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What are my birth control options?


eternalsummer
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I do not want to get pregnant for quite a while.  I would not be terribly upset if I never got pregnant again, but I don't know that I will feel the same way when I'm 40.

 

I believe the right to life begins at conception, so I don't want to use birth control that would cause a conceived baby to fail to implant (or otherwise terminate the pregnancy).  

 

I've taken the pill before (haphazardly) and had a copper coil, which was fine in terms of side effects.

 

I am prolapsed (stage 1).  I do not have a regular OB at the moment, as we've moved recently.

 

What are my options?

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I think in your position I'd do another iud. Outside of abstinence, it's the most effective birth control method out there.

 

ETA: some family practice docs will do them. A first stage prolapse may not be an issue. Is there a reason not to pursue one?

Edited by Barb_
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IUD's prevent implantation. If you believe that life starts at conception, you need an option that prevents the sperm from reaching the egg. I would combine a barrier method like the diaphragm with a hormonal method that includes estrogen to suppress ovulation (the patch, the ring, and most pills but not the mini-pill).

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With my current clotting issues we are worried about and breastfeeding, as well as the c-section, I have very limited options. We basically can do NFP and barrier methods. Right now I'm planning on trying out the Femcup and spermicide, but the failure rate for moms who have had kids is on the higher side and that's something to consider. Otherwise condoms are the best bet we have that isn't implanted or hormonal.

 

If you can do both implanted AND hormonal you have a lot better options. I agree copper or something like Mirena is going to have a much lower failure rate than a barrier of any kind.

Edited by Arctic Mama
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If you want to have zero chance of preventing a baby from implanting, your only options are NFP, barrier methods (condoms, a diaphragm, a cervical cap, or a sponge), and/or spermicidal products (creams, gels, foam, film, or suppositories). Condoms plus spermicide are 99% effective at preventing pregnancy. 

 

I'll post more in a bit.

Edited by MercyA
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Copying from a previous thread, regarding IUD's:

 

IUD's can indeed prevent implantation.  

 

Estimated post-fertilization losses specifically attributable to the IUD, per year, for various types:

Inert IUD--0.72 to 1.97 losses per year

Copper-380 IUD (Paraguard)--0.19 to 1.04 losses per year

Levonorgestrel-20 IUD (Minera)--0.19 to 1.82 losses per year

 

"These estimates indicate that, although prefertilization effects are more prominent for the copper IUD, both prefertilization and postfertilization mechanisms of action contribute significantly to the effectiveness of all types of intrauterine devices."

 

Source: Mechanisms of action of intrauterine devices: Update and estimation of postfertilization effects by Joseph B. Stanford, MD, MSPH, and Rafael T. Mikolajczyk, MD. American Journal of Obstetrics and Gynecology, 2002;187:1699-708.

 

"Insertion of an IUD in the early luteal phase is a highly effective emergency contraceptive, suggesting that the IUDs act after fertilization.† 

 

Source: Cheng L, Gulmezoglu AM, Van Oel CJ, Piaggio G, Ezcurra E, Van Look PFA. Interventions for emergency contraception [Reviews]. The Cochrane Library 2007; Vol. 2.

 

“Indirect clinical evidence is supportive of the hypothesis that the effect of the copper IUD on the endometrium plays a role in its contraceptive action (Spinnato, 1997)...Also, several long-term studies have established that when pregnancy occurs in IUD users the embryo is more likely to be ectopic than in control women using no contraception or in those who become pregnant while taking oral contraceptives (Sivin and Tatum, 1981; World Health Organization, 1994). The ratio of ectopic to intrauterine implantations is ∼1 in 6–8 among IUD pregnancies compared to 1 in 20 control pregnancies. The most plausible explanation for these findings is that IUDs are more effective at preventing pregnancy when it implants in the uterus rather than the tube, implying that with an IUD in place some embryos reach the uterine cavity but fail to implant.â€

 

Before objecting to the older dates of three studies above, please note that all were cited as valid supporting references in Oxford Journal's Human Reproduction Update, Volume 14, Issue 3, Pp. 197-208, 2008.

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Also copying from a previous thread, regarding oral contraceptives:

 

For evidence regarding implantation inhibition, please see the Archives of Family Medicine article... Postfertilization Effects of Oral Contraceptives and Their Relationship to Informed Consent, which says in part:

 

"To assess the clinical significance of an altered endometrium, it was helpful to examine data that compared endometrial thickness with the receptivity of the endometrium to preembryos during in vitro fertilization procedures. Magnetic resonance imaging scans of the uteri of women reveal that the OC users have endometrial linings that are consistently thinner than the endometrial linings of nonusers,48-50 up to 58% thinner. Of the first 4 ultrasound studies published, the first did not find a relationship between endometrial thickness and in vitro fertilization implantation rates; however, subsequent studies noted a trend, and one demonstrated that a decreased thickness of the endometrium decreased the likelihood of implantation. Larger, more recent, and more technically sophisticated studies all concluded that endometrial thickness is related to the functional receptivity of the endometrium. Furthermore, when the endometrial lining becomes too thin, then implantation does not occur. The minimal endometrial thickness required to maintain a pregnancy in patients undergoing in vitro fertilization has been reported, ranging from 5 mm to 9 mm to 13 mm, whereas the average endometrial thickness in women taking OCs is 1.1 mm. These data would seem to lend credence to the Food and Drug Administration–approved statements that " . . . changes in the endometrium . . . reduce the likelihood of implantation."We considered this level II.2 (good to very good) evidence (Table 1)."

 

Further:

 

"Integrins are a family of cell adhesion molecules that are accepted as markers of uterine receptivity for implantation....integrin expression is significantly changed by OCs. Integrins have been compared using endometrial biopsy specimens from normally cycling women and women taking OCs. In most OC users, the normal patterns of expression of the integrins are grossly altered, leading Somkuti et al to conclude that the OC-induced integrin changes observed in the endometrium have functional significance and provide evidence that reduced endometrial receptivity does indeed contribute to the contraceptive efficacy of OCs. They hypothesized that the sex steroids in OCs alter the expression of these integrins through cytokines and therefore predispose to failure of implantation or loss of the preembryo or embryo after implantation. We considered this level II.3 (good) evidence (Table 1)."

 

Regarding the assertion that hormone levels high enough to allow breakthrough ovulation will also provide a hospitable endometrium:

 

"If breakthrough ovulation occurs while using the COC, then to some extent ovarian and blastocyst steroidogenesis could theoretically "turn on" the endometrium, causing it to normalize prior to implantation in the ovulatory cycle. However, after discontinuing use of COCs, it usually takes several cycles for a woman's menstrual flow to approach the volume of women who have not taken hormonal contraception, suggesting that the endometrium is slow to recover from its COC-induced atrophy. Furthermore, in women who have ovulated secondary to missing 2 low-dose COCs, the endometrium in the luteal phase of the ovulatory cycle has been found to be nonsecretory.â€

 

Also consider:

 

"If the action(s) of OCs on the fallopian tube and endometrium were such as to have no postfertilization effects, then the reduction in the rate of intrauterine pregnancies in women taking OCs should be proportional to the reduction in the rate of extrauterine pregnancies in women taking OCs. If the effect of OCs is to increase the extrauterine-to-intrauterine pregnancy ratio, this would indicate that one or more postfertilization effects are operating. All published data that we could review indicated that the ratio of extrauterine-to-intrauterine pregnancies is increased for women taking OCs and exceeds that expected among control groups of pregnant women not currently using OCs. These case-controlled series come from 33 centers in 17 countries and include more than 2800 cases and controls."

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The subject of implantation is poorly understood. 3/4 of all IVF's fail because science still isn't certain what makes some embryos sticky and the majority not. They weren't any more certain in 1994.

 

An IUD works to create a hostile environment for conception. THEORETICALLY it could cause a hostile environment for implantation because any number of things we do or are exposed to on a daily basis can cause the same phenomenon. The majority of fertilized eggs are lost because of a failure to implant due to a variety of factors.

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My Catholic doctor assured me that mirena iud changes the cervical mucus thickness, prohibiting sperm from meeting egg. She has a several page handout that lists all birth control options, including iud and pills, and their risk for spontaneous abortion. The pill does have the risk, but not the iud. My non Catholic gyn, previously, said the same thing.

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My Catholic doctor assured me that mirena iud changes the cervical mucus thickness, prohibiting sperm from meeting egg. She has a several page handout that lists all birth control options, including iud and pills, and their risk for spontaneous abortion. The pill does have the risk, but not the iud. My non Catholic gyn, previously, said the same thing.

As someone who has had three Mirena IUDs over almost 15 years, I completely agree with the change in cervical mucus based on my own personal experience.

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I don't think we can say that IUDs work only by preventing conception.  In any case, both they and the hormonal methods, theoretically, can work that way, and as far as I know there is little information on how often that might really happen.  So - I guess it depends on whether you think of that as a sort of accident or as having intent attached.

 

That leaves charting and the barrier methods, or both together. 

 

 

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My Catholic doctor assured me that mirena iud changes the cervical mucus thickness, prohibiting sperm from meeting egg. She has a several page handout that lists all birth control options, including iud and pills, and their risk for spontaneous abortion. The pill does have the risk, but not the iud. My non Catholic gyn, previously, said the same thing.

 

That is one mechanism of the Mirena IUD, but not the only mechanism. Minera's own website says:

 

Mirena (levonorgestrel-releasing intrauterine system) prevents pregnancy, most likely in several ways:

• Thickening cervical mucus to prevent sperm from entering your uterus

• Inhibiting sperm from reaching or fertilizing your egg

• Thinning the lining of your uterus

 

According to the AJOG study I cited in my earlier post, the estimated number of post-fertilization pregnancy losses specifically attributable to the Mirena IUD is 0.19 to 1.82 per year of use.

 

When I took oral contraceptives, it was a Catholic doctor who prescribed them. I am very thankful for doctors, but they don't always have or share all the information that is important to me. 

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IUDs don't always prevent implantation. In the last year, two family members got pregnant with an IUD. One gave birth to a healthy baby, with the IUD in place for the whole pregnancy, because it was too risky to remove it. The other suffered a miscarriage, and it was really hard on her.

I have also known several women who got pregnant with an IUD in place; each of them miscarried.

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I don't think we can say that IUDs work only by preventing conception.  In any case, both they and the hormonal methods, theoretically, can work that way, and as far as I know there is little information on how often that might really happen.  So - I guess it depends on whether you think of that as a sort of accident or as having intent attached.

 

That leaves charting and the barrier methods, or both together. 

 

 

For me, if I know it can have that effect (preventing implantation of a fertilized egg), *and* I am taking the product specifically to prevent becoming pregnant, I think I'd have to think of it as having intent attached, unfortunately.    I am not opposed to being argued out of this position (because I'd really like something as easy and reliable as the coil!) but logically it seems pretty clear-cut to me with the way I see things.

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For me, if I know it can have that effect (preventing implantation of a fertilized egg), *and* I am taking the product specifically to prevent becoming pregnant, I think I'd have to think of it as having intent attached, unfortunately.    I am not opposed to being argued out of this position (because I'd really like something as easy and reliable as the coil!) but logically it seems pretty clear-cut to me with the way I see things.

 

No argument from me.  ;) If I take something that I know may prevent implantation, and it does, that is on me (whether I ever know about it or not).

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OP, I'm in a slightly different but similar pickle. I would like to get pregnant again (if we can make sure I'm healthy enough that DH is willing to take the risk), but because I'm recovering from preeclampsia and a c-section, I really should wait a year or two. I'm almost 40, so one would think my fertility would be slowing down, but my FSH level says I'm not really close to menopause. But being that I'm almost 40, who knows how quickly that might change, so I don't want to wait TOO long. Nursing gave me lovely 2-3.5 year spacings between babies, but I can't use that this time (because my baby is deceased), so I do need something. I don't want anything hormonal, nor permanent nor long term, and I'm uncomfortable with the IUD for multiple reasons. So it will likely be a combination of NFP and barrier methods. Sigh. I liked our previous approach of "if it happens, it happens" plus the assumption that eventually it won't happen, much better.

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Is the prolapse not likely to be a concern with a diaphragm?

 

Ugh, I'm going to have to do the charting. And then I'm going to mess it up and get pregnant anyway. On the plus side, my cycles are super regular and I can tell when I ovulate quite clearly.

I have a bit of a prolapse from a million children, it isn't supposed to be much of an issue with the femcup. The spermicide also helps but we may use an additional barrier during my most fertile days because of the failure rate and my insane fertility. So basically we will do all the methods :lol:

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I'm on the ring for PMDD. Nice slow steady hormone levels, and you don't have to remember to take a pill everyday. (You do have to remember to change it once a month.) We still use a barrier method (it was our only method for years), but it's nice knowing I'm probably not ovulating. Would a barrier method plus hormones make you feel confident you are not conceiving?

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It would Lawyer&Mom, but I am told that one of the effects of hormonal birth control is the prevention of implantation of a conceived embryo.

 

 

Off to look up FemCup.  I am also insanely fertile.

 

Happypamama, good luck!  I too liked the days of "if it happens it happens and eventually it will stop happening" but my last pregnancy was difficult and I don't anticipate another easy one, so I have to do something.  Breastfeeding works for me for about 6 months at most.

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ArcticMama, dumb question -- the FemCap requires spermicide, right? I'm sensitive to those, so they're a no go. (I'm also somewhat sensitive to plain KY, so I'm not sure that the non-oxynol spermicide would even work.). So that's probably not a spectacular option, although it sounds like a good idea.

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ArcticMama, dumb question -- the FemCap requires spermicide, right? I'm sensitive to those, so they're a no go. (I'm also somewhat sensitive to plain KY, so I'm not sure that the non-oxynol spermicide would even work.). So that's probably not a spectacular option, although it sounds like a good idea.

I'm using Contragel green because I can't tolerate the OTC conventional spermicides either.

https://www.amazon.com/Contragel-Green-Contraceptive-Gel-60ml/dp/B00GGMFPQ0/ref=cm_cr_arp_d_product_top?ie=UTF8

 

Neem oil is another option, though the efficacy seems higher in a more consistent dose.

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It would Lawyer&Mom, but I am told that one of the effects of hormonal birth control is the prevention of implantation of a conceived embryo.

 

 

I totally understand. For me, the barrier method is my birth control and the hormones are much needed medicine that inadvertently makes me less likely to get pregnant. Who knew PMDD could have a silver lining, right?

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I am pro-IUD and have no personal issue with methods that prevent implantation, but I think it's only fair to stick to facts when someone's shared their criteria.  Sperm sure as heck met egg with my Mirena, and my ectopic nearly killed me.

 

I see it as a real fluke, and I support all my friends who continue to use it.  But a fact is a fact.

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I'm using Contragel green because I can't tolerate the OTC conventional spermicides either.

https://www.amazon.com/Contragel-Green-Contraceptive-Gel-60ml/dp/B00GGMFPQ0/ref=cm_cr_arp_d_product_top?ie=UTF8

 

Neem oil is another option, though the efficacy seems higher in a more consistent dose.

I had no idea there were other options. I had such a severe reaction to spermicide a couple weeks and I'm still not right down there. 😔 I need to look this up. Edited by DesertBlossom
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I am pro-IUD and have no personal issue with methods that prevent implantation, but I think it's only fair to stick to facts when someone's shared their criteria. Sperm sure as heck met egg with my Mirena, and my ectopic nearly killed me.

 

I see it as a real fluke, and I support all my friends who continue to use it. But a fact is a fact.

I'm sorry :(

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My Catholic doctor assured me that mirena iud changes the cervical mucus thickness, prohibiting sperm from meeting egg. She has a several page handout that lists all birth control options, including iud and pills, and their risk for spontaneous abortion. The pill does have the risk, but not the iud. My non Catholic gyn, previously, said the same thing.

Just to be clear on the terminology, "spontaneous abortion" is the medical term for a miscarriage.  A "spontaneous abortion" is a non-deliberate loss of a fetus before viability (generally, the 20th week of pregnancy). So a risk of spontaneous abortion is a risk of miscarriage, for any reason, not just non-implantation.  

 

Pregnancy losses after the 20th week are called stillbirths.  Deliberate loss via pharmaceuticals is called "medical abortion".  Deliberate loss via surgery is called "surgical abortion".  

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