Anybody here knowledgeable about contraception?

[Askingabout]

Sorry I’m posting for traffic. I’m not particularly knowledgeable about contraception but need some advice. It’s not for me it’s for DS’s GF. She’s 18 and NC with her mum.

Shes’s confided in me that she’s having terrible problems with contraception. Her mum took her to get the implant 4 years ago when she was 14. Ever since she’s been bleeding virtually daily. Family planning clinic told her to take the combined pill alongside having the implant but the bleeding never stopped.

She went today to have the implant removed as she’d had enough and has come away with the mini pill.

It seems on the occasions she has gone she hasn’t been advised much about her options - maybe because she’s so young possibly.

She’s worried that because she’s bled so much for four years she’s completely ‘messed up her body’ and is upset she has somehow made herself infertile with all the hormones (I reassured her this is very unlikely), she doesn’t know if she can / should immediately start the mini pill (she took her combined pill this morning) or leave a gap?

Should I advise her to see the GP or practice nurse? She’s always light headed and often feels nauseous- I’m assuming from the blood loss?

Has she had blood tests to see if she's anaemic?

Was she given a reason as to why she was given the mini pill rather than continuing with the combined pill? The mini pill can also cause erratic bleeding although it can also stop periods.

She could start the mini pill tomorrow and then after 2 days of pill taking would be covered against pregnancy.

Mini pill and implant have same hormones. I would recommend a copper coil from the sexual health clinic. My dd was on mini pill and said coil is the best thing ever with no hormones. If she asks for local anaesthetic at time of insertion.

They don't have the exact same hormones. There are different types of mini pill that have different side effects as they have the different hormones.

Copper coil can lead to heavier more painful periods too so she may not want to try it if she is already bleeding a lot.

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.

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:

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!

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.

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

Thanks everyone, I’ve told her to make an appointment with GP, and that if the mini pill is not working for her she must go and discuss her options with a nurse / GP. I’m not sure much has been explained to her at the family planning clinic. Feel so sorry for her, I can’t believe she’s suffered for four years with constant bleeding!

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

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.

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

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!

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.

@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.

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.

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.

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.

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.

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

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)

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.

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.

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

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