Teen needs help considering birth control options

[SKL]

So we had the initial consult and were told various pros and cons of different methods.

(Note kid is not yet sexually active but we believe in being pro-active.  Kid does not have "heavy/painful" periods to address.  Kid uses tampons.)

I went in expecting that the copper IUD would be the clear winner, but the professionals seemed to have a lot of reservations about that.

Options discussed:  Mirena (progesterone) IUD, copper IUD, and the Pill (Estrogen + Progesterone)

Considerations we've been informed of:

• With both IUDs, pregnancy is still possible (though <1%); and a pregnancy would be dangerous, probably not viable, and possibly fatal to the woman.
  • It isn't clear to me whether one or the other IUD is more effective.
• Both IUDs will cause at least several months of discomfort and bleeding as the body gets used to it.
  • But they say the copper IUD is worse in this regard.
  • Not sure but did they say the copper IUD hurts more going in than the Mirena IUD?
• Copper IUD lasts about 10 years, Mirena IUD 7-8 years they say.
• They say the Mirena IUD will stop periods, but the flyer indicates this only happens for 20% of users.  Copper IUD does not claim to stop periods.
• Copper IUD is just 100% copper.  Mirena IUD uses progesterone.
  • They tell me progesterone is not linked to cancer.
• The Pill uses progesterone & estrogen.
  • They admit that estrogen is linked to cancer, but they imply the risk is low.
• All 3 methods can be stopped at any time and supposedly do not impact future fertility.

They were initially just going to prescribe the pill until I asked about IUDs.  After hearing the various pros and cons, we decided to start the pill and discuss at home and call to schedule whatever procedure we decide on.  They said the pill, which will also cause side effects as the body adjusts to the hormones, will make it easier to transition to whatever changes are going to happen with the IUD.  (We also understand that condoms should be used regardless of long-term method.)

My questions:

• Does anyone know whether the copper IUD or the Mirena IUD is more effective at preventing pregnancy?
• What are real-life experiences with each kind of IUD, in terms of pain and suffering?
• Any other considerations or facts that should inform this decision?

 

[fraidycat]

The only real life experience I have to share is that I bled almost non-stop for 6 months after copper IUD insertion - my periods flipped to bleeding for 21+ days and stopping for 5-7 before starting again, so had it removed. I was pretty much a zombie by the time it was out - so exhausted, I assume from loss of blood and minerals. 

Edited February 16, 2023 by fraidycat

[Carrie12345]

I LOVED my Mirena. I recommend it to everyone WITH full information. My sisters love theirs.

Mine failed. Ectopic. Miserable ordeal. Still would have gotten a second if not contraindicated.

There was no difference with insertion between that and copper for me, and no discomfort after the first day. Copper did make my heavy bleeding heavier. Mirena made it lighter.

I had my copper removed because I couldn’t take the bleeding.

[NewIma]

I am on my second Mirena and will encourage my kids to get one. Insertion is easiest during your period, as the cervix is slightly open. Both times i had a brief sharp pain (2 seconds) and then mild period like cramping for less than 24 hours. My periods started getting lighter immediately and after a year I only had very very light spotting for a day, every 3 or 4 months. I no longer have PMS or cramps. It has been glorious! 

The Mirena is more effective than even a vasectomy!

[kristin0713]

I would never recommend an IUD for a teen. I had a horribly painful experience with insertion of my first one. With my second, my m/w prescribed me something to dilate my cervix and gave me pain meds and it was a much less painful experience. FWIW I do love having an IUD. I just can't fathom a teen going through the insertion process. As far as effectiveness for BC, I don't know. I have it to control my awful periods. DH had a vasectomy years ago so the BC aspect is irrelevant for me. 

DD is on Lo Loestrine for her periods. It's not a mini-pill, but has the lowest estrogen of any regular BCP. Might be something to consider if you want to do a pill but a lower dose. 

[Amy in NH]

My 17yo got the mirena. She has a boyfriend, but was inexperienced with ob and otherwise.  Her good insurance was ending, and I wanted her to have something that would last her through college, so we planned ahead to get it done before insurance expired. We went to PP for it because we wanted a provider who does these all day every day. She did a trial of similar hormones in pill form first to make sure there were no adverse effects. Insertion was not an issue. She did have bad monthly cramping prior, which has since disappeared.

[Storygirl]

One of my daughters has the Nexplanon implant in her arm. We went to a clinic at our children's hospital, and they presented all of the options, and DD chose this one. It is good for 3-5 years. I don't see that option in what your doctor presented, but it's popular among my DD's friend group.

[prairiewindmomma]

Can this kid consistently take medication without fail? If there are issues with ADHD or other things in the mix, I would be hesitant to recommend the pill.

[Corraleno]

My DD has the Nexplanon insert, I'm really surprised the doctor didn't offer that as an option. It's like a little rod that's inserted under the skin of the upper arm; the skin is numbed so insertion is painless and it's not even noticeable once it's in there. It lasts 3-5 years, and you never have to worry about forgetting to take a pill.

[Guest]

I had Mirena and it was fine, but then I got bre€st cancer (which was estrogen and progesterone receptor positive) and had it removed and replaced with copper. My oncologist swore up snd down the cancer and mirena were not correlated but I have never been completely confident about that. 
 

Insertion and removal in both instances was honestly not that big a deal. It’s not an activity I would be keen to repeat frequently but it was quick and not any worse than other things I dislike, such as vaccinations and blood draws. 
 

It wouldn’t be my first choice for a teen though. My dd had serious dysmenorrhea, though so pills were the obvious choice in her case. 

[Christina78]

My 17yo also got Nexplanon. We didn’t choose an IUD for her mainly because we were told that insertion could be be quite painful since she hadn’t had sex yet. I have Mirena and love it!

[BusyMom5]

I had a copper IUD and would not recommend it at all.  I agree with being responsible and proactive,  but if sexual activity isn't happening or close to happening,  I would wait.  It isn't clear by your OP, so if it is a possibility, then I agree to start BC, but if not, it seems there are a lot of young adults who are not sexually active, so I  wouldn't want to use any method unless needed.  FWIW,  mine just got on the pill.   Shes responsible with taking daily medication and has a timer set on her phone.  

[Ottakee]

Nexplanon is what my girls have.  Works 3-5 years and insertion and removal is easy.

[City Mouse]

My own DD did the shots first and now has Nexplanon. In fact, she got her second implant this past fall when the old one was removed. She has no periods now and is very happy with it

[SKL]

I know someone who got pregnant with the arm implant.  How does the effectiveness compare?  What hormone(s) does it use?

[Storygirl]

8 minutes ago, SKL said:

I know someone who got pregnant with the arm implant.  How does the effectiveness compare?  What hormone(s) does it use?

It's been a few months since we talked about it with the doctor, so I can't answer your technical questions.

But we did discuss that no birth control method is 100% effective, and that if DD chose to have sex, they should also use a condom, both as back up pregnancy prevention and also disease protection. Because the arm implant won't protect against sexually transmitted infections.

I think it's an important message that two forms of birth control are always recommended. That should ease worries about the small chances of pregnancy.

Our doctor told us that out of five women with Nexplanon, one will never have periods. One will have constant bleeding and will go off of it and choose something else. And three will have light periods. So it may not be best for everyone.

We chose it because DD won't have to remember to take pills. And she wouldn't have to have anything inserted gynecologically. And it lasts for years. She has had no side effects, other than a bruise on her arm for a few days after insertion.

[kbutton]

Under what else do you need to know...anything that involves estrogen means a serious discussion about risk factors for blood clots in women who have migraine with aura. I assume you don't know about genetic clotting risks otherwise since your DDs are adopted. 

Some doctors are careful about this, and others are not the least bit careful. There are campaigns here and there for greater awareness of this issue that wax and wane.

I am not completely up-to-date on all aspects of the issue, but I do know that my doctors brushed off my concerns, and I used a combo pill safely for a while (though it did increase my BP every time) in spite of migraine with aura (and since that time, a whopping number of people in my family have had blood clots--it's a substantial history, and includes many people who contributed to my own DNA). I would be a poor candidate now for a variety of other reasons, so I probably still wouldn't get a good explanation. 

Knowing what I know now (family history that hadn't happened yet), I am horrified anyone ever put me on a combo pill due to migraines with aura, much less that at least three different doctors prescribed them for me without a hint of concern.

[bolt.]

My personal experience with Mirena IUD was that insertion was *very* painful. And the next few days had a lot of 'bad period' type of pain unless I spent most of my time laying down. After those few days, I did not have 'months' of discomfort to adjust to -- it was only that my next period after the insertion was among what I considered a 'bad period' (compared to my personal norm). The one after that was minimal, and since then they are either nothing (most common), a bit of cramping with no production, or some spotting or pink toilet paper.

It is so good to have no periods. I think "no periods" as a technical term would mean "absolutely nothing, ever" -- which isn't really what I describe above (occasional cramps, rare spotting) so maybe that explains the percent of people who can really say that their periods are completely eliminated. But, for me, my periods are functionally and experientially eliminated. Does that make sense?

My older teen's experience was similar overall, except her insertion was done by a pediatric gynecologist, under general anesthesia -- which is the norm for teens under our medical system. I think that's far better because it's invasive, painful, and personal. As a woman in her 40s I've had many experiences "down there" (sexual, childbirth, medical, etc.) and can compartmentalize the painful procedure away from my sexual understanding of myself and my body. A teen, especially a non-sexually-active or completely inexperienced teen, might find the insertion quite traumatic.

Aside from cancelling her periods (the main goal) I gain great comfort from knowing she is protected from unwanted pregnancy now and well into her future.

All the female people in my family have heavy painful periods that interfere with life. My younger teen might look into the same solution in the future. For now, we all feel really bad for that teen, as they are now the only member of the household dealing with menstruation!

Edited February 16, 2023 by bolt.

[Katy]

Most OBGYN’s use Mirena because it’s not only highly effective, the hormones are local, lower dose, and reduce period symptoms. 

[rebcoola]

My understanding is doctors are not really wanting to put either IUD in teens who are not sexually active because of pain.  We are doing the pill my kids already have daily meds so it's easy to remember. 

[stephanier.1765]

I loved Mirena but I was much older, as in my 40's. It slid me right into menopause helping to alleviate some of the symptoms. I did find the removal painful. I don't think insertion was but I don't have a strong memory of that. And even though I loved it and loved having no periods for years, I'm on board with the others that might not recommend that for an intact teen. I imagine that it would be painful.

[sweet2ndchance]

I've gotten pregnant twice on a paraguard copper IUD. Lost the baby the first time. The second time we removed the IUD early in the pregnancy but still lost the baby in the second trimester (16 weeks). No proof one way or the other if the IUD had any thing to do with the second loss. During neither loss was my life in imminent danger. I think the major threat to the woman's life is if the pregnancy is ectopic which is slightly more likely with an IUD of any kind but neither of my IUD pregnancies were ectopic.

All that said however, I am once again considering an IUD. I've had 3 paraguards; two of which failed (I know for sure the second fail was due to faulty insertion. Make sure they check with an ultrasound that the device is properly inserted after the procedure). If I do get another IUD I am going to try Mirena this time. Not because the paraguards failed but because I'm having heavy periods (well before I got pregnant recently which by the way was not an IUD fail) that make me anemic and my doctor wants me to try it.

All in all I would recommend an IUD if the person is a candidate for it despite my experience. My pain and discomfort with the paraguard was minimal. A little bit of pain going in (they always numb my cervix so maybe that's why? I don't know if that is standard or not to numb the cervix) but once the procedure was done the pain was gone. Periods were no more or less painful or heavy for me. They stayed the same as they were before the IUD. When the IUD was removed I have always been able to successfully conceive when I wanted to. My pregnancies on IUDs are a bit of an anomaly I'm told by my doctor. My experience, in that respect, is definitely not the norm.

 

[Clarita]

4 hours ago, SKL said:

My questions:

• Does anyone know whether the copper IUD or the Mirena IUD is more effective at preventing pregnancy?
• What are real-life experiences with each kind of IUD, in terms of pain and suffering?
• Any other considerations or facts that should inform this decision?

Don't know which is more effective. Although I never got pregnant with either one and I'm married so the deed is happening.

I HATED the copper IUD. It made my periods worse (more blood, more cramps, more discomfort). My periods were normal before, only using IUD to prevent pregnancy. I'm using Mirena now, it's much better (actually reduces my periods). 

I did use pill (a low dosage one) it put me in really bad moods. I was just a very grouchy person and normally I'm a pretty happy go lucky person. 

[Clarita]

No pain with insertion. I've had more pain/discomfort during pap smears and initial ultrasounds.

[Lecka]

I would be really concerned about the insertion of an IUD with a teen girl.  
 

I could also see it not being a concern with some, but I think it would be for some for sure.  

 

Even if it’s not painful it’s still a pretty intense for someone who is on the young side, I think.  

Edited February 16, 2023 by Lecka

[SKL]

The nurse who talked to us said both of her teens are on Mirena, so I assume the pain isn't horrific for most.  She said there is a pill they can give the girl in advance that dilates things some.  Nobody's denying there will be some pain, but I think being sexually active is going to involve pain at some points.

My issues with the pill are the links between it and health problems, and the fact that it depends on my kid's compliance.  My kid is on a daily OCD med that she doesn't remember to take every day.  She won't take vitamins / supplements without being coerced.  Despite having gone through a lot to diagnose her digestive issues, she won't use Lactaid or the pill prescribed to help manage her IBS.  She really does not like taking pills.  She says she'll take the BC, but ....

Edited February 16, 2023 by SKL

[kristin0713]

@SKL what about the depo shot? I hear you on the pills. My DD is on BCP for her periods and meds for OCD. I set it up every week in a daily pill case. We both have reminders on our phones and I look at the pill case every night to make sure she has taken her meds. I know I can't do this forever, but for now I'm still managing it. 

[bolt.]

12 minutes ago, SKL said:

The nurse who talked to us said both of her teens are on Mirena, so I assume the pain isn't horrific for most.  She said there is a pill they can give the girl in advance that dilates things some.

From the anicdata I have gathered on insertion pain, it seems like this is just one of those ways that anatomy (or something else) has a variation. It's not a procedure that just hurts x amount, and some people find it more of a big deal than others. The reality seems to be that women really have vastly different experiences with the necessary dilation for insertion -- and there's no predicting it.

I think sometimes the cervix spasms, and sometimes not, and sometimes to a greater or lesser degree. Maybe painful insertions are rare enough that pain management isn't something that makes sense to offer for every insertion. Maybe a lot of them are no more painful than a blood draw or a pap smear. But with a teen, I would want the most help available.

Sexual activity does not involve the cervix, and I have been sexually active for a long time, but (as I mentioned) my experience was truly awful. Like, she had to take a break and try again a second time. I've had children (which usually involves the cervix) but both by c-section: so it was kind of bypassed. Maybe that's relevant? But I don't think being sexually active or not makes a relevant difference. It's the cervix not the hymen that is relevant to the pain.

A dilation pill would certainly have been a help though!

[Corraleno]

5 hours ago, SKL said:

I know someone who got pregnant with the arm implant.  How does the effectiveness compare?  What hormone(s) does it use?

According to the CDC, the implant is one of the most effective methods there is, with a failure rate of 0.1%. It uses progestin.

Failure rate for other methods: Mirena IUD 0.1-0.4%; copper IUD 0.8%; shot 4%, pill 7%; patch or ring 7%.

[Clarita]

2 hours ago, Lecka said:

I would be really concerned about the insertion of an IUD with a teen girl.  
 

I could also see it not being a concern with some, but I think it would be for some for sure.  

 

Even if it’s not painful it’s still a pretty intense for someone who is on the young side, I think.  

Having done both I probably actually swing IUD for a teen than the pill. The IUD just felt more localized and less invasive. I was crazy on the pill. I understand a certain group of people insertion of an IUD is a problem. If it's not though, it isn't that traumatic. For a normal person it's pretty quick I think the whole appointment took less than 15min, there is more time spent on preparation than actual insertion. I mean I was prepped for a traumatic experience, I had the nurse holding my hand and everything. 

Unless there is some other medical concern that your doctor has for IUD vs pill I would 100% pick IUD. I know at one point in time there was a concern over IUD and future pregnancy and pill was more "safe" in that regard, but of course it seems like they know more or things are different now.

[KungFuPanda]

I loved the copper IUD, but hormonal bc was not a good fit for me at all. I’d go with the pill or an arm implant for a teen. Neither is good for STDs, so they’d need to double up anyway. 

[kristin0713]

3 hours ago, bolt. said:

From the anicdata I have gathered on insertion pain, it seems like this is just one of those ways that anatomy (or something else) has a variation. It's not a procedure that just hurts x amount, and some people find it more of a big deal than others. The reality seems to be that women really have vastly different experiences with the necessary dilation for insertion -- and there's no predicting it.

I think sometimes the cervix spasms, and sometimes not, and sometimes to a greater or lesser degree. Maybe painful insertions are rare enough that pain management isn't something that makes sense to offer for every insertion. Maybe a lot of them are no more painful than a blood draw or a pap smear. But with a teen, I would want the most help available.

Sexual activity does not involve the cervix, and I have been sexually active for a long time, but (as I mentioned) my experience was truly awful. Like, she had to take a break and try again a second time. I've had children (which usually involves the cervix) but both by c-section: so it was kind of bypassed. Maybe that's relevant? But I don't think being sexually active or not makes a relevant difference. It's the cervix not the hymen that is relevant to the pain.

A dilation pill would certainly have been a help though!

My experience was the same and I had two kids vaginally. It was so horrible. I can’t even fathom scheduling my daughter for an IUD. No way. 

[Clarita]

I mean the other thing is you can always switch if she doesn't like whatever she tries first. 

[Amy in NH]

RE: IUD Insertion...

I've had three Paraguard copper IUDs, and none of them were terrible insertions.

As I stated above, my 17yo recently got the Mirena without any insertion trauma, and she had never seen a gyn or been sexually active.  She said the worst part was the measurement, but even that wasn't as bad as her worst cramps.  And she is super-thrilled that she no longer has debilitating nausea and cramping because her period has been so light since she got the IUD.  I wonder how much of the trouble with insertion has to do with the experience-level of the inserter? 

[Laura Corin]

I was very happy with the Mirena - I had it after childbirth, so I don't know what insertion would be like in a teen.  My periods pretty-much stopped - just occasional spotting thereafter.

One thing to consider: there is a 'string' that comes out of the cervix into the vagina.  Husband found that very uncomfortable.  We had it trimmed very short so that - over time - it disappeared into the cervix.  I am very aware of my body, so had no concerns about the IUD expelling without my noticing. The lack of string did, however, make removal a slightly more complex procedure when the time came. 

Just something for your daughter and partner to know: discomfort can occur but there are ways around it.

[ktgrok]

I would NOT NOT NOT NOT ADVISE AN IUD in a teen girl with no sexual history!!!!!!

They can be traumatically painful to insert for MANY women. And not having had a kid before, or even sex, I'd think it more likely she'd be in that category. Add in having her first experience of something going in there with another person being tramautic and I'd be afraid it could effect her future enjoyment of sexuality, for fear of pain. 

You CAN find doctors that will do a cervical block to numb the cervix, but that isn't a bed of roses either, although MUCH better. 

The pill is a good option right now, as she can stop it if she wants, without having to go back in and have someone dig around in her hoo ha. 

[ktgrok]

16 hours ago, bolt. said:

From the anicdata I have gathered on insertion pain, it seems like this is just one of those ways that anatomy (or something else) has a variation. It's not a procedure that just hurts x amount, and some people find it more of a big deal than others. The reality seems to be that women really have vastly different experiences with the necessary dilation for insertion -- and there's no predicting it.

I think sometimes the cervix spasms, and sometimes not, and sometimes to a greater or lesser degree. Maybe painful insertions are rare enough that pain management isn't something that makes sense to offer for every insertion. Maybe a lot of them are no more painful than a blood draw or a pap smear. But with a teen, I would want the most help available.

Sexual activity does not involve the cervix, and I have been sexually active for a long time, but (as I mentioned) my experience was truly awful. Like, she had to take a break and try again a second time. I've had children (which usually involves the cervix) but both by c-section: so it was kind of bypassed. Maybe that's relevant? But I don't think being sexually active or not makes a relevant difference. It's the cervix not the hymen that is relevant to the pain.

A dilation pill would certainly have been a help though!

Yup. I'd had several vaginal births and it was HORRIFFIC. My cervix went into spasm and even with topical numbing they couldn't even get it in the first two times. Third time I went to a doctor that would use an injected cervical block and ultrasound placement. That worked, and was much better. But even then, my cervix spasmed or my uterus did (not sure) and kicked the dang thing back out at first! Like, he was just getting it in place and it started coming back out! 

And I've read probably a hundred other women say how traumatic is was for them (in comments, etc). It's not uncommon for it to be horrible. 

[theelfqueen]

On the question of effectiveness 

https://www.acog.org/womens-health/infographics/effectiveness-of-birth-control-methods

 

[SKL]

I wonder why they didn't talk about the implant if it's so effective.  Anyone have any thoughts on that?

[Lecka]

I don’t know why this specific person didn’t recommend the Nexplanon.  It’s recommended where I go, in general.

 

I think it’s worth looking into, though, because it is long-lasting.  
 

Edit:  just for birth control — I don’t know why it wouldn’t be an option.

 

But I don’t know if another choice is better for managing periods.  
 

 

Edited February 17, 2023 by Lecka

[Ottakee]

8 minutes ago, SKL said:

I wonder why they didn't talk about the implant if it's so effective.  Anyone have any thoughts on that?

Could be the doctor isn’t trained to do it.  I know my primary care is but not all are.  I would ask about it as it is a simple procedure and most effective.  You might need another doctor or the health department to do the insertion.

[Lecka]

I also think maybe being inconsistent with the pill is not a huge issue if she’s not sexually active.

And if she has other pills anyway — I think either you are monitoring anyway, or who knows, maybe she will be more motivated to take pills on her own if she is motivated for this.  

[Lecka]

For peace-of-mind birth control, I don’t know why not to recommend Nexplanon.  Like — if that is the primary goal.

 

It does not last as long as an IUD, but it lasts 3 years.  I think it’s pretty-much replaced the birth control shot.  

Edited February 17, 2023 by Lecka

[Sneezyone]

DD ended up choosing Mirena after consulting with PP and me b/c she wanted something longer lasting. They do use an anesthetic for insertion at PP. She said it was fine and had no issues beyond irregular spotting for the first 6 months. 

My childhood friend relied on nexplanon without issue. It’s a great option if you want something short term and less invasive.

My personal feeling is that any teen contemplating sexual relationships should be comfortable with the idea of getting an IUD and having vaginal exams performed. If that’s a bridge too far for the patient, they should be reconsidering their relationship.

Edited February 17, 2023 by Sneezyone

[Storygirl]

1 hour ago, Ottakee said:

Could be the doctor isn’t trained to do it.  I know my primary care is but not all are.  I would ask about it as it is a simple procedure and most effective.  You might need another doctor or the health department to do the insertion.

I suspect this.

Our pediatrician said that she would only prescribe the pill, and for other options, she recommended going to the teen birth control clinic at our children's hospital.

I would be concerned that she didn't offer all of the options. We were given a presentation with a variety of choices, including their pros and cons.

I also wonder if, since you mentioned that the doctor's own teens used IUDs, if she is predisposed to believing that is the right choice for most and therefore emphasized it during the appointment. It's not the best mindset for a physician, but doctors are human, after all.

[SKL]

13 minutes ago, Storygirl said:

I suspect this.

Our pediatrician said that she would only prescribe the pill, and for other options, she recommended going to the teen birth control clinic at our children's hospital.

I would be concerned that she didn't offer all of the options. We were given a presentation with a variety of choices, including their pros and cons.

I also wonder if, since you mentioned that the doctor's own teens used IUDs, if she is predisposed to believing that is the right choice for most and therefore emphasized it during the appointment. It's not the best mindset for a physician, but doctors are human, after all.

This was an OB-GYN office, so one hopes they know how to do these relatively routine things.  2 professionals talked to us, I assume the OB-GYN MD and a nurse in the practice.

They didn't bring up anything other than the Pill.  After it felt like we were about to be sent out with a prescription and no mention of other methods, I asked about IUDs.  I did not ask about other methods, and they didn't bring them up.

It could be because my kid is 16 and has no past history with sex or birth control.  Maybe their idea is to start out with the least invasive option.  Going in, I expected them to cover at least the basic range of popular options.  Silly me.  😛

At the moment I'm leaning toward the Mirena IUD.  I prefer something that will last well into my kid's higher education journey / early career.  I won't force it if my kid is too scared of the procedure.  She might actually prefer the arm implant.  She asked me about that, but silly me assumed the OB-GYN would have brought it up if it was a comparably safe, effective method.  Maybe we could discuss it on a call, now that she's an established patient.

[mommyoffive]

23 hours ago, kbutton said:

Under what else do you need to know...anything that involves estrogen means a serious discussion about risk factors for blood clots in women who have migraine with aura. I assume you don't know about genetic clotting risks otherwise since your DDs are adopted. 

Some doctors are careful about this, and others are not the least bit careful. There are campaigns here and there for greater awareness of this issue that wax and wane.

I am not completely up-to-date on all aspects of the issue, but I do know that my doctors brushed off my concerns, and I used a combo pill safely for a while (though it did increase my BP every time) in spite of migraine with aura (and since that time, a whopping number of people in my family have had blood clots--it's a substantial history, and includes many people who contributed to my own DNA). I would be a poor candidate now for a variety of other reasons, so I probably still wouldn't get a good explanation. 

Knowing what I know now (family history that hadn't happened yet), I am horrified anyone ever put me on a combo pill due to migraines with aura, much less that at least three different doctors prescribed them for me without a hint of concern.

I am having a migraine right now, so my thoughts might not be super clear. 

Do you have any more info on this?  Would just having the natural estrogen in your body and then be a person who has migraines put you at more risk for blood clots?  Or if you were on the pill decades ago, but then develop migraines?

[Sneezyone]

11 minutes ago, SKL said:

This was an OB-GYN office, so one hopes they know how to do these relatively routine things.  2 professionals talked to us, I assume the OB-GYN MD and a nurse in the practice.

They didn't bring up anything other than the Pill.  After it felt like we were about to be sent out with a prescription and no mention of other methods, I asked about IUDs.  I did not ask about other methods, and they didn't bring them up.

It could be because my kid is 16 and has no past history with sex or birth control.  Maybe their idea is to start out with the least invasive option.  Going in, I expected them to cover at least the basic range of popular options.  Silly me.  😛

At the moment I'm leaning toward the Mirena IUD.  I prefer something that will last well into my kid's higher education journey / early career.  I won't force it if my kid is too scared of the procedure.  She might actually prefer the arm implant.  She asked me about that, but silly me assumed the OB-GYN would have brought it up if it was a comparably safe, effective method.  Maybe we could discuss it on a call, now that she's an established patient.

Our pediatric primary doc took the same approach. Some of them(docs) are VERY uncomfortable with long-acting forms of BC for teens and won’t mention them despite the fact that they’re the most reliable and effective forms of BC for young women and girls. You may have to ask and be firm on asking about all options. You also might want to ask if they provide numbing or pain meds with insertion. Some don’t do that routinely (which is why my own insertion days after delivery was miserable but DDs was not) but PP does as a standard practice. It’s worth it to see a physician who places lots of IUDs, especially in nulliparous women.

Edited February 17, 2023 by Sneezyone

[Condessa]

I had a copper IUD because I didn’t want something hormonal after the crazy emotional issues I had on the pill.  It worked fine without issues for several years until it became embedded in my uterine wall, which was very painful.  Having it removed after it was embedded was extremely painful.

After some years of using natural family planning methods and a surprise baby, I nervously decided to give the arm insert a try.  The doctor said the emotional swings I experienced on the pill were less likely because it is a steady rate of release instead of the hormone levels varying through the day when taking the pill, and it has proved to be way better.  I would definitely recommend an arm insert over an IUD as it works very similarly without the danger of becoming embedded and with less chance of causing an ectopic pregnancy.

ETA: The copper iud did make my periods a bit heavier.  Getting it in failed the first time and was very painful both then and on the second try.  
 

After one period while my body was adjusting to the arm insert, I haven’t had any periods since then.

Edited February 17, 2023 by Condessa

[Condessa]

2 hours ago, SKL said:

I wonder why they didn't talk about the implant if it's so effective.  Anyone have any thoughts on that?

Maybe because it’s newer, so not all OBs do them?  My regular OB has never done the arm implant, after talking over all the options and my past experiences she recommended it to me, but then had to refer me to someone else to get it.