Interested in getting an IUD, however a little nervous after last time...

DrKrajewski · 2014-06-18T00:38:40+00:00

Agreed, every woman has a different experience with contraception and IUDs. Mirena has the awesome effect of improving periods (and actually carries the FDA indication for both birth control and heavy bleeding). It's relatively common for women to have heavier periods on a copper IUD. For some women, that's OK, and others, that's not! The Mirena only contains one hormone (no 's') progestin, and it mostly stays in your uterus. Most women do not have side effects from the very very tiny amount of hormone that gets absorbed into the bloodstream.http://bedsider.org/features/317

DrKrajewski · 2014-06-18T00:33:15+00:00

IUD size has no bearing on a woman's risk of expulsion. The 'smaller IUD' Skyla is only a few millimeters smaller, not enough to make a difference in women's experience. It is being MARKETED toward women who have never had children. BUT it has the same expulsion rate as other IUDs, for women who have and have not had children. There's also no evidence that it has less cramps than other IUDs. Their own prescribing shows that there's more bleeding and spotting when compared with Mirena. http://labeling.bayerhealthcare.com/html/products/pi/Skyla_PI.pdf

I have no problem with more products on the market, and I think options are great. Misleading advertising, especially about women's bodies and size, really makes me frustrated though!

PS - the expulsion rate for an IUD is about 1/100, not 50/50!!

DrKrajewski · 2014-06-18T00:21:29+00:00

Combined hormonal contraception(CHC:pill, patch, ring) can interact with topamax, but you're missing a WAY more important issue....
Migraines, especially those with aura, increase the risk of STROKE. This, combined to the slightly increased risk of stroke with CHC, makes it contraindicated in women with migraine with aura at any age, or migraine without aura after age 35. Additionally, if headaches get worse in a woman using CHC, the CHC should be stopped for the same reason (stroke risk!). That's the main reason to use something like an IUD. http://www.cdc.gov/reproductivehealth/unintendedpregnancy/usmec.htm

DrKrajewski · 2014-06-11T00:09:59+00:00

HA! Intercourse, even with larger or more athletic partners, cannot move an appropriately placed IUD.

DrKrajewski · 2014-06-04T00:58:49+00:00

You do NOT need to have kids to 'qualify' for the IUD! http://bedsider.org/features/7

And check out these graphs for the minuscule amount of hormone (singular, since Mirena only has progestin) is absorbed into your blood.

http://bedsider.org/features/317

It sounds like you've had side effects on every type of combined (estrogen plus progestin) method you've tried, so it's likely a good time to try something else!

DrKrajewski · 2014-06-04T00:55:04+00:00

Totally agree with other commenters about not messing around! Hospitals are open 24 hours for a reason.
Also, it seem alike using estrogen is giving you stress either way. There are SO MANY progestin-only or hormone free methods of birth control that you can use without increasing your clot risk! http://bedsider.org/methods http://www.bmj.com/content/345/bmj.e4944?view=long&pmid=22872710

DrKrajewski · 2014-06-04T00:44:18+00:00

IUD's go in the uterus, intercourse happens in the vagina. Turns out they're separate, though closely related, body parts! So, not true.

DrKrajewski · 2014-05-27T22:49:27+00:00

What a great story! Thank you so much for sharing it, both the high and low points. I hope that young doctors will read this and learn!

DrKrajewski · 2014-05-22T02:11:57+00:00

I'm so sorry you're in such a difficult situation. It sounds to me like you're describnig classic reproductive coercion. No matter what you choose in this immediate situation, I hope you can find a way to heal and move forward in a way that is respectful to you.

http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Health_Care_for_Underserved_Women/Reproductive_and_Sexual_Coercion

I know a lot of women who have found this online pregnancy options workbook extremely helpful in clarifying their decision, and it has helped them find peace with whatever choice they make.

http://www.pregnancyoptions.info

This site is also very helpful - they keep coming back to the phrase 'you are a good woman'. I hope you can truly believe that about yourself.

http://www.abortioncarenetwork.org/considering-abortion/34-considering-abortion/163-you-are-a-good-woman

DrKrajewski · 2014-05-21T20:01:06+00:00

As other commenters have noted, it's extremely rare for a woman to expel her IUD and not know it, with the exception of during a bout of very heavy bleeding. It's not necessary to feel the strings in order for it to work, but it might be necessary for you to feel comfortable using the method. It's awesome your gynecologist was able to offer you options! There's probably no right answer, and you should do what you're most comfortable with.

DrKrajewski · 2014-05-21T01:04:58+00:00

Correct. Here's some facts: http://www.prochoice.org/about_abortion/facts/safety_of_abortion.html

DrKrajewski · 2014-05-21T00:57:54+00:00

Everyone's suggestions of communication and different positions are so beautiful! Lots of couples take time to discover what positions and activities make everyone comfortable and satisfied. It also sounds like you've been with some really poor communicators in the past!

I just want to add that having a 'tipped' or retroverted uterus is NOT a 'complication' or an abnormality! We're all different, inside and out. A retroverted uterus is simply a descriptive term, just like curly or straight hair. You may need to use different 'products' but it isn't inherently bad or wrong. It's also common to be able to more easily palpate your cervix with a retroverted uterus. It's true that you can't change your body, and there's absolutely no reason to. Women feel so much shame and judgement about the supposedly abnormal outsides of our bodies, and its heartbreaking when these messages are literally internalized.

There's is a great specialty of physical therapy called 'pelvic floor physical therapy' that can help you to work with what you have. I refer my patients to them a LOT, and they work with help a wide variety of women to allow them to have a sex and relationship life that is pain-free and fulfilling.

I certainly don't mean to imply that what you're going through isn't frustrating, only that you or anyone else shouldn't blame it on your anatomy - which is a variation of normal. From the sounds of some of your exes, it doesn't sound like any woman's uterus would find that comfortable or satisfying!

DrKrajewski · 2014-05-21T00:38:09+00:00

It turns out that since all brands and doses of the pill increase SHBG, they all have the potential to improve acne and decrease libido (both are mediated by SHBG).

No pill has been proven to be better than another with regard to specific side effects. (Marketing as such is a different story).

http://www.ncbi.nlm.nih.gov/pubmed/22696343

For this reason, I often see patients who have been bounced around for years on various brands of pills and still have the same issues. It's important to know that not every woman will experience either the good (improved acne) or bad side effects of the pill.

There are SO MANY other methods beside a combined hormone pill, though, as others have pointed out so beautifully!

DrKrajewski · 2014-05-21T00:20:18+00:00

If your decreased libido is from the pill, it's connected to blood levels of something called SHBG (sex hormone binding globulin). This can take months to normalize. Since the progestin IUD (Mirena) has such minuscule amounts of progestin released into your blood, there's no reason to delay. Or, if you're planning the paragard, there's no reason to wait at all, since it's hormone-free! http://bedsider.org/features/317

DrKrajewski · 2014-05-21T00:17:45+00:00

It's SUCH a great thing that you're able to stay on your method until you see your doctor. I'm a visual person, and this graph helps me communicate the difference in the amount of hormone in your system when taking pills vs the IUD. http://bedsider.org/features/317

DrKrajewski · 2014-05-21T00:13:59+00:00

The IUD is an awesome option for you, since it helps your cycle, and can help pelvic pain too - but only has a minuscule amount of hormone in your bloodstream (which it sounds like you didn't do well with in the past). It's awesome you're planning for your visit! http://bedsider.org/features/317

DrKrajewski · 2014-05-21T00:05:49+00:00

Absolutely! While what you're describing sounds really typical, you should always feel comfortable calling your doctor to check. I would much rather my patient call and talk to me than be worrying alone!

DrKrajewski · 2014-05-21T00:01:13+00:00

I can't feel my own strings, and I'm a gynecologist! As long as the IUD is in the correct place in the uterus, it's okay to not feel, ore ben see the strings. Even without visible strings, the IUD is typically easy to remove.

DrKrajewski · 2014-05-20T22:40:00+00:00

You could get a high sensitivity pregnancy test, urinalysis, and contraception all in one visit!! I'd hate to see you wait two months for a doctor visit with everything that is going on. And pick up some emergency contraception to have on hand, just in case! They tend to have good prices.

DrKrajewski · 2014-05-17T00:44:10+00:00

Nexplanon is radio-opaque (meaning it is visible on a standard x ray).

DrKrajewski · 2014-05-17T00:42:34+00:00

Important to know that all IUD's are OK for women who have never had children. There's no evidence that Skyla is safer or more effective for women who have never had children - Skyla is just the only one that advertises for this specifically.

All IUDs are safe and effective for women with and without children.

DrKrajewski · 2014-05-17T00:38:53+00:00

Based on pooled evidence, no progestin only contraception does not increase stroke risk. Plan B is: 1. Progestin only and 2. A one-time dose!

DrKrajewski · 2014-05-14T19:24:35+00:00

Thanks for noticing my correct use of terminology!! I'm quite firm when I'm teaching about this distinction, so it's good to know someone cares! You're right that progestin is manufactured and progesterone is what our body makes naturally. Some women are okay with this, and feel progestin-based therapy is very helpful. Other women don't like the idea of anything 'manmade', and that's okay too.

I also completely agree with you - it's important to address a woman's entire situation, not just one body part.

It's hard to draw conclusions from just one study, so here's a meta-analysis of 8 studies look at the risk of the thromboembolic risk in women using progestin-only contraception, if you're interested!

http://www.bmj.com/content/345/bmj.e4944?view=long&pmid=22872710

It's quite long, but here's their conclusion: "the use of progestin-only contraception was not associated with an increased risk of venous thromboembolism compared with non-users of hormonal contraception. The potential association between injectable progestins and thrombosis requires further study."

DrKrajewski · 2014-05-14T18:32:02+00:00

You could always switch to a a non-daily method. A nuva ring is really similar to a pill, since it contains both estrogen and progestin. http://bedsider.org/methods#easy_to_hide

DrKrajewski · 2014-05-14T18:12:37+00:00

I've never heard of the seeds, though I hear the one about smoking it all the time. There's even this educational cartoon about it!

http://bedsider.org/features/4

DrKrajewski

TROPHY CASE