Freaking out a little

[ratperson]

My OBGYN put me on the Depo shot with the combined pill (TriNessa) simultaneously because the shot alone caused bleeding. The first month, the pain was unbearable for a few days, but less than before. The second month had unbearable pain for only two days and the rest was quite painless. This month, I got the shot three days before the 12-week deadline, and I had a small amount of spotting on Tuesday of this week (woke up first thing, wiped and there was blood, but none showed up on pad or anything) but haven't had anything since. My doctor told me multiple times that combining the pill and shot would not decrease the effectiveness of either one, but when I looked on the page you guys have about combining methods, it said it does. That scares me a bit, since my boyfriend and I have been taking a few more risks than usual. At one point, we had sex; he withdrew (we use the withdrawal method along with hormones) but ejaculated on my buttock. After several minutes, it slid down onto my outer labia, and I wiped it up a little while later. I think because of the hair and the location (more toward my urethra), as well as the fact that it had been exposed to air, that time wasn't a high risk. However, pre-ejaculate can contain sperm if he hasn't urinated between an ejaculation and the next intercourse, and he hadn't several times this month. I didn't have as many ovulation pains this month, either (ovulation pains being not true ovulation but rather pain of ovarian cysts rupturing, which happens typically several times a month).

It seemed as though, in terms of period (withdrawal bleed, really) length, they shortened significantly. I'm not sure if getting the shot the day after the pills stopped working might've made my period late. It's only late by a day or so at the moment (it normally starts on Wednesday or Thursday now that I'm using both hormonal methods), and I know it could very well be the amount of hormones, but I'm still panicking. I'm listening to new music to distract myself and studying for a test, but is there any other way to avoid panicking until I do get my bleed/take a test (if necessary)?

I'm trying very hard not to panic, but my boyfriend has gotten worried about the situation as well, which isn't helping me much. I think this means next times we have sex he needs to withdraw and ejaculate away from my 'hind end' and that he needs to urinate after every single time, as that procedure before greatly helped me stay calm and has worked for us for a while with no problems.

I have no other early pregnancy symptoms - no nausea or vomiting, no frequent urination or breast tenderness, and I haven't at all this month.

Sorry this post is long and I'm probably overreacting since it's been only a day or so, but I felt like posting this would give me some measure of comfort so I can sleep tonight. If I do start my period, I'll add a reply to this explaining that I did so you don't have to worry. Thanks so much for this forum - I'm glad this has been my first true scare and that you're here to help!!!!

[Johanna]

If you are on the shot and have been getting your shots on time, then you do not need to worry about a pregnancy risk. Combining two methods does not compromise the protection of either, and our article about combining methods doesn't even mention your particular combination, so I am not sure where you are getting the information from that it compromises protection. Your doctor is correct: as long as you take both methods as directed, they will both offer their full protection.

If you are still worried, of course, you can take a pregnancy test for your peace of mind.

[ratperson]

The place I found that information was here: http://www.scarleteen.com/article/sexua ... ol_with_a_. The paragraph about effectiveness states, "However, we have only listed combinations of methods which are safe and sound to use together and make for good mates. For instance, it would not be safe to combine Depo-Provera with another hormonal method." That's why I was concerned.

Thanks so much for your help! I was fairly sure I was just being paranoid but seeing that was really the tipping point. The bad thing is, I've been wanting my bleeds to stop altogether, and now that it has (at least, so far), I'm worried about it. --'

When my doctor first told me I'd take both, I looked online for scholarly information about combining hormonal methods and found this: http://www.ncbi.nlm.nih.gov/pubmed/20705153 on page 5, it says that adding on combined oral contraceptives to depo shots can prevent bleeding, though it's an unlicensed use. That was something that reassured me before.

I also found this just now while searching: http://www.ncbi.nlm.nih.gov/pubmed/20705153 so if they'll give vaginal estrogen supplement as part of a clinical trial, I think I can assume I'm relatively safe with it.

Thanks again for your help! Leaving those sources as further help in case someone else has this issue.

[Johanna]

It is not a common combination, for sure. I have only heard of it a handful of times, and every time it was a case of oral contraceptive being prescribed to manage bleeding on the shot. Buf if your doctor prescribed this combination to you, and you are following their directions and taking both methods as directed, then they should be doing their job and protecting you from pregnancy. And if you have any further questions about this, your doctor is also the very best person to ask.

[ratperson]

Thanks so much! I have an appointment on the 30th so I can ask about it then. You've helped me calm down a ton. I'll honestly be glad if this isn't just a one-off situation, because this is a treatment for endometriosis until I can get a laparoscopy done. If I have any more questions I'll ask my doctor. Thanks again!

[ratperson]

I have a question just because I'm curious, i searched the old boards and the main site and didn't see a situation like mine. I know since I'm on the depo shot I'm protected no matter what happens to my pill. I was switched to lo loestrin fe and I'm taking it without placebos along with the shot, and i missed Sunday's pill. I usually take pills at 10 pm but i was away and unable to take Monday's until midnight. I saw then that i missed Sunday's and took both simultaneously. My question is, does that qualify as only one missed pill, or would it count as a late pill for Monday, since even though i took it within 3 hours of normal, i missed the one before? This isn't a risk question - i had my shot exactly on time and that protects me from pregnancy, I'm just curious and a bit nitpicking about details. Thanks!

[Redskies]

So, Sunday's was a whole day later than it should've been, and Monday's was two hours later than your usual time. That means Sunday's was a missed pill (which you made up), and Monday's was as it should have been.

[ratperson]

Okay, thanks for clarifying! Things like this are why I'm glad the doctor put me on both to treat my endometriosis (I'm lucky - it's on my ureter, and that's one of two places, the other being a vein or artery wall, where it can't be removed), because i get the suppression of bleeding which relieves a lot of pain AND it's a backup in case i screw up with the pill. I don't think i will again though, missing that one and then taking both made me spot!