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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?

RoxanneReidsChafingFishnets Wed 30-Oct-13 22:46:18

Is that drug even safe to take? Doesn't it babe dangerous side effects? I'm sure I saw a programme about it

fivefourthreetwoone Wed 30-Oct-13 22:48:06

It can have bad side effects, yes, such as depression, birth defects, etc. That's why you're monitored carefully throughout treatment and have regular tests.

Really though I'm desperate to try anything now. I just want my acne to go away.

ShowMeYourTARDIS Wed 30-Oct-13 22:49:25

I've always heard the implant was more effective than the pill, partly because you can't forget to take it. With the pill, there's always the chance you'll forget, lose the pack, throw it up, etc.

RoxanneReidsChafingFishnets Wed 30-Oct-13 22:51:12

Get a prescription for pill, show him it, get roaccutane, dont take pill

AnyChippednailvarnishfucker Wed 30-Oct-13 22:53:23

I've never heard this before OP - contraception yes, it having to be the pill, no.
You have my sympathies acne is very depressing, on the plus side I know people who have used roaccutane and had fantastic results.
Good luck.

APartridgeAmongThePigeons Wed 30-Oct-13 22:54:05

Effectiveness is an important and common concern when choosing a birth control method. The birth control implant is very effective. Less than 1 out of 100 women a year will become pregnant using the implant. It lasts up to three years.

So in other words exactly the same as the pill, except you can't fuck it up and forget it.Get a different doctor to prescribe, he's being ridiculous

meditrina Wed 30-Oct-13 22:55:24

NHS page says you need to be on one, ideally two forms of reliable contraception but does not specify which type.

I'd have thought implant was better than the pill (no chance of user error).

I hope you get this sorted out.

Btw: remember that you mustn't give blood whilst taking it and for one month afterwards whilst it clears your ody.

APartridgeAmongThePigeons Wed 30-Oct-13 22:56:00

www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Acne&medicine=Roaccutane&preparationRoaccutane%2020mg%20capsules

Roaccutane may harm a baby if it is taken during pregnancy. It may also increase the chances of having a miscarriage. Women must not become pregnant while they are taking Roaccutane. For this reason women who could become pregnant are only prescribed Roaccutane if they are very careful about using contraception to prevent pregnancy. Women who are being treated with Roaccutane and who do not have a menstrual period or who are not currently sexually active must also use contraception.

If you are a woman and you are taking Roaccutane, you must not become pregnant during treatment and for at least one month after stopping treatment with Roaccutane. You must use one form, or preferably two forms, of effective contraception one month before you begin treatment with Roaccutane.

You must continue to use this contraception while you are taking Roaccutane and for at least a month after you have stopped taking Roaccutane. During this time, if you become pregnant, or think you have become pregnant, you must immediately contact your prescriber. For more information about using contraception and what types of contraception should be used while taking Roaccutane talk to your prescriber or read the Patient Information Leaflet that comes with your medicine.

Treatment with Roaccutane can only be started in a woman once the prescriber is certain that the woman is not pregnant. Women will need to have a pregnancy test before, during and five weeks after stopping treatment with Roaccutane. For more information about pregnancy tests during treatment with Roaccutane, talk to your prescriber.

Edendance Wed 30-Oct-13 22:57:35

Good for you to get roaccutane! I was on it for 6 months when I was 14-15 and it's fantastic stuff. I had the usual minor side effects, pink/dry skin and dry inside of nose but I only had to wash my hair once a week- result!

Re contraceptive, the doctor sounds ignorant of the most up to date options, I would try and get yourself a 2nd opinion to be honest.

APartridgeAmongThePigeons Wed 30-Oct-13 22:58:15

It says nothing about which form of BC you need to use, just a reliable one.

I think it's shit they can dictate that tbh, I understand you don't want to get pg on it, but maybe you don't want to take hormonal contraceptive you shouldn't have to.

What if you're a nun? hmm confused

APartridgeAmongThePigeons Wed 30-Oct-13 22:58:49

Maybe get a note from the doctor who installed the implant?

CoffeeTea103 Wed 30-Oct-13 23:01:27

I was on roaccutane for 8 months and it's definitely the best treatment for severe acne. I was also advised on taking the pill, but as I had already been on it I didn't question alternative measures. They will test you for pregnancy before prescribing it, and also at every checkup.

meditrina Wed 30-Oct-13 23:03:21

Patint information leaflet here. It doesn't specify type of contraception, but does recommend doubling up with a barrier method as well.

It doesn't mention nuns, but does say that even women who are not sexually active at time of prescribing should be referred or contraceptive advice (unless compelling reasons otherwise - which might encompass Holy Vows I suppose).

fivefourthreetwoone Wed 30-Oct-13 23:07:39

I'd have thought implant was better than the pill (no chance of user error).

That's what I was thinking. I mean, you can forget to take the pill or take it at the wrong time and that would impact how effective it was...you can't do that with the implant because it's always there if you see what I mean.

Things like vomiting and diarrhea can make the pill less effective too which I don't think is the case for the implant.

Get a prescription for pill, show him it, get roaccutane, dont take pill

I would actually do that but my GP won't actually prescribe me the pill. Like I said, I can't take it on medical grounds, hence no doctor would actually give me a prescription. It's not just me being fussy about not wanting to take it. The pill actually would be my first choice of contraception if I could take it.

justabigdisco Wed 30-Oct-13 23:13:25

The implant is the most effective contraceptive there is. Can you get your GP to write to the dermatologist and perhaps offer to teach them a thing or two about contraception?

fivefourthreetwoone Wed 30-Oct-13 23:14:31

Sort of OT here, but how recent is the contraception requirement when taking roaccutane? I keep reading that all women of child bearing age must take one, preferably two, forms of birth control but I have a friend who took roaccutane about ten years ago and she wasn't required to use any form of contraception at all. She just had to swear to remain abstinent during the course of the treatment and sign a form saying she wouldn't get pregnant and that was it. confused Like I said, that was years ago though.

I actually think her derm was either very trustworthy or incredibly stupid letting her do that, I can't decide which.grin

If I take roaccutane, I'd be doubling up with condoms anyways, so the implant and condoms should count as two methods.

I'll talk to my dermatologist again. If he still insists on the pill, I guess I'll have to find another doctor.

APartridgeAmongThePigeons Wed 30-Oct-13 23:15:27

What if you are a nun and the only male around the grounds is a male game keepers whos had the snip?

Is that two forms of contraception?

Also do they make young girls take the pill 11 or 12?

fivefourthreetwoone Wed 30-Oct-13 23:22:46

*What if you are a nun and the only male around the grounds is a male game keepers whos had the snip?

Is that two forms of contraception?

Also do they make young girls take the pill 11 or 12?*

Apparently in America you're allowed to select abstinence as a form of birth control when taking it. However not every doctor there accepts that, but it is considered to be a valid form over there. I'm not sure if it's the same over here? Like I said above, a friend of mine was allowed to use abstinence as her method of birth control and that was it, but like I said, that was years ago.

Tbh I think the birth control thing is just to cover the doctors back more than anything else. It's so people can't sue them if you do get pregnant. So can't really answer your nun question lol. Not sure what they'd do.

I don't think many doctors would actually prescribe roaccutane to 11 or 12-year-olds anyways because it is a very strong drug. I'd imagine though that yes, the requirement would apply to them too...

PepsiBubbles Wed 30-Oct-13 23:38:01

I didn't have to use contraception when I was on roaccutane neither. My dermatologist told me that it is 'recommended' you go on the pill but didn't say I had to so in the end I didn't. I just had to sign a form saying I would remain abstinent throughout. This was 6 years ago.

LordEmsworth Thu 31-Oct-13 08:41:52

My GP told me the implant is more effective than the pill. Your dermatologist is presumably a man who can't be bothered to look into contraceptive techniques?

As an aside - have you read Jillian Michaels' Master Your Metabolism? In the first chapter she talks about her experiences with weight loss and the impact on her hormones, taking Accutane (is that the same thing?) and how she "overcame" it. I am not saying don't go on the Roaccutane - just that you might find it interesting to read...

happygirl87 Thu 31-Oct-13 08:44:39

Friend of mine took it and had to do regular pregnancy tests at the dr- could that be an option for you? See if that will appease the dermatologist. Otherwise you could a) ask him for a prescription for the pill (and not take it), b) ask your GP for a letter to dermatologist saying you cant take the pill but have implant which so more reliable, or c) get a new dermatologist, cos he sounds like a twat! (But I know it's not always that easy) good luck!

Edendance Thu 31-Oct-13 08:45:09

I didn't go on any form of contraceptive when I was on it at 15, I hadn't even kissed anyone by that point and was mortified when my mum got me to say for myself that I wasn't going to get pregnant while on it, in the appointment!

killpeppa Thu 31-Oct-13 08:45:48

I have the implant after getting pregnant on the pill TWICE!

its fab, no worries no remembering and 99% effective

cardamomginger Thu 31-Oct-13 08:53:25

I was on roaccutane, was monitored with monthly appoointments and blood tests to check liver function. I was told I just had to be on contraception when using it and for 1 month afterwards. She didn't say which sort, but thinking about it I guess the pill is the 'easiest' in terms of an add-on as it is non-invasive and has a short wash-out period if you want to stop taking it.

I think the doctor is being ridiculous in not accepting implant plus condoms. Rather than have the faff of finding another dermatologist, can't you just get the pills prescribed and not take them? OTOH if she/he is being so silly about this, maybe she/he is not the best person to see - what else might they be silly about??

Sorry just seen you can't take the pill. Change then - if the dermatologist is so inflexible and can't actually be bothered to look at the reality of the medical situation, i.e..implant works and you can't have the pill, then they can't be a very good doctor IMHO.

cardamomginger Thu 31-Oct-13 08:53:41

BTW - good luck! Roaccutane was amazing for me!

emmadash Thu 31-Oct-13 08:57:50

LordEmsworth is right, the implant is more effective than the Pill. Typical use failure rate for the implant is 0.05%, making it the most effective form on this chart. The pill has a typical use failure rate as high as 8% - not really reliable enough if you definitely needed to avoid pg as in this situation.

If you wanted to use Roxanne's approach, a simple way to get hold of a prescription for the Pill without any fuss is to use an reputable online pharmacy. I've ordered from the Superdrug online pharmacy as it was quicker and easier than getting the Pill from GP, just answer their questions in the right way (i.e. ignoring your medical issues, as you won't actually be taking it) and pay about £20. All above board, it gets reviewed by a real doctor and you get sent the pills in the post which you can show it to the dermatologist. Having tried to get my GP to write to consultants in the past/advocate on my behalf, I'd choose this option as far quicker and easier (albeit more expensive) than trying to get my GP to argue with the dermatologist.

fivefourthreetwoone Thu 31-Oct-13 11:12:57

After sleeping on it, I've come to the conclusion that my doctor is a complete loon and I'm going to be looking for a different dermatologist.

I can't believe a doctor would be this clueless about contraception though even if he is a man grin you would still think he would have researched alternative contraception methods, it's not hard.

After looking at that chart that was posted above, I'm actually quite surprised that so many dermatologists suggest the pill over any other contraception seeing as it has a higher failure rate than other methods. That's assuming the person was even taking the pill correctly in the first place...? I guess because the pill is easier, you can just stop taking it after finishing treatment if you want and that's that, it's a shorter acting contraception if you will. But still you really do not want to end up pregnant whilst taking roaccutane.

fivefourthreetwoone Thu 31-Oct-13 11:15:01

Friend of mine took it and had to do regular pregnancy tests at the dr- could that be an option for you? See if that will appease the dermatologist

I think that regular pregnancy tests are a requirement for all females, regardless of what contraception they're using.

APartridgeAmongThePigeons Thu 31-Oct-13 11:16:44

Is it easier for you to get another dermatologist than to get a note from the doctor who put you on the implant explaining the failure rate?

Just thinking that if you have to wait for another appointment it might be worth just calling and getting a note.

fivefourthreetwoone Thu 31-Oct-13 11:24:47

Well I actually can't remember who put my implant in. I had it done at one of those family planning/sexual health clinics rather than my own doctor. It was also put in when I was living at the other end of the country and as it was over a year ago now, I can't remember the name of the doctor. I've checked the little card I got at the time but it just has the name of the clinic on not the doctor who fitted it. Not very helpful, I know.

I suppose I could ask for a note from my GP even if he didn't fit it explaining that I have it and that it is a reliable form of birth control?

I should also add that I'm seeing this dermatologist privately, so if I changed, I would still go private and wouldn't have to sit through NHS queues so actually wouldn't be too much of a hassle to change.

APartridgeAmongThePigeons Thu 31-Oct-13 11:29:20

Oh in that case, I would just swap, you're paying extra for a bit of a dim bulb

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.

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?

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.

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

She never asked me to POAS.

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 22:11:33

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

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.

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!!!

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.

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.

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

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...

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

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.

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....

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 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.

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.

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

Needles why don't you just take the pill?

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?

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

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

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.)

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.

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

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

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.

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