth control is sold without a prescription in Mexico.
posted by clearlydemon at 2:10 PM on November 9, 2016

Well, thank you all so much for your answers; I may mark them all. I made an appointment with my GYN; first available appointment January 4, 2017. I love my Paraguard, and if I swapped it out for a new one, that would put me at age 43.5 at its end of life and I would be okay with that since most of the women in my family have gone through menopause early (45ish). The insertion was one of the best decisions I've ever made.
posted by sara is disenchanted at 2:10 PM on November 9, 2016 [1 favorite]

I'd also check with your ob-gyn about whether you will need a new IUD when you say you do -- my understanding is that the copper-based IUDs, in particular, don't really have an expiration date. (The Mirinas run out of progesterone eventually ... though my friend who is an ob-gyn says the science isn't clear that the hormones are the reason the Mirina works, either.)
posted by steady-state strawberry at 6:19 AM on November 10, 2016

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