What contraception would you go for in this circumstance?

[Givemestrengthorgin]

39, married, 2 children and not planning any more. I've currently got the copper coil and hate it due to longer and heavier periods. I'm getting it out next week but don't know if I should:

A) try the mirena coil. But i am worried about the acne side effect as I've struggled terribly with hormonal cystic acne in the past. Pregnancy seemed to settle it down and it's much better now and I'm scared to reignite it again.

B) the combined contraceptive pill. I was on this for years when i was younger and I was gererally fine. But it seems to be prescribed with caution once you hit 40. Also, coming off the pill inflamed the terrible acne and I wouldn't want to go through that again. But control over my periods and a decent cycle length would be amazing.

C) good old condoms. Functional but not much fun and a bit yucky. Would also mean I would still get periods which were quite heavy before I even had the copper coil put in. Plus I have a short cycle of around 23 days so would mean having to put up with that. But no hormones and so hopefully no skin issues.

D) the snip. But unfortunately a close friend of ours has had pain and problems ever since he got one and it has scared us both off it.

E) any other suggestions very welcome?!

How long have you had the copper coil? My periods were heavier and longer at first, but returned to normal within 4 months.

Can you be sterilised? Otherwise I would opt for the combined pill.

@yips 15 months! Each month I think it might get better...to no avail.

@2020BetterBeBetter I could look at getting sterilised but seeing as I would still get periods I think I would rather just use condoms.

You’ll still get periods to some extent with options A and B and definitely with D, so you might as well go with C then.

I have the mini pill (cerazette) and love it. Been on it for about 6 years now (am 35) and haven't had one period in all that time.

Could that be an option over combined pill??

Mini pill/pop

Implant/ patches

Rhythm method

Depo provera

Snip is most effective and persistent pain is rare But your periods would still be there.
COC very effective, great cycle control and assuming not overweight/ non smoker/ no migraine etc ok to take with low but not nonexistent risk profile.
Mirena; you will bleed less but cycle control not guaranteed. Very effective contraceptively and side effect profile low. Less hormones than pill or implant.easy to remove if doesn't suit
Condoms less effective, periods remain a nuisance, have to be used.
Progesterone only pill, fairly effective, periods likely to be light or disappear , not as good as mirena in side effect profile or effectiveness but easy to use.
Implant , similar to pop but more effective, more annoying bleeding and kerfuffle of insertion and removal.

Sorry I should have listed the mini pill in with the mirena coil. They are both progesterone only which is apparently how it can inflame skin. Anything that encourages androgens makes the cystic acne come back. Apparently the oestrogen in the combined pull helps to stop that happening.
I don't mind still getting a period - just not the tsunami I have every month now! And a 28 day cycle from either pill would be amazing!

Combined pill, I had it until I was 44, would have stayed on it but i had a hysterectomy.

I would just have to add, we decided that OH could have the snip - he did, it was quite painful and he had some weird things happen (electric shock from the equipment in his ball bag 😱😱😱), and he still gets some weird nerve pain now if he sits in a certain position.

However the biggest problem for me was when I stopped the Combined pill, my periods when crazy, PCOS meant I didn't know when they were coming, and they were awful - horrendous flooding, extreme period pains (like labour pains). After a referral to gynae, the consultant simply put me back on the pill 🙄 Poor husband 😵

Mirena and an improved skin care regime!

Wash face morning and twice in evening followed by a toner containing salicylic acid.

Boots skin clear is cheap and effective.

If that fails - give it minimum6 months then tell him he's getting the chop.

I have problems with my blood pressure so we used condoms for years and years. DH got the snip just over a year ago. It's been great with only mild discomfort. He's also very proud of himself and tells everyone.

vasectomy- your friends experience is irrelevant -look at the statistics

or celibacy

Vasectomy carries 10% risk of PVPD , which is frequently untreatable. Stats don't include discomfort/pain suffered up 0-3 months. Don't trivialise the risks involved. They are real.

I’d give the mirena a try (or dh get the snip!). I had acne for many years which didn’t go until I had a course of roaccutane. I’ve had the mirena for 3 years now, have one day of ultra light bleeding a month and have had no issue at all with spots.

Cervical cap or diaphragm plus rhythm method.

Condoms. No hormones, no side effects, effective if you use them properly, and usually obvious when it hasn't been effective (ie you can see it has split and take the MAP).

For your heavy periods - have you tried the mooncup? I have quite heavy period and find it better than tampons. Also recommend period pants if you tend to have leakage issues.

Mirena - will definitely helps with heavy periods (may even stop them), acne much less likely than with oral progesterone, and as you move towards menopausal age mirena can be used as part of a lower risk HRT regime (if needed)

I do think the periods are a consideration here. A 23 day cycle is pretty hard work and you have the opportunity to find a solution which works for both contraception and periods.

I’m in a pretty similar position to you but I get migraines with aura so couldn’t have the combined pill. My husband offered to have the snip but I’d still need something to control my periods so it seemed a bit pointless for him to take that risk. I have a mirena and I don’t think it affects my acne (I actually had it put in so I could start roaccutane for my skin) but it’s hard to say if my skin would be better if I didn’t have it now I’ve had that treatment. Out of all the progesterone only options it’s the one with the least systemic absorption of progesterone and so the fewest side effects and least likely to affect your skin. I wouldn’t use any of the other progesterone only methods if you’ve had cystic acne.

To be honest, if I were you and I didn’t have any contraindications to the combined pill then I would probably take one of the more skin friendly combined pills because it’s an easy option and won’t upset your skin. That said the “best” option taking in to consideration periods, effectiveness and risks whilst prioritising you’re skin just slightly less is probably the mirena I would think.

Is Dianette still available?

Tricky one really. The snip,is mentioned but depends what your husband thinks. My husband was reluctant after a friend of his and then subsequently a colleague both had real problems with it, one resulting in a month off work after and he point blank refused which I respect. When you research it complications with vasectomy is not that unusual...circa 10% when we researched it

Condoms...god no. Well everyone to their own but when in a committed relationship or marriage I can't abide by them. And in reality how reliable are they without another form of contraception. Without doing TMI you have to be exceptionally careful not not have any precum or cum anywhere near you. I can't think of any time when we make love that I haven't got some on my hands or he has and who wants to be washing hands in the middle of things?

I went fr Mirena and love it. Now on my second. Periods zilch and I dint know it is there. You know when the hormone is running out as you tend to start getting a light bleed which I did at 4 years and just had it stopped.

If that didn't work well with your acne I'm not sure the mini pill would as it is progesterone again, although it is higher dose and once a day compared with Mirena

As ever no easy answers

Mirena without a doubt. The level of circulating progesterone is very low compared to pills and unlikely to influence acne.