25 Feb 2014

Contraception Conversations

I would never think to do a post on contraception. It's such a private and personal subject but I wanted to share and hopefully educate people on an option I recently decided to make. It's an option which I think is seen in a negative light hence why I don't think most people even consider it.

  • This is a post best read for my female readers and contains concepts and description that make make men go "Eww!!"
  • I'm not here to sell or suggest any one form of contraception is the best option, but to hopefully provide information on different options. 
  • Obviously please see and discuss your medical professional regarding your circumstance and medical history when deciding on a form of contraception. 
A few weeks ago I had my four month post pregnancy check up with my doctor. We discussed how things were going with me, baby, home dynamics and anything else that comes to mind. Four months after giving birth most doctors ask parents about their thoughts on family planning. That is whether discussion of more children have come up and time frames the parents are thinking to achieve this.

For us ... we're agreeing to disagree on this topic at the moment. Ian is happy with two, where as I'm open for more .... but not right now. So we want to put a plan in place to make sure we stick to that in the mean time.

I didn't want to get back on the pill because I'm horrible at taking it. If you want an example of someone falling pregnant while being on the pill ... I'm your girl. Admittedly I was skipping a few days, then taking it a few days, then missing again. A behaviour I had been doing for years.

I first got on the pill for my skin when I had severe eczema in my twenties therefore never really cared about the science behind its contraception powers nor understood the risks of not taking it regularly. So over the years I developed a lazy attitude towards taking it regularly especially after my skin condition cleared.

Anyways .. two kids on and although they can be a form of contraception, I knew I had to be proactive about not falling pregnant. I asked female friends about what options they use or know about. Here are some options I've heard about and the knowledge I had (prior to speaking to an actual doctor) about these different types of contraceptions:
  • the "Rod" which is an implant inserted under your arm that slowly releases the same hormone as the pill. 
  • Get a needle (shot) of hormones ever few months, which also releases hormones into the blood stream that prevents ovulation. 
  • And last option I heard about was inserting a device internally and some how prevents pregnancy. 
Bottom line every contraception option had a list of pro's and con's as well as potential side affects and ultimately I knew if we're not planning to grow the family right now I need to decide on one, even if the decision was to go back to taking a pill a day.

My doctor asked me a series of questions to gauge which options she would suggest for me and discussed the advantages and disadvantages of each option. As she informed me more about the inserting an internal device option, I soon realised it seemed to fit me and my life style more than the other two options. But before I make a final decision I had lots of questions about this option and the key question I had were:

What's the official term for it? 
Intrauterine System (IUS) is a type of intrauterine device (IUD). Mirena is the approved brand of IUS used in Australia. It's a long acting reversible contraception method.

What does it look like?
It's a small T-shaped soft flexible plastic device with a string at the end of it. Some images can found here and here.

How does it work, as in how does it prevent me falling pregnant?
It creates a barrier preventing sperm from entering the uterus and it also thins the lining of the uterus making it harder for an egg (if fertilised) to attach to the womb therefore hopefully preventing a pregnancy.

How is this thinning achieved and is it safe to have a thin lining? 
The plastic device contains a small amount of hormone which is released directly the uterus which thins the lining. Every month when a women is ovulating, their body naturally grows and thickens the lining of the uterus to prepare for the release of an egg. So when and if you decide to have children, once the device is removed your body will continue this process naturally.

How is it inserted and will it hurt?
Similar process to having a pap smear, a speculum is used to assist in the process so of course its going to be a little uncomfortable. The doctor will insert the speculum into your cervix and clean the area using an antiseptic. The doctor will then insert the device inside the cervix using a narrow applicator tube. Once the IUS is inserted, the application tube is removed and the arms of the t-shaped device opened.

What are the potential side affects?
There are a range of side affects but the most common one's are:
  • Abdominal pain including cramps, which should subside shortly after insertion. 
  • Infection as the uterus is a very sterile area therefore inserting anything that is not properly sterilised inside can cause infections. An infection will be evident within the first three weeks of placing the device in.
  • The device could fall out by itself if not properly placed.
  • The device could perforate (damage or create a hole) the wall of your uterus. This is very rare occurrence and may happen when the device is being inserted. 
  • Changes in bleeding. Period may become irregular and may spot between menstrual periods. After a few months when you body adjusts, periods usually get lighter and the number of days bleeding is likely to decrease but remain irregular.
She did inform me of very rare side affects related to this option including:
  • Does not protect you from sexually transmitted diseases.
  • During insertion bacteria could enter the uterus causing an infection.
  • If not inserted carefully could puncture the wall of the uterus which could then move around and harm other organs of the body.
How long is it affective?
The IUS contraception is good for up to 5 years. If you do decide you want to have children it can be removed and commence trying to conceive straight away.

I'm still breast feeding can I use this as a form of contraception and will it affect my baby or milk supply?
Yes you can still be on IUS while you are breastfeeding. It is a progestin only contraceptive (like the mini pill) which does not affect milk supply. There have also been no adverse effects found in the health, growth or development of nursed babies. Although small amounts of the hormone released is pass onto the breast milk of nursing mothers.

Will I or my partner feel it?
You or your partner should not feel the device during sexual intercourse as it is inserted into the uterus, not the vagina. If you do it could mean device has moved and wont be effective and best to return back to your doctor to verify placement.

I've heard so much negative experiences and stories about IUD is it safe?
The main difference with the Mirena is releases small amounts of hormone and has only been around since 2001 where as the older IUD "coil" technology has a copper filament wrapped around the T shape and had no hormones.

What are the benefits of IUS over other contraceptive options?
  • Cost effective.
  • Safe to use while breastfeeding. 
  • Can be removed whenever you want to stop using. 
  • Fertility return after the first cycle following removal. 

After I decided to go with this option she gave me a script to collect my IUS device from a chemist. When I returned she proceeded with placing the device inside my uterus. Yes it was as uncomfortable as a pap smear, the antiseptic stung a little and she did warn me that I will feel a hard cramp slash contraction kind of pain while she attaches the device. The whole process probably took 5 minutes it could've gone quicker but there was a medical student in the room she was also teaching along the way. 

Yes I agreed to let a medical student sit in the room. Yes she was a girl and no I didn't mind cause after giving birth to two kids all shame goes out the window ... No, not really. I just remember a friend who was doing his time as a medical student saying he barely got to sit in actual examinations cause most patients opt not to have a student present. So I let this girl who looked like she just finished high school, doing her first day of work experience (is that what its called?) sit in on a intrauterine system insertion - lucky her. 

So a month on and I'm pretty happy with my contraction decision. My experience so far has been positive.  I only experienced some spotting during the first few days. Only other thing I noticed is I've been getting headaches some days for a short period of time, nothing that would make me take a panadol. I don't usually get headaches so I concluded it must be related. Other positives of course no more worrying about taking a pill every day and cost savings.

I will need to get an xray and see my doctor again in 6 weeks time to check that the device hasn't moved and discuss how it's all going so far. 

There you have it ladies my personal experience of the IUS. I think so many women don't even consider this option because due to the fear, misunderstanding or lack of knowledge available from people with first habd experiences. I also think it built up a bad reputation amongst older women because when it was first introduced the technology as well as the experience of doctors with this option was limited. It has come a long way and the benefits in my opinion out weighs so many of the existing other forms of contraception out there.

So, if you're like us and not ready to extend the brood (or not ready for kids at all) and want a form of contraception you don't have to think about and has no on going cost, think about the Mirena IUS. I encourage you to still talk to your doctor about IUD/IUS, discuss all options and ask lots of question even the one's you think are dumb, like my "is it safe to have a thin lining?" 

The Royal Women's Hospital, Intra Uterine Device (IUD), The Women's Organisation, accessed 17 February 2014, <https://www.thewomens.org.au/health-information/sex-sexuality/contraception/intra-uterine-device-iud>

Kelly Bonyata, 2011, Birth Control and Breastfeeding, Kelly Mom Parenting and Breastfeeding, accessed 17 February 2014, <http://kellymom.com/bf/can-i-breastfeed/meds/birthcontrol>

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