Contraception Question.....Please Help!!

[Jessyca143]

well from experiences ive heard from my friends, depo is the worst of the worst. she will gain weight, and because it is injected, its harder to stop it compared to a pill. im right now having a battle with bc. i take ortho tri cyclen, seems to be the best for sides, and weight gain for me anyway. is she interested in taking anything to help her overcome this? cause clen is doing wonders for me, and my estrogen

jessyca =P~

 

[X.X]

Star, I've never read that the IUD was unsafe or had to be used only after a woman has had a child. I know that there can be perforation of the uterus or perhaps displacement. Infection? I'm not sure about the statistics on that though. I'm just curious as to why this might not be a good option.

 

[MaxBiceps]

well from experiences ive heard from my friends, depo is the worst of the worst. she will gain weight, and because it is injected, its harder to stop it compared to a pill. im right now having a battle with bc. i take ortho tri cyclen, seems to be the best for sides, and weight gain for me anyway. is she interested in taking anything to help her overcome this? cause clen is doing wonders for me, and my estrogen

jessyca =P~

She's about to go on some clen and she's got some phentermine too. Not taking it yet, though. She wanted to go on depo cause you only need one shot once every three months or so, but I guess the sides are the worst of all the options, huh?

 

[Star]

You can only have an IUD after you have given birth. The cervix has to be wide enough and that does not occur unless you have had children. There is not only the risks of what you have mentioned but also the extreme danger that a woman is put in if she does in fact become pregnant while using an IUD. There's also something else about the copper wire. (can't remember though). I would say the odds are 8 out of 10 women have them removed after insertion because of complications.......Cramping......bleeding.....yada yada yada

Star

 

[X.X]

Okay. Interesting. I was assuming that the cervix would be dilated when inserting it. I'm surprised then that there are so many complications. Thanks.

 

[thebabydoc]

a little knowledge...

Ok folks, here it is- (and I AM an Ob/Gyn)

Contraception 101

A. Depo-provera - ("depo") = Medroxyprogesterone acetate, 150mg.
(Progesterone only).
How given: 1 shot every 12 weeks.
Failure rate: 2/1000
Benefits: Extremely effective, requires minimal patient effort other than showing up every 12 weeks, MAY decrease ovarian, uterine cancer risk.
Side effects (roughly in order of frequency):

1. Menstrual Irregularity.
Irregular (LIGHT) spotting for 1st 3-6 months is the norm. Can be every day, once weekly, or monthly. (Note: Women who continue to have monthly menses have a SLIGHTLY increased failure rate, although still about 5x better than the pill). Approximately 75% of women will experience amenorrhea (no periods- a norm for weightlifters anyway) after 2-3 injections. This is NOT DANGEROUS and because the failure rate is so low (2/1000 or .2%), pregnancy testing is unneccessary. The progesterone actually protects against cancer of the uterus.

2. Weight gain (~5%).
YES, 5% of patients. You only hear about the horror stories, it's called SAMPLING ERROR. In other words, who's gonna go around telling you "I'm on Depo and I love it!!!"? Most (>95%) of patients do very well and do not gain significant amount of weight (<5lbs). Patients with history of eating disorders, excess weight are definitely at greater risk of large weight gains (10, 20, even 30+ lbs) over time. This weight gain is reasonably reversible once shots have run out.

3. Depression, mood changes.
Generally tends to occur with patients with prior history of depression or the like. I am very cautious about prescribing depo to women with a history of antidepressant use. Often improves rapidly with a short course of Prozac, Zoloft, or any of a dozen SSRI's (new antidepressants) with few, if any side effects.

4. Hair loss.
Unusual, but tends to spontaneously resolve within 6 months and rarely significant (i.e. no bald spots, etc…)

B. IUD = IntraUterine Device.
Application: In office, less than 5 minutes
Failure rate: from 1/100 – 1/200
Benefits: Effective long term, no systemic hormones, minimal patient effort/compliance needed.
Mechanism of action: Sterile, localized inflammatory reaction. NOT an abortifacient!!! (i.e. it does NOT work by causing the abortion of a fertilized egg at any stage; it prevents fertilization by destroying egg and/or sperm)
THE IUD IS THE MOST WIDELY USED METHOD OF REVERSIBLE CONTRACEPTION IN THE ENTIRE WORLD AND HAS EXISTED FOR THOUSANDS OF YEARS!!

3 types:
1. Copper- Paragard T380 (10 years)
2. Progestasert (1 year, progesterone-containing)
3. 5 year progesterone-containing

Side effects:

1. Copper- Heavier menses (more cramping, clots), usually resolve within 3 months. Occurs in approximately 10% of women.
2. Progesterone containing- Occasional spotting, irregular bleeding, or missed menses; periods may be stronger (cramping).

Risks:
1. PID (Pelvic Inflammatory Disease).
This is more likely with multiple sexual partners or in the presence of STD’s (especially chlamydia and gonorrhea). Localized (vaginal, cervical) STD infection can more easily spread to uterus, tubes, ovaries, and pelvis. If not promptly treated this can in turn lead to internal scarring of reproductive organs and subsequent infertility. This was one of the reasons for previous recommendations that nulliparous women (without children) should not be offered IUD’s. The major culprit for PID resulting from an IUD was an IUD called the Dalkon Shield, which has been off the market and the company bankrupt for 20+ years. This was due to a design flaw in the string used on that particular IUD.
In general, the incidence of PID can be reduced by proper patient selection and education. A rare form of PID caused by an unusual organism called Actinomyces israeli occurs mostly in older women and only with copper-containing IUD’s. This bacteria can be detected on Pap smears.

2. Perforation/migration.
Incidence of 1 in 1,500. Usually occurs at time of insertion. Definitely operator- dependent, but can also occur with time left in place (VERY rare). Can require surgery to remove. Also can lead to internal scarring and infertility if perforation is not detected and the offending IUD removed.

3. Expulsion (IUD falls out).
Not always detectible by patient. This leads to unintended pregnancy. Tends to occur most often in the first several months of use as the uterus contracts and cramps and the IUD is more properly positioned within the uterus.

4. Pregnancy.
0.5-1 in 100 women will become pregnant. Upon missing a period, pregnancy test must be done immediately and the IUD removed ASAP. 50% of the time, the pregnancy will not be normal and will spontaneously abort after IUD removal. There is a higher complication rate in patients with IUD’s either removed or in place during a pregnancy.

C. Birth control pills, Oral Contraceptive Pills (OCP’s)
Use: Must be taken every day at roughly the same time (usually bedtime).
Failure rate: about 1/100, higher with non-compliance.
Benefits: Regular, lighter, less painful menstrual cycles, ability to control/ skip periods, PROVEN reduction in lifetime risk of ovarian cancer, improvement in skin (acne reduction). Can be taken non-stop until menopause (providing no risk factors).
Mechanism of action: prevents ovulation by fooling the brain into thinking that a pregnancy exists.

Side effects: (most can be improved by switching brands)

1. Weight gain.
Usually not significant, averaging 2-3 lbs in the first year. Depends on the patient and often described more as a feeling of bloating or water retention.

2. Mood swings, change in sex drive. (Remember I said that it fools the brain
into thinking the woman’s pregnant?)

Risks:
1. Blood Clots/ Strokes: With smokers, especially after age 35 as well as patients
with family or personal history of clotting problems.

2. Hypertension (Blood pressure elevation).

THIS LIST IS NOT MEANT TO BE ALL-ENCOMPASSING OR COMPLETE IN ANY WAY. HOPE IT HELPS BUT, MORE IMPORTANTLY, ASK YOUR DOCTOR, NOT YOUR POTENTIALLY UNINFORMED FRIENDS.

 

[Sassy69]

got a question for the babydoc.....

I've been on Triphasal for like 15 years - always regular as clockwork. But went off in Feb of this year to see if I could lean out more. I did a light cycle of winny a month later. Had a normal period for 2 months.... now has dwindled down to nothing. I feel the bloat for a day or two, w/ my usual 1 day mood swing, then nothing. I wasn't aware of any such result from AS and I'm not on any contraceptive now. Actually my periods before starting Triphasal were about 7 days long and crampy. Now nothing.... Any ideas?? Or just stress or what?

 

[CherryPie]

my first time on Depo I had no side effects not even weight gain. Got off. Got back on, then I got all the sides, especially cystic acne along my jaw line. Got off and got on the pill for 6 months. Weight gain, hello, just got off in May to clear out my system, have not lost the weight nor have I gotten my period yet.

I would recommend condoms.

 

[Sassy69]

I was just laughing to myself - NOWHERE on any of these threads has anyone mentioned abstinance as an option....

 

[thebabydoc]

Sassy:

It is probably a bad thing for me to be giving any kind of specific medical advice as that might constitute establishment of a physician-patient relationship. But for the sake of example...

It is not unusual for patients on OCP's to miss cycles even while on them. Sometimes women will miss periods after discontinuing them- "post-pill amenorrhea".

By decreasing BF%, the amount of fatty esters available to produce sex steroids (i.e. Estrogen and Progesterone) is also decreased, resulting in a hypoestrogenic state (low estrogen). Without estrogen, the lining of the uterus does not grow and amenorrhea (no periods) ensues. A big problem is the use of steroids, which I TRULY abhor from a medical perspective. This contributes to another, more complex, problem which is caused by many factors, including the use of AS, as well as low BF%, and excessive exercise called hypogonadotrophic amenorrhea, which simply means that it's coming from the brain and not the ovaries.

Just remember... have you ever noticed that the first 4 letters of Amenorrhea are "AMEN"?

The only significant danger from hypoestrogenic amenorrhea is the risk of osteoparosis which is essentially negated by the excessive weight-bearing exercises performed by BB's and Powerlifters.

-thebabydoc