What birth control option is best for me?

[Mariposa01]

Hello, I have put a lot of time into researching different birth control options over the last few months and I am wanting a second opinion before my upcoming appointment with my doctor. I went on b.c. when I was 13 and I am now 19(I was born in 2001, not 2004). I have been on more than 20 different birth control pills since first starting b.c. due to a huge hormonal imbalance where my body makes 4 times the amount of estrogen that it needs and I only make 1/4 amount of testosterone that I need. I usually switch to a new pill around every 3 months cause I end up having bleeding that lasts 28 days with maybe 2 days of no bleeding from where my body gets too used to the pill I take at that time.

My doctor in the past has told me to skip my placebo week to stop my period, but when I did that, I had horrible bleeding and was in constant pain until week 2 of the new pill pack (I would take weeks 1-3 pills, skip placebo week, but bleed horribly during week 1 and until week 2 of my new pill pack). I have been on the patch which I loved since I only had to change it once and not worry about taking it everyday, but soon my body went into the 28 day bleeding cycle all over again.

My doctor has told me I am a candidate for the shot, the implant, and the IUD, or I could continue switching pills every 3-4 months to continue to monitor my period cycles. However, I am a little hesitant due to my hormonal imbalance being so out of wack, and have heard that getting either the implant and IUD hurt more coming out than going in.

I also want to mention that having my period makes my brain rest easy as my boyfriend and I do have sex. We don't do it often maybe twice a month) as we don't want our relationship to be based on sex, however when we do, he always wears a condom, ejaculates outside of me, and I religiously take my b.c. pill every night and have not missed a pill in ages.

I read a lot of the articles and message boards already published on this site but I was left more confused than when I started (I thought I wanted the implant but now I don't know what I should tell my doctor).

[Heather]

Hey there, booknerd. I have a couple thoughts.

First, are you seeing an endocrinologist about your estrogen levels, not just a GP? I ask because I feel like treating that is perhaps something best considered separate from BC methods. I also ask because if that is the case, you using combined hormonal methods that add even MORE estrogen to the mix not only sounds like the wrong way to go for you, but to the degree that I'm actually concerned about the safety of you using *anything* that adds more estrogen (and even more so, taking those methods without breaks). In a word, I'd strongly advise you get a second opinion for a different provider than the one you have been seeing. Unless there's something I'm missing or not understanding here, I'm really questioning their approach.

That all given, I'd expect anyone advising you on contraception to *only* suggest methods that do not involve any estrogen.

How would you feel about a non-hormonal IUD? Do you have heavy or painful periods? If not, a non-hormonal IUD could be in for ten years or more -- that means having it inserted and removed would be rare (and it shouldn't be outrageously painful either: it's very quick, even when it does hurt). It also wouldn't add more hormones to the mix and would allow you to keep having your periods as you prefer. The shot, implant or hormonal IUD would all likely make it so you have spotting, but not so much the regular flow you feel most comfortable with.

[Jacob]

Hi booknerd!

In terms of removal being painful... I think that sorta depends on personal preference, some people hate the idea of a skin incision more than the idea of an iud being removed, and some the other way round but it is worth remembering that it is something that might only happen once in a very long stretch of time.

I'm not completely certain what's been going on with your bleeding thus far, as taking oral contraceptives actually does stop periods and hence there isn't really a cycle anymore. It is replaced with withdrawal bleeds in the placebo week, almost just to make people feel comfortable, but are not themselves periods, other bleeding can happen for a variety of reasons. So I'd guess that something else is going on. The idea of the body getting 'too used' to the pill or brand of pill sounds like it might not be 100% accurate.

I'd also think about excessive bleeding as something that could be investigated further with a doctor, maybe a more specialised doctor, rather than just switching methods every couple of months, which doesn't sound like great advice... especially if switching methods isn't helping.

If everything else turns out to be fine, the IUD could be a good thing to consider simply because hormonal action is much more local to the uterus and is just one of the ways it prevents pregnancy. I also see that hormonal IUDs are also recommended to people who struggle with heavy bleeding, even if irregular bleeding often still happens.

EDIT: I'm also agreeing with Heather that I'm questioning your doctor's approach for real.

[Mariposa01]

hey y'all, and thank you for the responses. My period when I do not take any form of b.c. lasts almost 3 months with constant heavy flow. I'm talking about changing a super flow pad 8-10 times a day. During the night, I have to set alarms to change my pad every 2 hours and sleep on top of a chuck (basically a pee-pee pad for humans). I was prescribed Yasmin in June and can already tell that the pill isn't going to work for much longer.

Literally my first period ever at 13 years old lasted 1.5 months with 3 days of no bleeding at the end, and I started bleeding again. Before b.c. or when I'm not taking a pill, it is more normal for me to not be bleeding than it is for me to bleed. Also whenever I don't take a pill, I never get a missed period, it's always a bloody mess lol.

It's scary and depressing that I will have to take a pill or some form of b.c. until I hit menopause which isn't until another good 40 years at least. I have also looked into getting my reproductive organs removed, an ablation, and even a hysterectomy. Unfortunately, I live in a very conservative and rural state (WV) and female healthcare is kind of backwards compared to other places in the US.

[Mariposa01]

edit for second post: i meant to say it is more normal for me to be bleeding than not to bleed. I haven't seen an endocrinologist, but this is my second doctor I have seen for my period and other health issues. My mom had an ablation when she was in her late 40's as she would also bleed heavy like me. She ended up needing to get a second ablation five years ago because she remained constantly bleeding. She and I are the only women on both sides of my family to have issues like we are having with our periods.

[Heather]

I can’t suggest strongly enough you try and see a different doctor, ideally an endocrinologist. Having someone take estrogen who apparently already has a body that makes too much is just really bizarre and potentially dangerous, and I also find it really strange this doctor hasn’t referred you to one.

Can you look into that second opinion first, before taking anything new this one suggests?

[Heather]

Also, you likely do NOT have to take BC until you are in menopause, especially since again, taking more estrogen if your body already has estrogen dominance is not a healthy approach. It is literally the opposite of what is generally advised. I don’t mean to freak you out, but I am earnestly concerned you’re health may be at risk from poor quality care.

[Mariposa01]

I can try to look into seeing an endocrinologist. Thank you for talking to me about this

[Sam W]

That's definitely a sound next step. Do you have a sense of where to start with that process and how to get in to see an endocrinologist? If not, that's something we can help you out with.

[Mariposa01]

I do. It might take a while to get into see the endocrinologist that's under my insurance but I will discuss with them before making any new plans with my doctor

[Sam W]

Sounds good! If there's anything we can help with, just let us know.