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So, I'm looking for some suggestions and advice from women who are possibly in the same situation as me.
I found out about two months ago that I have a blood clotting disorder, thrombophila, which puts me at high risk for blood clotting and deep vein thrombosis. I had genetic testing performed by a new OB/GYN I went to. Blood tests determined I have two genetic mutations- C677T polymorphism and Factor II prothombin. After being on birth control pills for 8 years and not knowing I had this disorder, I was told immediately to get off and to be seen by a Hematologist to be "cleared" to go back on hormonal birth control. Long story short, it was determined that there is no way I can take anything that contains estrogen (i.e. birth control pills, fertility treatments, estrogen during menopause etc).
I discussed my options with my OB/GYN and decided to have the non-hormonal IUD placed, Paragard. Generally, this isn't recommended for women who haven't had children, but my doctor agreed to place it given my circumstances. I had the IUD placed last Wednesday. The insertion was by far the most horrendous pain I ever experienced. I walked out of there cramped up and bleeding. After a week, I was having such a bad reaction to the IUD, that I had to make an emergency appointment this past Wednesday to have it removed as my body was rejecting the foreign device and was trying to expel it.
So, I'm now left with dilemma as to what other birth controls options I should be looking in to. I'm a 27 y/o female, a professional & engaged...I have no immediate plans to have a baby. I have always felt more comfortable having myself protected (as a back up) in addition to using condoms. But now need some suggestions and advice as to what other alternative options other women have used and how it has worked for them.
Progestins may be your answer, unless you go with barrier methods:
Quote:
One alternative is progestin-only contraceptives. Progestin-only contraceptives include progestin-only birth control pills such as Micronor®, Nor-Q.D.®, and Ovrette®; the levonorgestrel (Mirena®) intrauterine device (IUD); every 3-month injections of medroxyprogesterone acetate (Depo-Provera®); and the new, 3-year implant (Implanon™). While progestin in the higher doses used to treat abnormal vaginal bleeding has been shown to increase the risk of thrombosis five- to six-fold, progestin in the doses used in contraceptives has NOT been shown to increase the risk of deep vein thrombosis or pulmonary embolism.
A World Health Organization (WHO) sponsored study of VTE associated with progesterone only use evaluated 74,086 women in the UK general practice research database. A nested case control study of 59 women with idiopathic VTE found an overall 2.4 increased relative risk.24 When they separated those who used progestins only for contraception the risk was 1.3 (95% CI: 0.3–6.8) compared to 5.3 (95% CI: 1.5–18.7) for those who used progestins for other reasons.
The thing to keep in mind that increased relative risk may be statistically significant, but the absolute risk may still be small. In other words, if the risk of a clot in a certain population is 1 in 10 000, increasing the risk 10 times increases the abslolute risk to 10 in 10 000, still a relatively small risk. Your doctor would have to tell you what the absolute risk is for your specific condition.
That relatively low absolute would go along with your having used the birth control pills for so long without a problem.
I am curious why you were tested. Did you have a clot? Are you taking any anticoagulant medication?
The risks of clots with birth control pills that do not contain estrogen, progestin only pills, or "POPs", appear small. The primary drawbacks of POPs are a bit more irregular bleeding and a slightly higher failure rate. Using a POP plus condoms and taking the pill as close to the same time of day every day as possible miniizes the pregnancy risk.
Taking a POP on a rigid schedule also minimizes the irregular bleeding, which tends to get better over time if you keep using the POP.
The use of even a POP is a bit controversial, however. You may find some docs do not want you to use it.
Keep in mind that pregnancy itself increase the risk of blood clots, even in women without a thrombophilia, and thrombophilias can increase the risk of miscarriage. The down side to an unplanned pregnancy may be greater than the risk of a clot on a POP.
The thing to keep in mind that increased relative risk may be statistically significant, but the absolute risk may still be small. In other words, if the risk of a clot in a certain population is 1 in 10 000, increasing the risk 10 times increases the abslolute risk to 10 in 10 000, still a relatively small risk. Your doctor would have to tell you what the absolute risk is for your specific condition.
That relatively low absolute would go along with your having used the birth control pills for so long without a problem.
I am curious why you were tested. Did you have a clot? Are you taking any anticoagulant medication?
The risks of clots with birth control pills that do not contain estrogen, progestin only pills, or "POPs", appear small. The primary drawbacks of POPs are a bit more irregular bleeding and a slightly higher failure rate. Using a POP plus condoms and taking the pill as close to the same time of day every day as possible miniizes the pregnancy risk.
Taking a POP on a rigid schedule also minimizes the irregular bleeding, which tends to get better over time if you keep using the POP.
The use of even a POP is a bit controversial, however. You may find some docs do not want you to use it.
Keep in mind that pregnancy itself increase the risk of blood clots, even in women without a thrombophilia, and thrombophilias can increase the risk of miscarriage. The down side to an unplanned pregnancy may be greater than the risk of a clot on a POP.
Hi Suzy,
To answer your question...I had switched to a new OB/GYN b/c my insurance had changed since I changed employers... When I went for an annual exam the beginning of February, I had spoken to her about changing the birth control medication I was on at the time because I was having a problem with horrible mood swings and nightsweats (I later found out the medication I was on, LoOvral, was recalled for a packaging error!) So, she wrote me a new script for a different medication. As she was doing so, she wanted to know my family history for her records and I told her...
My grandmother died at 46 years old from a pulmonary embolism. All of the women on my mothers side of the family have ALL had recurrent miscarriages and reproductive issues. My mother specifically had two full miscarriages, almost lost my younger brother and suffered a post pardom hemorrage after she delivered my brother....then ended up having a total hysterectomy about 10 years later b/c of endometriosis (sp) and cysts/fibroid tumors. When I told my doctor this she asked me if I was ever been tested for a blood clotting disorder. When I told her no, she had blood work drawn up on me and lo and behold it turned up that I have thrombophila.
I did my research and asked her about the POP before I opted to have the IUD inserted, and she wasn't comfortable prescribing that for me because according to her there was no definite study proving that progestrin wouldn't put you at an even higher risk for clotting (I had inquired about the mini pill).
My doctor is now talking to me about using a dyraphram or a sponge....I'm not really comfortable using either. I just feel like I have my back against a wall here and I'm stuck.
To answer your question...I had switched to a new OB/GYN b/c my insurance had changed since I changed employers... When I went for an annual exam the beginning of February, I had spoken to her about changing the birth control medication I was on at the time because I was having a problem with horrible mood swings and nightsweats (I later found out the medication I was on, LoOvral, was recalled for a packaging error!) So, she wrote me a new script for a different medication. As she was doing so, she wanted to know my family history for her records and I told her...
My grandmother died at 46 years old from a pulmonary embolism. All of the women on my mothers side of the family have ALL had recurrent miscarriages and reproductive issues. My mother specifically had two full miscarriages, almost lost my younger brother and suffered a post pardom hemorrage after she delivered my brother....then ended up having a total hysterectomy about 10 years later b/c of endometriosis (sp) and cysts/fibroid tumors. When I told my doctor this she asked me if I was ever been tested for a blood clotting disorder. When I told her no, she had blood work drawn up on me and lo and behold it turned up that I have thrombophila.
I did my research and asked her about the POP before I opted to have the IUD inserted, and she wasn't comfortable prescribing that for me because according to her there was no definite study proving that progestrin wouldn't put you at an even higher risk for clotting (I had inquired about the mini pill).
My doctor is now talking to me about using a dyraphram or a sponge....I'm not really comfortable using either. I just feel like I have my back against a wall here and I'm stuck.
First, you have found a magnificent OBGYN. She has found out something that could potentially cause you a lot of problems and made it possible for you to head them off.
The IUD was a great first choice, and I am sorry it did not work out for you.
Second. Condoms work. So do diaphragms. The diaphragm can have a failure rate as low as 5% if it is used every time you have intercourse, always with a spermicide. Some women insert it every time they go to bed, so it is always ready and may hinder spontaneity even less than a condom. Depending on how long it has been in place, additional spermicide can be used, and more spermicide without removing the device if another act of intercourse will occur.
If you want a "belt and suspenders" approach until you are ready to get pregnant, you could use both diaphragm and condoms.
Using a diaphragm is no more difficult than using a tampon.
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