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comets! posted:So, my gyno offered me Mirena with virtually no discussion whatsoever (said it would be fine because I'm ok on the Orsithyia pill). Turns out my insurance will cover it 100% and, since I will probably be losing that insurance soon, the prospect of BC taken care of for 5 yrs is attractive. You shouldn't have increased UTIs with Mirena and if you do it's incredibly unlikely that they're caused by Mirena and more likely due to another cause. The string is cut ~2cm from the opening of the cervix, and it usually will curl around the cervix so that it won't bother you or your partner. If it does, the strings can be trimmed.
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Oct 4, 2013 21:38
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One if the nice things about paragard is that it's also really effective emergency contraception!
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Oct 11, 2013 15:15
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Ceridwen posted:Mirena is probably the most likely to work. It results in no periods and no spotting for 20% of women who use it, and no regular periods but some intermittent spotting for another ~60%. The remaining 20% will still have regular periods but for almost all it will be much lighter than before the Mirena. Altogether it reduces bleeding in more than 90% of women who use it. I tell my patients about 40% of women on Mirena will have amenorrhea at 6 months based on the literature I've seen.
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Nov 16, 2013 15:40
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Paragard is also the most effective form of emergency contraception we have available.
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Nov 21, 2013 05:19
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InEscape posted:Emergency birth control? Could you clarify? Like "Oops, the condom broke, we're going to insert this 10-year copper IUD into you, you can take it out in a week, that'll be $800 please?" It doesn't seem effective in terms of feasibility of patient care at all. In a select set of circumstances (e.g. a patient who desires long term contraception and presents having just had unprotected intercourse or the condom broke, etc), it's a great choice.
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Nov 21, 2013 05:57
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snackpants posted:Up front facts: I'm an idiot. He's an idiot. We're all idiots. Plan B has a decrease in efficacy the longer after unprotected intercourse you take it, but can be effective up to around 120 hours after. Ella (ulipristal) maintains about the same efficacy out to 120 hours but requires a prescription - do you have a doc you can visit? Another option would be a paragard as mentioned earlier if you're also interested in longer acting contraception.
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Nov 27, 2013 04:13
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While there have been a few studies done up to 7 days, 5 days is the usual effectiveness limit used for Paragard. Where are you in your cycle right now?
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Nov 27, 2013 04:39
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snackpants posted:Getting into week four, but my cycle can be a bit irregular. Hopefully you ovulated a week or more ago, but it's still possible that you haven't yet. Do you have a local PP or good OB/Gyn you can get a same-day appointment with tomorrow? superbelch fucked around with this message at 04:52 on Nov 27, 2013 |
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Nov 27, 2013 04:46
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A quick word on why it's not harmful or a sign of ineffectiveness to have either no periods or irregular spotting with hormonal birth control: The two main hormones affecting the endometrium (lining of the uterus that's normally shed every month during a woman's period) are estrogen and progesterone. We consider the cycle to start with menstruation (since that's the easiest thing to observe). After menstruation, estrogen predominates in the first half of the cycle (before ovulation) and causes the endometrium to grow (proliferate - hence, proliferative phase). After ovulation, the follicle that held the egg becomes the corpus luteum and releases massive amounts of progesterone, which quickly surpasses estrogen and causes the endometrium to mature. This maturation is called the secretory phase since it involves the secretion of substances that make the uterus hospitable for an embryo to implant. Progestogen-only methods (minipill, Mirena, Nexplanon, Depo-provera) act to thin the endometrium. Breakthrough bleeding on these methods tends to be what's called atrophic bleeding - bleeding because the lining gets much thinner than normal. Not all of these methods will work by inhibiting ovulation, and it's important to remember that ovulation will cause a change in the hormone profile, so that it can be hard to predict exactly what the pattern will be as these effects will vary from woman to woman. Depo is a high enough dose of a progestogen to reliably inhibit ovulation, and so it also has the highest amenorrhea (no period) rate - 80% at 5 years. Nexplanon has a little bit less suppression of ovulation and tends to have less amenorrhea. Mirena has a lower dose of progestogen in the blood stream, and has even less suppression of ovulation (but has higher rates of amenorrhea than Nexplanon because it has a larger local effect on the endometrium). Because the minipill does not have a high enough dose to predictably inhibit ovulation, it's important to keep the circulating dose of progesterone high to keep the contraceptive effects like cervical mucus thickening. Higher dose progestogen-only pills like Cerazette (lucky UK goons!) have levels of progestogen similar to that of Nexplanon, and thus Cerazette has a more forgiving time window (12 hours as opposed to 3 with Micronor). Combined methods (pill, patch, ring) use an estrogen and a progestogen to suppress ovulation as their primary method of action. Having a progesterone present with the estrogen keeps the endometrium from becoming built up like it would in a normal cycle, and keeps it thinned out. When OCPs were first developed, they tried doing a progestogen only pill but kept the estrogen because having the progestogen-only pill had unacceptable rates of breakthrough bleeding. Pills with a lower dose of estrogen (lo-estrin, etc) tend to have a higher rate of breakthrough bleeding because the estrogen in combination with the progestogen tends to have a stabilizing effect on the endometrium. (I may have made it sound like estrogen and progesterone work against each other, but it's actually a more complex relationship - estrogen actually increases the number of progesterone receptors in cells and makes progesterone more effective). Extended/continuous-use regimens of OCPs reduce breakthrough bleeding and also likely increase effectiveness because continuous or extended use is better at suppressing follicular growth/ovulation. Irregular spotting on hormonal contraceptive methods should not be confused with irregular spotting due to conditions such as PCOS, in which high estrogen keeps the body from ovulating. The increased estrogen also causes the endometrium to proliferate/grow and keep growing without sufficient progesterone to step in and tell it to mature. This is dangerous because this unregulated growth can lead to abnormal endometrial cells and even endometrial cancer. In fact, in patients with endometrial carcinoma who aren't candidates for surgery (usual first-line treatment) because of their other medical problems, we will often prescribe then progesterone methods or even put in a Mirena. Sorry, guys, just realized I geeked out a little bit more than I meant to. Hopefully this makes sense!
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Feb 2, 2014 08:16
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Paragard works as EC because of the effect it has on sperm before fertilization and implantation afterwards. Hormonal IUDs work primarily by thickening cervical mucus and making it harder for fertilization to occur and don't really have as a big of an effect on implantation. I typically will tell patients to use backup for 7 days just to be on the safe side.
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Mar 15, 2014 11:56
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Silver Nitrate posted:I have to get my Implanon changed next month. Do they put the new one in a different arm? How bad is getting it taken out? They'll put the new one in the same arm as the old one. To get the old one out, they'll inject some numbing medicine under one end of it and then use a scalpel to make a very small incision which will allow them to grab it and pull it out.
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Mar 24, 2014 10:50
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Erysipelothrix posted:Does anyone know anything about antibiotics and hormonal IUDs? I've just been put on Minocycline for 3 months and I have a skyla IUD. My doctor said she doubts it will effect the IUD but I might want to use condoms just in case. I would really rather not use condoms if I don't have to. I know minocycline can cause some pretty nasty birth defects if taken while pregnant. So I think that might be why she was suggesting I be extra careful. But if it lowers the effectivenss I will definitely use a back up method. Googling doesn't really come up with anything too concrete with regards to mino and hormonal IUDs. The antibiotic/hormonal bc problem is with rifampin (which can alter the liver metabolism of hormones in the bloodstream, particularly ethinyl estradiol). Minocycline is a tetracycline and doesn't have that effect, but there are other drugs like phenobarbital and griseofulvin that do. The main effect of hormonal IUDs is through local effects on the cervical mucus and uterine environment, so you do not need to use a backup method.
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Apr 19, 2014 02:41
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Freckles posted:(I'm a sex educator, not a doctor, for the record. Your sister should talk to her doctor about this.) I'm an OB-GYN resident doc with a special interest in family planning and a masters degree in public health. The bone density concerns about depo are very common and I've seen them in my colleagues as well. Depo does cause bone density loss, but this plateaus after two years (at about 5.5 to 7.5%) and recovers after women stop using it. The big reason that we would worry about decreased bone density is increased fracture risk. However, all we have are retrospective studies (whereas a prospective randomized trial would be ideal). The data does show that there is an increased fracture risk in women who use Depo, but also points out that the women who choose Depo as birth control are at increased risk of fracture to begin with before using Depo, meaning that it's likely not the Depo causing that risk but rather a function of the general population that chooses Depo as birth control. There is no data to support limiting the length of use of Depo either, given that the bone loss plateaus at 1-2 years. It's also important to note that the degree of bone loss is similar to that seen in pregnancy and lactation, and so it shouldn't be necessary to do bone scans, although I do generally counsel patients to make sure they have adequate vitamin D and calcium intake as well as exercise.
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Apr 24, 2014 13:35
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Reduction in menstrual blood loss and amenorrhea tends to be lower with skyla.
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May 24, 2014 15:45
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Bina posted:This is kind-of serious. I'm 26. What terrifies you about other methods of birth control?
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Jun 14, 2014 00:43
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Infuriated but not surprised. Between this and the abortion clinic buffer zone decision, this has been a very bad week for women thanks to the Supreme Court.
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Jul 1, 2014 00:13
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AquarianFire posted:I'm not on Skyla but on Depo for a year and I just started spotting yesterday with some slight cramping. I have not had a period since the beginning few months and I thought they were gone for good. I'm not even close to my next shot (still another month away). Skyla is low dose progesterone so just like any progesterone only BC, irregular bleeding can be part of the package. I'm thinking of changing to Nexplanon but that contains an even lower dose of progesterone than the Depo and irregular bleeding is the number one side effect. Ugh. About 50% of women are amenorrheic (no bleeding for >90 days) after a year of Depo - this continues to increase to about 70% of women after two years. I'd recommend sticking with it if you've been happy with it overall. If irregular bleeding is a no-go for you, then Nexplanon is probably not for you since you're much more likely to stop having periods with Depo.
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Oct 10, 2014 04:09
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Cat Catterson posted:Condom failed, plan B failed, and now I'm pregnant. And I have sex like once every three months. Now I know why all my hair fell out and why all of a sudden all muscle converted to fat! Hooray! Abortions are apparently really expensive plus I have to wait two weeks because that's the first available appt they had. On the plus side I don't live in one of those crazy states where you have to talk to a counselor and look at baby pictures for 24 hours. But on the minus side no one will ever give me a tubal ligation because I "may want a babby some day." If you're getting a suction d and c, consider Mirena or Paragard at the time of the procedure.
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Oct 10, 2014 20:43
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Not a Children posted:My girlfriend went to see her doctor today to try to get a script for Mirena, but they talked her out of it and she's planning to get the Depo shot in a couple days. Where do you live? Pm me and I can try to help you find a provider.
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Dec 15, 2014 23:23
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cash crab posted:HELLO FELLOW NOT-PREGNANT PEOPLE I am a doctor. You will be fine.
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Apr 18, 2015 01:15
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Absolute Evil posted:So I'm only 2 weeks post-partum but I'm planning on going back on the pill at my 6 week appointment. I was on Trinessa and liked it. I'm seeing conflicting info out there: some sites say that combined BC pills can affect lactation, others say that idea is old news and studies find combination pills don't affect lactation in any appreciable way. I'm breastfeeding but also supplementing already. I asked my OB and he said he hasn't heard of any studies saying combo pills are okay with breastfeeding. Anyone? http://www.ncbi.nlm.nih.gov/pubmed/22143258 http://www.ncbi.nlm.nih.gov/pubmed/23623474 The main argument against combined OCPs in the early postpartum period (first 3-4 weeks) is because of increased clot risk from the estrogen during a time when your clot risk is already very high. You have a good sense of the data - there are some older studies showing that COCs can decrease milk production, but newer studies haven't borne that out. The first link there is to a really well done randomized controlled trial in 2012 that showed no difference in continuation of breastfeeding or infant growth between progestin only pills and combined OCPs. It's definitely reasonable to go back on cOCPs at the 6 week visit.
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May 15, 2015 02:05
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Kimmalah posted:There's no general gynecology thread that I know of. But I do know that there's at least one gynecologist who posts in Goon Doctor and tends to answer these types of questions. There are a few ob/gyns on here that I know of - I am one. Happy to answer questions either in the thread or by PM.
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May 22, 2015 00:25
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First of all, I'm so sorry that you had this kind of experience. The nature of what we do is sensitive and many of the procedures we do are invasive, and it's of utmost importance that you should not feel violated by a medical exam. Not that it excuses this behavior, but seeing and doing pelvic exams and ultrasounds constantly can make it easy to forget that sensitivity and invasivity of what we do. I feel that these exams and visits represent an important opportunity for women to become empowered about their reproductive health, but we unfortunately fall short of the mark much of the time. I'm really not sure why she said she hadn't heard about that before. Your worsening pain/pressure with menses seems pretty classic for endometriosis. It's also not uncommon to have pain with defecation due to endometriosis, if the implants of tissue involve the posterior part of the pelvis. Did you discuss doing a continuous regimen of the OCPs, or switching to a progestin only like depo Provera? Generally, CNMs are women's healthcare "mid-level" providers who have much of the same scope of practice in office-based gynecology as a gynecologist apart from some surgical procedures. Generally they'll focus a little more on the obstetrics/pregnancy side of things but not always, depending on where you are. I wouldn't necessarily write off any other midwives/NPs/PAs because of your negative experience with her. The best gynecology practitioner I know is a WHNP (Women's Health Nurse Practitioner) - she's who my female colleagues go to for their care. If you'd like, PM me with your location and I'll see if I can make a recommendation for another provider in your area.
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May 22, 2015 02:40
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hobbez posted:My GF is now back from across the planet after an extended trip and so her "pill taking" time is now off by 16 hours from what it was a week ago. How long until we can consider the pill working 100% again? Assuming it's a combined OCP, should be fine without needing backup.
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Jul 5, 2015 23:21
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Geolicious posted:Are you a candidate for NovaSure? NovaSure is a technique of endometrial ablation with the aim of burning off the endometrial tissue inside the uterus. Endometriosis is when there is endometrial tissue outside the uterus.
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Aug 29, 2015 15:56
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Scudworth posted:You can temporarily take the ring out, as per the instructions, for up to 3 hours if it gets in the way of sexytimes. Now imagine how many people have hosed that up. The only antibiotic that decreases the effectiveness of hormonal BC is Rifampin (used to treat tuberculosis) so most people will be safe if taking antibiotics while on a hormonal method. Epilepsy/bipolar meds are much more likely to be a culprit in terms of messing with effectiveness.
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Feb 14, 2016 16:04
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Eponine posted:So I posted in here a few months ago when I got Nexplanon but I'm seeing my doctor Monday to probably get it taken out. I got it to reduce periods, but I'm basically having 9 day periods now with about 4 days in between. There are definitely options other than the Nexplanon for reducing your periods. Mirena reduces blood loss by 80% at 6 months, 90% at a year, and around a third of women won't have periods at all. It's also a MUCH lower dose of overall progestin to your body as most of its effect is local on the uterus. Depo Provera has a better shot at completely stopping your periods with long-term use, but does so with higher serum levels of progestin. Progestin-only pills could be an option as well. In terms of non-hormonal treatments, tranexamic acid and ibuprofen can be helpful when taken during your period.
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Apr 17, 2016 04:25
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Radio! posted:Went to my gyno today to ask about getting an IUD because I won't have insurance after the end of the month and she told me that because I haven't had kids it would be too painful and I shouldn't even consider it. Is this bullshit because it sounds like some bullshit. Am a gyno. This is bullshit.
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Dec 20, 2016 00:52
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evelynevvie posted:Hello thread, I have a hypothetical. One thing to keep in mind is that the Mirena is actually effective as contraception for seven years.
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Feb 2, 2017 02:16
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evelynevvie posted:I was told five. When did that change? FDA approval is for 5 (the company likely didn't want to spend the money initially to show that their devices didn't need to be exchanged as often), but medical literature says 7 years. It is used this long in Europe routinely. There is a trial currently enrolling in the US that will be used to pursue FDA approval for 7 years.
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Feb 2, 2017 14:38
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Dirty Deeds Thunderchief posted:I'm posting this in here instead of the endometriosis thread since its more of a general question. I was on Seasonique and then Lo Loestrin Fe for a year and a half or so, and both had pretty lovely psychological side effects for me that lead to me being in a really emotionless, flat fog for the time I was on it. My current obgyn is great and has me off of all forms of b/c (since I was only on it to manage my periods to deal with the really horrible cramps she suspects is due to endometriosis) and has given me a prescription for ketorolac for pain during my periods, and sometimes it's fine, but other periods are total hell. I don't like taking the ketorolac to begin with and I don't want anything stronger, but I'm going to be heading back to college soon and don't know how I can manage entire days that I'm losing to the pain. I know I should probably talk to my obgyn and pursue trying a different type of b/c to help manage this, but my experience with it the first time had such a negative impact on my life that I'm scared to try a different type and wind up losing another 6-12 months of my life to an emotionless fog. I'm a gynecologist. Depending on your fertility plans, I'd recommend considering Mirena, since it can reduce pain related to endometriosis (which we can't definitively diagnose without laparoscopy) and adenomyosis. It's a hormonal method, but because most of the dose is local to the uterus, the systemic dose is lower and side effects regarding mood are much less common. Skyla has an even lower dose of hormone and can be an option if you have side effects with Mirena. I tend to lean towards starting with Mirena because the bleeding profile is typically better (as in, more likely to stop having periods, etc) and the slightly higher dose may be more effective at stopping pain. If you are considering pregnancy, endometriosis does tend to get better with pregnancy. Endometrial ablations are typically much better for bleeding than they are for pain, and if there is endometriosis (endometrial tissue outside the uterus), the ablation wouldn't affect the pain from that tissue.
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Feb 8, 2017 20:17
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Dirty Deeds Thunderchief posted:Thanks for all the responses, guys. Definitely understand trepidation with IUDs or any invasive procedure. However, I would keep in mind that an IUD insertion is a good bit less risky than even a minor surgery like diagnostic laparoscopy. Even if surgery does confirm diagnosis, there will still need to be treatment and it may be worth strongly considering as an option even without confirmation, since it can also be helpful for other conditions that wouldn't necessarily be diagnosed with surgery. I will also say that I have inserted IUDs in women who haven't had babies and women and teens who haven't had sex (for heavy bleeding and/or pain) and the vast majority have done well (which is not to say there was no cramping or discomfort). Please feel free to PM!
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Feb 8, 2017 23:10
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pizzadog posted:Does anybody have any ideas if a low dosage birth control would help with the acne i'm still getting at over 30 years old? Getting a little old, kinda clashes with my grey hair. The estrogen-containing methods are the hormonal methods most likely to help with acne. Usually I'd recommend doing them along with a topical retinoid, potentially an antibiotic. The third generation progestin-containing OCPs (like Yaz) tend to have the best anti-acne activity. Spironolactone is another medication that can help with acne in the same way as OCPs.
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May 6, 2017 03:14
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Bollock Monkey posted:I've been on the combined pill for most of the last 13 years, and over the last 12 months or so the idea of trying a copper coil (I don't tolerate progesterone-only contraception - I had to have the implant taken out after 6 months of constant spotting) has been popping into my head. It's partly because I wonder what I'm like without the pill, and how my sex drive would be (which has tanked over the last few months) and also because in the next few years it'll be time to think about getting pregnant and I worry that after so long on the pill it'll take me forever to get back to baseline hormonally. Being on the pill shouldn't cause any long-term effects in fertility. Women will generally start ovulating again within a few months of stopping the pill. If you have really heavy, painful periods I'd recommend you at least consider one of the levonorgestrel IUDs, especially Mirena or another 52 mg device (which are approved for treating heavy bleeding as well as pain in addition to providing excellent contraception). While like the implant bleeding can be unpredictable, overall the profile is much better and maybe 25-30% of women will stop having periods after 6-12 months with most of the rest of women having only intermittent light spotting. The systemic dose of progestin is low compared to the implant, and since the device doesn't work by inhibiting ovulation, return to fertility is quicker than other methods of contraception.
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Jun 13, 2017 02:21
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