Anybody here knowledgeable about contraception?

@FurthestUPNorth depo can also cause bleeding (I spotted constantly with it) and is known for weight gain too. And you can't just get it out your system easily if it doesn't suit

Depo injection can stop periods altogether

Ref comments about fertility not returning for a year

At 18, I assume that she is not wanting a child at her age

I believe I read that a slightly smaller copper coil is now available on the NHS, a useful choice for nulliparous women. It is an option, I agree about the double appointment with the GP in the practice that has the most interest in this area of medicine, and if she would like you to go with her? The GP may want to examine her and ask other questions about her bleeding etc., take bloods etc.

But, maybe it would be reassuring for her to actually use condoms carefully with your son for a bit and to learn how to track her cycles as they come back to what it normal for her. Not as contraception obviously but to learn about her individual body (although if using condoms could also avoid the more likely fertile days as well). I've done that in the past.

I couldn't use any hormonal contraception. We just opted for condoms in the end.

Implant was horrendous for me woth bleeding. Combined pill Marvelon was fine. Had mirena fitted and it's been amazing

If she is having a lot of bleeding with hormonal contraception I would recommend giving the copper coil a go. I had implants for about 9 years, then a copper coil for 2 years, then took it out to TTC and now I have another copper coil.

I don't know why people say copper coils aren't suitable for women who haven't had children. There's no reason for that to be true.

Poor girl, she’s had a rough time. I’m amazed wherever she went for her implant to be removed didn’t do a blood test. She really needs that asap as she may well need treatment.

Re: infertility: the Depo injection can cause a delay in return to fertility of up to one year, all the other methods: normal fertility returns very quickly once the method is stopped (and the copper coil has no effect on fertility at all)

Also: the implant lasts/is licensed for 3years so if she has been relying on it for contraception for longer than that she may have put herself at risk of a pregnancy: hopefully the family planning clinic did a pregnancy test while she was there

Sexwise is a good site for information, Brook do one too, can you see if your local GUM service runs a Young Person's clinic: they can talk through contraception options with her.

Thank you for sharing. Always happy to learn. I do know women who have the copper coil and have been fine despite not having had children, and it was recommended as an option for me pre baby. From what you've posted it looks like a more important factor is the size of the uterus itself, rather than whether or not the women have been pregnant. That's the case for any coil and why there are different sizes. There will be plenty of women who can accommodate the copper coil despite not having had children, and plenty who can't despite having had children.

Could you offer to go with her to a sexual health clinic/gp appointment so that she can discuss her concerns with a doctor? I did this with my sister once (who is 8 years younger than me) as she kept getting fobbed off by doctors and turned out to have endometriosis.

Unfortunately contraception is one of those areas where you have to use trial and error to work out what works best for you. If she has heavy bleeding then the Mirena might be useful as it's licensed to treat heavy bleeding as well as being a contraceptive. I've always had more helpful advice at sexual health clinics than via a gp to be honest.

@annahay from NICE:
In 15 studies comparing IUD performance in parous vs. nulliparous women, nulliparous women had higher rates of expulsion and removals due to bleeding and pain. Among 8 studies examining different types of copper IUDs in nulliparous women, some evidence suggests IUD size and shape play a role in performance.

I can send you the link if you like. the uterus is much smaller in nulliparous women hence the reduced tolerance. Gynaecologists I have worked with generally don't reccommend them in this group of patients.

copper coils are not great for women who have not had children tbh

Copper coils are absolutely fine for women who have not had children. It's highly effective, foolproof, and doesn't mess with your hormones. I had one for years before DC and it worked perfectly. Insertion was straightforward and only very briefly uncomfortable.

It often does make periods a little heavier, which can be a problem for those who already have heavy periods. I would guess the GF is anaemic and would probably give the minipill a go and look into some iron supplementation. She could then look at an IUD if desired, or if the bleeding doesn't stop on the minipill.

I've been plagued with contraception issues since forever!

I've tried multiple different pills and they either send me loopy or I fall pregnant (!) I had the implant and that was worse. I ended up asking for a copper coil in 2019 and it's been the best decision I've made!

There's no reason that a copper coil would be more problematic for women who haven't had children.

I was on the implant for about a year and kept bleeding. Had it taken out and went on the mini pill instead and have not had a period since.

I could not tolerate pills and have always had to use condoms (other than when ttc) can she just come off them altogether? It doesn't sound like they're particularly good for her

Make a GP appointment and go with her. Fight her corner if you can.

See if you can get a double appointment with her GP. I did this when I was in a right flap about contraception and the doc went through every single option and the pros and cons. I ended up with the Mirena coil even though I was really averse to the idea. It turned out to be the best thing ever and I'm so glad I took the time to grill the doc about it.
No one can give her the appropriate advice without seeing all her medical history. Definitely one for the GP.

I had the implant. Had it removed due to wanting to ttc. Had a dc 9 months and 10 days later.. Be careful tell her!

If she's been bleeding constantly for four years she should speak to a nurse or gp, and ask for a blood test, she might need some iron tablets.

Has she had a look at the NHS advice on contraception:

copper coils are not great for women who have not had children tbh ... but works for some.

definitely would get her checked for anaemia

and it's perfectly reasonable to want a break from hormones and just use a condom?

really it's time some male contraceptives came out. why is that women always have to shoulder the responsibility.