Why am I being so weird about Birth Control?

[Atonement]

So, I have been using the Nuvaring since January 2013, when it was first covered by my insurance.

Throughout my time on it, it had been GREAT. Periods were reduced to basically spotting that didn't negatively impact my life at all.

However, one year ago I went to a gynecologist who informed me that the way I was using the Nuvaring (4 weeks in, switch, 4 weeks in, switch, 3 weeks in, period) was wrong. I had been using it this way at the recommendation of a previous gynecologist. Honestly, even though her reasons that this might be ineffective don't make sense to me (If people usually take it out for a week anyway, how could using it for 4 weeks make it ineffective?), it scared the crap out of me.

I considered the Implanon, but this gynecologist advised me against it because “It tends to make cycles irregular and people don't like it” and encouraged me to get an IUD instead.

After debating for a long time, I decided to get a Paraguard IUD and continue to use the nuvaring to control my cycles (plus, double protection! Yay!). I had it inserted on Feb 2.

Paraguard has not been a good experience. The first month I bled constantly and took so many NSAIDs I was afraid I ws going to give myself an ulcer.

After taking out the Nuvaring for a week and having a withdrawal bleed, I had 9 glorious cramp and blood free days where I thought this was going to be ok. Then it came back last week. Cramping, bleeding, leaking onto clothes, and occasionally this awful sensation of something poking my cervix from the inside.

I talked to a lady from my doctors office this morning, and she informed me that while it was possible my uterus could get used to it, it would also be completely normal if my uterus kept deciding to have multiple periods a month.

A huge past of me feels like its time to cut my losses and either try out the implanon or stick with the nuvaring. However, the lady from the office warned me that implanon can cause irregular bleeding too (though, I'm hoping not quite as badly as this IUD).

The thing is, I feel weirdly paranoid about just using the nuvaring. I'm so afraid of getting pregnant on it.

The rational part of me thinks this is ridiculous. I know nuvaring is still a really effective birth control, and I would be using condoms anyway. But I really liked the idea of a 99.x% effective IUD paired with a Nuvaring. Somehow, I feel unsafe without the idea of extremely effective backup.

This is doubly ridiculous because I am 27 years old, I have a good job, and I have no moral opposition to abortion. Even if abortion was banned in my state or country, I travel enough that obtaining one somewhere else wouldn't be the end of the world.

The third ridiculous aspect is that I haven't had a sexual partner in YEARS, and though I would like one in the near future, there is no one I am considering at the moment. So this isnt even a concrete thing to worry about.

I know this is something I should talk through with my therapist, but I'm not going to have an appointment with her until after my appointment with my gynecologist. So, I'd like to reach some kind of decision on whether or not to power through for a couple more months and see if it gets better, or take it out and stop being miserable.

What do you guys think? I shoud get this stupid thing removed, right? Should I try the implanon and see if it works out, or just learn to trust my Nuvaring?

[Mo]

Oh no, I'm so sorry you've had such a bad experience with the IUD. It's up to you, of course, but it does sound like you're having a pretty unpleasant time with it, so if you're feeling like you should get it removed, then I think it's ok to go ahead and do that. I think it can be good to "stick it out" for a bit to see if things settle down with a new birth control method, since sometimes the side effects are worse at the beginning, but you don't have to keep it up when you're miserable.

In all honesty, I don't know why your current gynecologist is so against the way you were using your Nuvaring! The standard method is 3 weeks in, 1 week out all the time (without any 4 weeks in months), but I also don't see why keeping it in for that week would make it less effective. Possibly this doctor just isn't comfortable using it any way but exactly as per the manufacturer's instructions. You could definitely ask for some more information from her about why she doesn't like that method.

I'm also not sure why your doctor said people "don't like" the implant. Of course there are people who've tried it and don't like it, as is the case with every available birth control option, but plenty of people who get the implant love it. And as you've come to find out, some people don't like the IUD even though it has a legion of fans! It's true that the implant can cause irregular and/or frequent bleeding, although many people who experience it frequently find that it's pretty light, especially after the first few months. It makes sense to warn patients about potential downsides, but I feel like she's not communicating that to you effectively or in an unbiased way.

All this to say: it's ok to get your IUD taken out if you are feeling miserable with it. It sounds like it might be good to prod your doctor a bit for more discussion of your birth control options. And even though the appointment won't come until afterwards, I think this is something to talk to your therapist about!

[Atonement]

One thing I should mention:

The doctor that advised against how I was using the Nuvaring and discouraged the Implant is not my current gynecologist. Honestly, I only saw her the one time because I didn't really like her. Which, I guess should say something, but she kind of planted the seed for fear and mistrust.

I haven't really talked to my new gynecologist about it yet because I had already decided to get Paraguard by the time I started seeing her.

Maybe I should talk to her more about the Nuvaring and my concerns about it.

Luckily enough, my therapist texted me today and said she had an opening for tomorrow. So, I'll talk to her about it then.

[Heather]

My understanding is that the amount of hormone in the ring is only enough for 21 days, not 28 (or more). So, if you left it in for longer, you'd basically have times where the ring is in without enough hormone to do the job, then -- if my brain is parsing this right, which I think it is -- keep pushing back how much time you're going without hormone with that extra week plus the break, before you put your next new ring in. In a word, I agree, this would likely make that method frequently less effective or ineffective.

I also want to add that since it seems a given the next time you do have intercourse will be with a new partner, no matter what method you used, you'd be backing up with condoms anyway unless you're not practicing safer sex. So, even if you switched back to the ring (and using it in a way you can be sure it's fully effective), you'd already be backing up with condoms.

[Atonement]

No, I think you're misunderstanding my nuvaring routine

When I leave the ring in for 4 weeks, I do not take an inactive week. In those cases, I switch right to a new ring at the end of the 4th week, skipping the withdrawal bleed altogether.

In months that I do have a withdrawal bleed (usually every 3rd cycle, like with extended cycle birth control pills), I only leave the ring in for 3 weeks and then use week 4 as my week off like normal.

I don't understand why leaving the ring in for the 4th week would be any less effective than taking it out and having a withdrawal bleed, though I can see how the routine might confuse someone who hadn't seen it written down. Its possible that you and my previous gynecologist has the same mix-up.

[Heather]

Ah! I misunderstood.

You’re right, it’s okay and no less effective to use the ring like this. In the event you think the other doc may have misunderstood like I did, if you say you’re using the ring in the way you do for menstrual suppression, they should get it. (I would have.)