To think that the implant is a reliable form of contraception?

(57 Posts)
fivefourthreetwoone Wed 30-Oct-13 22:41:19

I've had acne for years now. I've tried every over the counter remedy, every antibiotic prescribed by my GP and dermatologist but nothing has worked. We're now down to the last resort of trying roaccutane. I've read up on all the risks and am aware of how important it is not to get pregnant on it because of the birth defects. I have decided however that this is the last resort and am willing to try it to get rid of my acne.

I have the implant and thought that would be okay on the contraception front but at my appointment with my dermatologist today, he insisted that I must be taking the pill before he can prescribe it. I explained that I have the implant but he was insistent that the implant wasn't good enough and that it had to be the pill.

The thing is though, I can't take the pill for medical reasons (that's the only reason I have the implant for!) otherwise I would be on the pill anyways.

I was actually quite confused about this and have done some reading. Apparently the implant is over 99% effective, which is the same (or slightly better?) than the pill.

Is it standard that the only accepted contraception is the pill when taking roaccutane or is my derm just odd?

Chippednailvarnish Sun 03-Nov-13 20:56:21

British medical journal is far more reliable than the BBC.
I think if you are going to consider this treatment you need to be objective about the risks.
Eg. What are the numbers of people suffering from side effects out of how many prescribed doses. And what would the incidence in the general population.

I would also change dermatologist as they should have already discussed all of the potential risks of this treatment, before they consider prescribing it to you.

fivefourthreetwoone Sun 03-Nov-13 18:23:33

That documentary that everyone is mentioning. Is that Dying for Clear skin? It's on youtube.

Depression and feeling suicidal is a known and rare possible SE of Roaccutane and the risk of it happening should be fully covered in the pre-prescibing counselling - there is a reason why Roaccutance should only be prescribed by doctors who have experience with the drug (not exclusively dermatologists, but usually).

Depression and feeling suicidal is actually far more common in young people and adults with severe acne which has been treatment resistant (including 'successful' suicides sad).

So, yes, potential effect on mood needs to be taken seriously, but it is a)not common b)usually reversible on stopping of the medication c)and the risk is reduced if everybody is well-informed e.g. the patient and a loved one know to look out for any changes in mood.

Haberdashery1 Sun 03-Nov-13 17:30:58

Hope you get a better dermatologist. The implant + pill is definitely not the recommendation of anyone who knows about hormonal contraception!

I took Roaccutane 4 years ago. I wasn't sexually active at the time and hadn't been for some years (partly because of the acne). My dermatologist was very good, talked me through the risks and recommended the pill and condoms. I told her I wasn't in a relationship, wasn't planning to have sex, and after a bit of discussion agreed that in my case not having sex was also an option. I think that she was a bit worried I was abstinent for religious reasons and would be against abortion if I did get pregnant - she changed her tune abruptly when I just said "If I get raped, I'm having an abortion regardless".

I accept that given the really nasty effects of Roaccutane on a foetus, and that unfortunately some women don't take these seriously enough, they do have to push the contraception line hard. But dermatologists should be informed enough to know what the contraception options actually are and not put stupid barriers in the way of women's access to vital medicine. Mine was - sounds like OP's isn't!

(OP - Roaccutane changed my life. The side effects weren't fun, but I'd have put up with much, much worse for the skin I have now. Not a single spot since I finished the course.)

NeedlesCuties Sun 03-Nov-13 17:21:55

Will PM you shall is too long-winded to write about on this public thread.

Shallistopnow Sun 03-Nov-13 17:02:43

There was a BBC programme about the poor young chap who took Roaccutane & became depressed. It seemed to permanently change him. He killed himself. I think that programme made me cry. Just hearing the name of it sends shivers.

Is your skin not better when its has some sun Five?

Shallistopnow Sun 03-Nov-13 16:59:04

Needles why don't you just take the pill?

Oh, I know, it is a really scary drug.
You do know that nobody could legally hold you to the 'contract' you signed though, don't you? It is more a form to make sure you have fully understood what the consequences of a pregnancy on Roaccutane are.

My understanding was that barrier contraception ie condoms would be 'permissable' as one of the forms of contraception. Ah, well.

CamelBalls Sun 03-Nov-13 15:22:11

He told me I would need to take two lots of contraption - ie pill and implant, pill and coil etc
I was eating the same amount and doing the same amount of excerise in the same job and I put on about 4 stone :O it took me ages to shift it hence why I really don't want to go on this medication, I would take it otherwise.

I understand about the pregnancy/fetus - but it kind of scares me signing a form saying I would have a abortion if this happens, even though I'm not planning for children for a long time yet.

CamelBalls, you wouldn't need to take 2 types of the pill: it could be pill + condoms, or coil + condoms if you want to avoid additional hormones altogether. Any form of hormone treatment (contraception, HRT or fertility drugs) can give some people a horrific appetite, hence the weight gain. It's not the pill that kind of 'passively' puts weight on you, so some people with previous weight gain problems manage fine on hormonal contraception as long as they are very aware of what they eat (and don't suffer from Hand To Mouth Disease like I do....blush).

If you were to conceive on Roaccutane the resultant fetus would be severely affected, if not terminated the pregnancy is likely to end in miscarriage and if the pregnancy was continued would likely end early with a severely affected baby whose malformations are likely to not be compatible with life.

It IS a nasty drug that works VERY well for severe acne.
Not a step to be taken lightly.

CamelBalls Sat 02-Nov-13 23:32:28

I was offered this in August - and was told I must be on two forms on contraption, because o the harm it would do to the baby, I was also told I would sign a form saying if I fell pregnant whilst on the medication I would have to have a abortion shock

Don't want to go on two forms on pill as makes me put on weight and have lost 3 stone this year so think unfort I'm going to leave it....

fivefourthreetwoone Sat 02-Nov-13 23:06:46

Nah, I've never had irregular periods or problems with weight gain so I don't think it's polycystic ovary syndrome. I think I've just been really unlucky in having really bad skin.

NeedlesCuties Fri 01-Nov-13 20:00:42

Interesting thread!

I've had the implant in since Nov 2012, and also take the combined pill due to heavy periods caused by the implant. Your derm doctor would love me grin

Nope, hormone levels for people on the pill are not checked - too easily confused with own natural hormones, there is no point.

I am involved in Roaccutane prescribing and I am v familiar with all the issues including reliable contraception, but it gets me feminist goat that after careful discussion and counselling the contraception side is not left to the woman.

MHRA approving of implant

Or was he wanting you to have the pill AND the implant ie the fabled two methods?? Rather than, say, implant and condoms.

I may now be overthinking this...

SeaSickSal Fri 01-Nov-13 00:37:41

Have you been checked for polycystic ovary syndrome? That causes acne. Do you have irregular periods or excess weight/hair

fivefourthreetwoone Thu 31-Oct-13 23:23:00

I'll tell you a bloody effective contraception, depo provera! Nobody is getting pregnant even after they stop taking that!!!

Lol I've heard such horrible things about the depo jab. I don't think I've met a single person who has had a good experience with it but obviously it must work for some people otherwise it wouldn't still be available.

fivefourthreetwoone Thu 31-Oct-13 23:21:33

Is your implant palpable in your arm? Could you demonstrate that it's there? Does your wee card state the date when it was put in?

Yeah, you can feel it's there. I even showed him the card with the date it was put in, date it runs out and the name of the clinic where it was fitted (though like I said before, the name of the doctor who fitted it isn't on there) and even told him he could feel it in my arm if he wanted grin (which he turned down) but he still insisted on the pill.

I've just come to the conclusion he's just very strange indeed.

Although how on earth he'd know whether you are actually taking the pill I don't know...

That's the thing though; I've been doing some reading online and apparently when you have the blood tests they don't actually check to see if you're on hormonal birth control because they don't actually check your hormones in the blood (or something like that). From doing some reading on acne.org it actually isn't unusual for people to say they're taking the pill even though they're not. Some doctors require a prescription as proof but even then some people just get the script but don't bother taking it. And as they don't check hormonal levels in the blood tests, nobody knows they're not taking it. Then there's the issue of even if the pill is been taken, how would the doctor know it's been taken correctly?

Wheras with me, you can actually feel the implant and you can feel it's there.hmm

Like I said above, given the high failure rate the pill (surprised by that chart tbh) along with you can't actually prove whether it's actually been taken or even taken correctly, I'm surprised that it's the first choice method of contraception for a lot of dermatologists when prescribing roaccutane. You really do not want to get pregnant whilst taking it so if you're sexually active presumably you should be using the most effective method you can.

BeigeBuffet Thu 31-Oct-13 22:24:54

I'll tell you a bloody effective contraception, depo provera! Nobody is getting pregnant even after they stop taking that!!!

Of course the implant is more effective contraception than even the pill - glad to hear you are considering changing your dermatologist.

Is your implant palpable in your arm? Could you demonstrate that it's there? Does your wee card state the date when it was put in?

I am just asking because I am wondering whether your dr feels the need to not trust you with reliable contraception and needs proof?
Although how on earth he'd know whether you are actually taking the pill I don't know... hmm

Roaccutane is v strong medication - which is why it works really well and why it also has significant unwanted effects (to misquote Newton "No action without equal and opposite reaction"). The careful counselling about the drug and regular monitoring is designed to pick up any problems before they are severe. SE are reversible when Roaccutane is stopped.
The one SE every single person I've had dealings with on Roaccutane gets is incredibly dry skin which gets worse as the course carries on. So arm yourself with bucket loads of moisturiser, the heavier and greasier the better. You may be prone to nose bleed (dry nasal lining), sore eyes (due to dryness) and cracked lips. Most people who have acne bad enough to be prescribed Roaccutane are used to having greasy skin and don't know what hit them.

Good luck, I hope you find a dermatologist you are happy with and have a good result from treatment.

cardamomginger Thu 31-Oct-13 22:11:33

Also had to google it quite recently grin. Been looking for an excuse to use it!

fivefourthreetwoone Thu 31-Oct-13 21:56:38

POAS - I actually had to google that blush

Unfortunately though I'm not near London.

have always been told by my doctor that the implant often aggravates acne. Could this be why the dermatologist seems keen on the pill?

Worsening acne is a potential side effect of the implant, but I only started using the implant just over a year ago wheras I've had acne for years. It didn't make my acne worse. I think he's just more concerned about the contraception angle.

cardamomginger Thu 31-Oct-13 21:00:19

She never asked me to POAS.

cardamomginger Thu 31-Oct-13 20:59:51

If you are in London five I can recommend my dermatologist Dr Susan Mayou. She is lovely.

AlwaysSleepingBeauty Thu 31-Oct-13 14:45:53

I'm interested to see all the different experiences here, as I was on Roaccutane when I was about 15. I took the pill alongside it, even though I had never even kissed anyone but was never asked to do pregnancy tests. This was about ten years ago.

I'm currently on the pill now, and have always been told by my doctor that the implant often aggravates acne. Could this be why the dermatologist seems keen on the pill?

fivefourthreetwoone Thu 31-Oct-13 12:45:15

I will deffo be swapping now I've really thought about it. Think I'll be looking for a female this time and will be making sure she's okay to have the implant as contraception before I make any appointments.

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