Contraception - need to decide what to use by tomorrow and am clueless. Help!

[MuffinMclay]

Having mine and ds2's 6 week check tomorrow, which seems as good a time as any to discuss contraception with the GP. I've been googling etc and still don't have a clue what I want to ask for.

I haven't used anything at all since about 1996 (mini-pill) and have no idea what the advantages and disadvantages of the different types are.

I think I'd like the pill again, in some form, but don't want it if it will make me put on weight or give me acne (or are those urban myths). Are there different types of the pill that have different side-effects?

My gp isn't the sort to enter into long discussions about things. I have to go in and know exactly what I want.

I tried doing that and gave up. It involved queueing for an eternity and no pushchairs are allowed in the building. No fun with a newborn in my arms and a tantrumming 2 year old.

GP seemed a much easier option.

Tell me a bit more about your 'contraceptive needs' and I'll try and help you. I'm a GP with a specialist interst in FP.

How old are you?
Do you want something permanent or do you plan more children?
Do you want a daily method or a long-term reversible method?
Do you have any medical problems or taking any medication?
Do you have any particular feelings about pills, patches, injections, implants, coils?

1. 35 years old
2. Something fairly permanent - pretty convinced that I don't want more dcs, but never say never
3. not fussed on daily v. long term. No objection to daily - I wouldn't forget to take a daily one.
4. no medical problems or medications (except occasional eczema, hayfever)
5. don't want coil or anything stuck inside me, or condoms.

Like the idea of the pill, but am worried that it might have long term side effects (no idea what) and might make me put on weight (am trying to lose the baby weight of 2 dcs).

Muffin - am in exactly the same situation, so interested to hear what advice is offered...

As long as you are low-risk (i.e not overweight or a smoker or have a history of clots or high blood pressure) going back on the combined pill is a viable option. The pill doesn't make you put on weight or give you spots. Besides, if it didn't suit you, it can be easily stopped. If you are crap at remembering to take tablets, but want the convenience of the pill, there is a weekly patch called Evra which works in the same way.

Depending on how long you may want to use a pill, there is always the mini-pill which doesn't have any oestrogen in it and therefore doesn't increase you risk of breast cancer in the long-term. There are 2 types of mini-pill: the traditional one which you have to take within the same 3 hour gap each day and cerazette which allows you 12 hours (but some GPs are reluctant to prescribe as its expensive).

If you are worried about weight gain,I would steer you away from Depo-provera (the injection). There is also a hormone implant which fits under the skin at the top of your arm and can last for up to 3 years, which is reasonably problem-free and reversible. There are also traditional copper coils and hormone coils (mirena- good for ladies with heavy periods) which can last for up to 5 years and are easily removed.

That's pretty much all of your options apart from condoms and sterilisation!

Is there anything else that you'd like any info on or have I totally bamboozled you??

Hello emma1977 - sorry to highjack. I am in a similar situation but very overweight (bmi 37) and I need to know what my options are.......haven't used contraception for years and have put on abut 3 stone since I was last on the pill.......thankyou!

Blimey, I could start my own 'Dr Emma's contraception corner'!

mrslurkalot, the combined pill/patch wouldn't be suitable I'm afraid. Depo would be inadvisible due to the risk of increasing your BMI further. Your options would be (in a nutshell) the mini-pill, implant or either type of coil.

Thanks Dr Emma!

Just out of interest, what would my BMI need to be to be suitable for the combned pill (am currently trying to losing weight). Thanks!

Hello Dr Emma - can I ask for help too? (bet we could get you a corner!) What pill would you recommend when breastfeeding? And does being overweight atm (12 stone/5 foot eight) have a bearing?

I'm not Dr Emma but your options of pills would be the mini-pill as it is less likely to affect your milk supply. I'm on cerazette (mini-pill) due to my weight and have been very happy with it

Thanks Seona!

Mrslurkalot- BMI under 25 is ideal but most doctors would hapily prescribe up to 30 provided that you have noadditional risk factors. Over 30 increases your risk of blood clots and over 35 is an absolute no no.

Alva- I would agree with Seona1973. Any mini-pill is OK when breastfeeding and your weight is not a problem at all. I personally prefer Cerazette too as it is less likely to be forgotten when trying to juggle BFing and caring for a baby. Its also what I use and I'm BFing (I'm not biased or on commission promise).

Oh good, thank you - this has really helped!Was trying to get my courage up to have a mirena coil fitted, but it just feels too invasive an option atm...

thanks dr emma! very helpful!

Alva- Flippin heck, after experiencing childbirth having a Mirena fitted is a doddle!

Mrslurkalot- Glad to be of help

Do you think I'be earned my own corner yet? It'll keep me out of trouble while I'm on matty leave.

I loved the combined pill.

But can't take it any more as blood pressure too high.

DH having the snip after no. 3 is born.

Think it's because of childbirth that I'm not keen! That and infection risk.
Def need a corner - and since the chickens have one now, there should be no question!

I'm debating this too. DD is 5 months old and DH is waiting for snip. Theres a really long waiting list- about 9 months we've been told. Are there any pills I could take if I'm on St Johns wort? Cant have combined as I'm 37 and a smoker. Thanks.

Interesting thread.

I was a bit [hmmm] on the op's behalf that pushchairs are not allowed in the fp clinic. Also I did have a little chuckle - sorry.

Kind of defeats the object really. (Health and Safety one assumes...but the reason that most of us go for contraceptive advice is because we already have enough children...)

Thanks for that Dr Emma, really helpful - you should have your own corner.

I'm not overweight, but used to be really slim and now am not (but dream of becoming so again). BMI now 24, but used to be 18. Not a smoker either. Generally BP is fine, but it was high during both pregnancies (pre-eclampsia).

Sounds like the mini-pill is my best bet.

Went for the mini-pill in the end (Micronor). Thanks for advice.

Ess- sorry for the delay in getting back to you.

Unfortunately SJW interacts with both the combined and the mini-pill. The patch would also be unsuitable

You may wish to try the depo injection or have a coil or implant fitted short-term. In my experience, depo ends to be the most popular choice in this situation.

Thanks Emma. Do I have to see my GP for that or does a nurse usually do it?

The nurses usually give the injections but you may have to see a GP first to discuss that you are definitely suitable for it. However, your surgery may work differently, so why don't you ring your practice nurse and ask.