Can you combine a hormonal IUD with the pill?

[Leafwater]

Hi!
My girlfriend and I are looking to be sexually active fairly soon, and she just had an IUD inserted. Since we're both teens, I'm trying to be as safe as possible and not get her pregnant. To ease my anxiety she is also on the pill. Does the pill with independently from the Mirena IUD? Her nurse today said it did, and if yes what are the chances of her getting pregnant? Also I will use a condom for now, but we are both clean of STI's. She is thinking about not using a condom, what are the chances if we don't? Thanks for the help!

[Sam W]

Hi Leafwater,

The IUD is one of the most effective means of pregnancy prevention out there, so backing it up with the pill is not really necessary. You can read more about how effective it is here: Intrauterine Devices (IUD, IUC or IUS) . Did the doctor who gave her the IUD know she was on the pill or vice versa?

As for condoms, we recommend using them all the time, even if both partners are STI negative. You can read more about why we suggest that here: http://www.scarleteen.com/blog/heather_ ... _safer_sex

If you're curious about how effective it is to combine various methods of birth control, this article is great for that: The Buddy System: Effectiveness Rates for Backing Up Your Birth Control With a Second Method

[Leafwater]

Thanks for the reply. Her nurse knew she was on the pill, but said that she could get the Mirena instead of the copper. Just to clarify, the hormones of the Mirena and the pill won't interfere with each other correct?

[Sam W]

You're welcome! My understanding is that the two methods will not cancel each other out (if they were going to effect each other, the nurse likely would have told her that). It is a bit unusual to be on both, as the pill generally gets discontinued when someone goes on the IUD. However, if she has concerns about how the methods will interact, she can always ask her doctor.

[Heather]

It would be unusual, for the record, for a healthcare provider to suggest someone should use a hormonal while on the hormonal IUD, simply because the burden on that person per side effects could be pretty mighty (and again, because the IUD is nearly 100% effective, so the pill really can't add anything to that).

Sometimes people will be on both because they are being prescribed one of those methods to address a health issue, but outside of that situation, using both simply isn't usually advised or prescribed. It also is always medically advised to try and keep use of any kind of synthetic hormones as low/limited as possible, only using as much as needed. Using extra hormones when not needed, as in this case, can present additional health risks.

If you want to use two methods and she's using an IUD, you adding condoms really would be the way to go, especially since only condoms can provide protection against STIs and other infections, which is just as important as preventing unwanted pregnancy. Too, if some of this is about you suffering from anxiety, getting help and treatment with that not only doesn't put extra health risks on her by trying to use all these methods at once because you have anxiety, and would likely also benefit you and your life on the whole by helping you learn to manage your anxiety.

[Leafwater]

Thank you for the insight. I talked to her about it, and we will use a condom to begin with. She wants to do it without a condom eventually because she doesn't like the feeling of one. If we end up not using a condom, should she stay on the pill in case the IUD is expelled or misplaced? I am also a little confused on why the Mirena and the pill can work together without lowering the effectiveness of the other since they are both hormonal.

[Karyn]

It's pretty rare for IUDs to be expelled, so as Heather has said, unless she has a medical reason for using the pill and an IUD, the pill isn't necessary and can actually be a health risk. Condoms are a far better backup method if you feel more comfortable using two methods, and again as Heather pointed out, are really recommended in terms of preventing STIs as well as pregnancy. There are plenty of things that can make condoms feel better for both partners; trying different brands (including non-latex ones) and adding in lube if you aren't already using it can make a big difference in terms of how condoms feel, so finding something that feels good to her is likely just a matter of experimentation with different styles, brands and lube.

Have you spoken to your girlfriend about your concerns about pregnancy risks? She may prefer not to use condoms, but if you feel more comfortable with them then that's a limit you get to have, and one she needs to respect. It might also be worth considering if becoming sexually active right now is going to be a positive for you rather than a negative, if you have all this anxiety: sometimes anxiety is a sign that we're not quite ready for something yet, and we need a little bit more time to get informed and figure out how to deal with risks in a way that is comfortable. If you haven't already seen it, our sex readiness checklist is a useful tool and one you could go through with your girlfriend if you like to make sure you're both on the same page.

As for why the pill and Mirena don't cancel each other out, my understanding is it's because they both have similar hormones in them. The Mirena contains small amounts of a kind of progesterone, and birth control pills contain progesterone as well as estrogen. Using the two together amplifies the effects of those hormones, they don't cancel each other out. Kind of like if you drink a cup of coffee and then a can of Coke, the caffeine in each doesn't cancel out: they're caffeine in different forms, but still caffeine.