So what's new in birth control?

March 31, 2022 3:13 PM

I had IUDs back to back over the span of 10 years, then got it removed to have a baby, and we've been using condoms but are getting sick of it. However, I am reluctant to get another IUD at the moment because the insertions were terribly painful and we might try for another baby at some point so I don't want to get it put in then taken out in short order. I know there are birth control pills but I prefer something more localized, like the Mirena was. Is there a middle ground option here?
posted by Forty-eight to Health & Fitness (26 answers total)

Nuvaring?
posted by heatherlogan at 3:17 PM on March 31, 2022 [7 favorites]

There's an implant you can get that goes into your arm, I think it's called Implanon these days. It's the same hormone as Mirena and is inserted just under the skin on the underside of your bicep. Once it's healed, you can feel it if you prod at it, but mostly you won't notice it there. The procedure isn't very painful (definitely not as bad as an IUD) and once it's in, you can mostly set it and forget it. I believe it lasts 3 years.

I've had both this implant and Mirena and had the same experiences with both in terms of side effects, but the insertion/removal of the arm implant was much easier.
posted by fight or flight at 3:24 PM on March 31, 2022 [1 favorite]

Depo-Provera shots, once every 2.5-3 months. Works great for me (and gets rid of your period) but not necessarily for everyone, though.
posted by jenfullmoon at 3:29 PM on March 31, 2022

Nexplanon is the arm implant. My removal was not easy — think “kid digging around in a full cereal box for a toy surprise” — but that particular doc flunked out of her fellowship shortly thereafter, so my experience may be atypical. (I had it removed after three months of nonstop bleeding, which is not typical but also not unheard of, and it’s certainly not immediately reversible.)

NuvaRing is about as localized as any non-IUD options get. I struggled with it in my late 30s but it worked fine for me earlier on.
posted by armeowda at 3:30 PM on March 31, 2022 [1 favorite]

Thirding Nuvaring - I am now a really good pill taker but I would still not want to go back to pills for BC.
posted by soelo at 3:48 PM on March 31, 2022

My doctor recently mentioned a newer version of Nuvaring that has fewer side effects and can be left in longer (I think Nuvaring was 3 months). Blanking on the name but worth asking your medical provider about.
posted by lovableiago at 3:49 PM on March 31, 2022

My doctor recently mentioned a newer version of Nuvaring that has fewer side effects and can be left in longer (I think Nuvaring was 3 months). Blanking on the name but worth asking your medical provider about.

Annovera? I have one. It can be used continuously for a year.
posted by sm1tten at 3:57 PM on March 31, 2022 [5 favorites]

So, they are kinda old school I suppose, but I personally like my diaphragm. No hormones, really no risk, and used with spermicide (which some people have a reaction to, I did not though), pretty darn effective.
posted by coffeecat at 3:58 PM on March 31, 2022 [1 favorite]

I have Nexplanon, the arm one, because when I went in for the IUD my anatomy was uncooperative and my doc said it was the same hormone. I'm on my 3rd one. Insertion is easy least compared to my unsuccessful IUD attempt (which wasn't horribly painful. Rather just a fair amount of discomfort that was abandoned because imaging later showed it wasn't physically possible). Removal is...not fun, but still not as bad as the IUD attempt. The 2nd one was actually the worst to get out: the inserting physician placed it on the deeper side and then the removing physician was a newbie who wasn't bad just... didn't proceed with confidence.

IIRC, there's a slightly greater chance of prolonged bleeding with Nexplanon. I have prolonged bleeding right after insertion, but flow is lighter than what I have without BC, so it's a wash for me. With the first one I hit the 6 month mark and went in, and my doc put me on a pill and ibuprofen for a month to reset, which worked, but I never bothered to follow up with the next two (and the bleeding didn't last as long either).

When I first started I had to change out every 3 years. This last time I went in and they told me it's every 5. So that's nice.
posted by ghost phoneme at 4:01 PM on March 31, 2022

@sm1tten, that’s the one, thanks :)
posted by lovableiago at 4:04 PM on March 31, 2022

There’s an alternative to spermicide for use with diaphragms and cervical caps called Contragel. It works by changing the pH of the…zone.
posted by Comet Bug at 4:10 PM on March 31, 2022 [2 favorites]

Nuvaring might be just the thing!
posted by Ochre,Hugh at 4:14 PM on March 31, 2022

In my experience, after giving birth the IUD insertion (and removal) was completely painless, and I strongly recommend. Obviously, your body changes after giving birth. Give it a go.
posted by mumimor at 4:17 PM on March 31, 2022 [11 favorites]

Seconding mumimor -- I got mine in a few months after giving birth and literally didn't feel the insertion. This isn't just anecdotal - there's actual research about it. If you had a vaginal birth it is very likely that the IUD insertion will not be anything like it was pre-having a baby. There are also doctors who will do local anesthetic for IUD insertion (both like topical lidocaine and the sort that is a small shot), so you can ask around. If the IUD worked really well for you other than the insertion, it may be worth trying again.

But you shouldn't feel obligated to go that route if you don't want to and there are many other excellent suggestions in this thread.
posted by brainmouse at 4:57 PM on March 31, 2022 [4 favorites]

I haven’t tried it and don’t know anything about it, but there’s a new non-hormonal contraceptive gel called Phexxi.
posted by somedaycatlady at 5:05 PM on March 31, 2022 [1 favorite]

NuvaRing or similar is probably going to be your best bet. But I’m gonna third everyone in recommending going back to an IUD. Insertion post-baby is a serious non-event, I didn’t feel a thing when I had it put back in after giving birth, whereas my pre-baby ones all hurt a lot.
posted by anderjen at 6:09 PM on March 31, 2022

I opted for Nuvaring after hearing some nightmare experiences with hormonal IUDs and depo, and didn't have the best experience personally with pills. I loved the ring (as much as one can love birth control) and experienced wayyyy fewer hormonal side effects compared to the many birth control pills I tried over the years.

But I think that since you tried the Mirena before and that there's scientific and anecdata support that insertion will be less paintful, definitely something to reconsider!
posted by Paper rabies at 6:30 PM on March 31, 2022 [2 favorites]

Came in to agree with others that IUD insertion post childbirth is a completely different procedure. I've had three now and can honestly say I barely felt them go in.
posted by potrzebie at 6:38 PM on March 31, 2022 [2 favorites]

I got an IUD put in 6 weeks after childbirth and felt literally nothing. When I got it replaced 5 years later it hurt a bit more, but nothing like what I've heard some women (pre-childbirth)go through. Having a kid really numbs your cervix.
posted by you'rerightyou'rerightiknowyou'reright at 6:44 PM on March 31, 2022

Yeah, I came to say that about Mirena post childbirth-it was almost painless and a great method all around-for me, at least.
posted by purenitrous at 6:54 PM on March 31, 2022

Just a note on implanon. I had it for 3 years and I only figured out, once it had run out, that it was responsible for aggravating my depression quite severely. So it's worth investigating whether that might be an issue for you.
Oh and I had the same problem with having it removed as was mentioned above. Digging around precisely describes the process.
posted by Zumbador at 10:10 PM on March 31, 2022 [1 favorite]

IANYD etc etc

Depends on what you mean by “localised”.

IUDs mainly work by effect on the endometrium and cervical mucus. Nothing else has the same effect on the endometrium. Progesterone-only or minipills work on the cervical mucus. They can be less effective because there is a very narrow window for “missed pill”.

While nuvarings physically go inside the vagina, physiologically their mechanism of action is identical to the combined contraceptive pill.

Implanons work by central effect ie turning off your ovulation, like the combined pill. You still have to get something put in and taken out so it’s not any different in that respect to the IUD.

I think short interval IUDs are a very appropriate contraceptive method between pregnancies if that works for you (about to get my fourth in a decade next month myself!). I needed my first put in in an operating theatre but it just got easier after each baby. Honestly I think she could have chucked the last one in like a javelin,
I’ve had pap smears take longer.
posted by chiquitita at 2:46 AM on April 1, 2022 [1 favorite]

Demand appropriate pain medication for the insertion and removal. If you knew it wouldn't be painful, would that change your calculations? You shouldn't have to deal with unknown effects of a new form of birth control when they SHOULD be making the process pain free. If more women demanded it, maybe the gaslighting around IUD insertion would change too.
posted by asimplemouse at 7:53 AM on April 1, 2022 [7 favorites]

Came here to say what asimplemouse said -- demand that they give adequate pain management and also ask for the drug they give to soften the cervix (I think it's mifepristone).
posted by Medieval Maven at 8:36 AM on April 1, 2022 [1 favorite]

Nthing that Mirena insertion after a vaginally delivery was not really painful.
posted by jeoc at 2:50 PM on April 1, 2022

I have Kyleena and have had Paragard in the past, I only felt maybe a tiny pinch with insertion and removal after cesarean birth.
posted by tatiana wishbone at 8:07 PM on April 2, 2022