Contraception

[Tiredskin]

My 15 year old dd has a boyfriend for the last 9 months. They're not having sex, yet. But they seem very settled as a couple and will probably last some time longer. Her friends have had the contraceptive bar put in. I would prefer, when the time comes, for her to have the copper coil, like I have.
I'm against hormonal contraception for a few reasons: it wrecked my libido, I put on weight and I don't trust the long term impact on fertility.

Interested to hear other people's thoughts?

My sister and I are both nulligravidas and both have IUSes. She has Mirena and I have Fibroplant. We've both had Mirena and Fibroplant in the past and I'va also had Flexi-T 300.

My and my sister both struggled with the frame size with Mirena the first time, with cramping during and between periods. The insertion pain is off the scale, screaming levels of pain. When I went to the late Dr Wildermeersch for my first Fibroplant, he did something no other coil fitter had done before. He gave me cervical anaesthetic. Local anaesthesia during a coil fit is a game changer: ask for it!

The Flexi-T 300 was bearable without anaesthesia but not pleasant. It was nowhere near as bad as the Mirena and it's one of the IUDs recommended for nulligs.

Why don't my sister and I just take the pill or a hormonal LARC? Dsis was hospitalised with a blood clot in her lungs caused by the interaction between the oestrogen in her patch and an, at the time, undiagnosed clotting disorder. You don't know what you and your DDs are undiagnosed with, is it worth that risk? I was banned from the pill aged 20 when NICE decided that quadrupling women's risk of stroke was only OK if they didn't have migraines. My sister and I both become depressed on progestogen-based contraceptives. I went on depo provera in my early twenties, I wish I'd never let that needle near my body because I gained three stones in nine months and started self-harming, and I've never lost more than half of that weight since.

The complications I mention above are not as rare as you might think. Weight gain on depo provera is well-known, as is depression.

So, OP: encourage your DD to get a Flexi-T 300 and ask if the clinic can use cervical anaesthetic. You are entirely reasonable in wanting her to avoid the adverse side-effects of hormonal contraceptives.

And tell her to use condoms anyway, she doesn't know where her boyfriend's been not who he's been there with.

Amused at how PPs' definition of "invasive" doesn't include putting exogenous hormones into every single cell of your body.

The only reason why Dsis and I have IUSes and not IUDs is that she has "fainting with the pain" levels of dysmenorrhea and I have endo. With the IUS, the hormones are dosed in the uterus where they are needed, so you don't need as high dose as if you take a pill or injection/implant.

If you can avoid hormonal contraceptives, I'd recommend it.

And before anyone jumps on me: yes, I know it's up to DD. But I don't want any woman having the awful and permanent side-effects of depo like I had, nor ending with a stroke or a clot in her lungs, for lack of knowing that nulligravidas can have IUDs and the insertion doesn't have to be torture.

She should be led by a family planning practitioners advise, not yours. Unless of course you are a family planning practitioner?

Dirty little secret of the family planning clinic: after the doctor has written the prescription, it takes a nurse to give depo and a pharmacist to give the pill, but a chaperoned gynecologist to fit a coil. So they recommend what's cheap and easy for them, not necessarily what's best for you.

No it doesn’t

I’m a sexual health nurse, I can give pills and depo under my own PGDs and am soon to complete training in implants and coils to fit under PGD also. The only thing you’re correct about is needing a chaperone, the rest is bollocks. FWIW we actively encourage LARC as gold standard contraception. I’d really love to know which sources you’ve used as you may need to update your research

My experience of being steered, very insistently, to depo about 22 years ago, followed after I came off it by me reading the cost-benefit rationale published by NICE at the time, which explicitly mentioned things like cost per woman-year of use with and without weightings to take failure rate into consideration, and mentioned the cost to NHS of the device and typical cost of staff.

If things have changed in 20 years, that's fantastic.

Copper IUD is the LARC with least impact on the woman's body as a whole. Depo is well-known to cause weight gain. We have an obesity crisis, why give women a contraceptive that causes weight gain when other LARCs exist?

Because not everybody wants to have an implant or a coil, but might be rubbish at taking pills, or might want something that doesn’t rely on user technique.

I don’t give depo without making it crystal clear that one of the side effects is weight gain, especially if the user is already overweight. However, not everybody is obese. If I have a 20 year old, fit and healthy woman in front of me with a normal BMI and she is adamant she wants depo after I have counselled her for all options, I will explain the risks and she can have it if she wants it. If I see a 45 year old woman who is overweight, wants depo and has no other contraindications, I will counsel for all options, carefully explaining risks and side effects and she can have it if she wants it. Ad infinitum.

Patient choice is at the centre of what I do and I will not push something if a patient doesn’t want it; I will do whatever I can to offer them their first choice of contraceptive if it is safe for them to have it.

That's fair. When I got my depo aged 20, no one warned me of side effects. When I started the pill at 17, no one said "oh by the way this quadruples your stroke risk".

I am really glad that you are warning women about these risks.

Personally I wouldn't go near hormonal contraception of any kind, and certainly wouldn't have entertained the idea of a coil as a teenager. Condoms and a diaphragm worked for me.

When I was 18 and started taking the combined pill they didn’t say ´by the way this will quadruple your stroke risk’ in exactly those words.
But they DID talk to me about blood clot risk increasing and what that can lead to (stroke/pulmonary embolism) and check I didn’t have any risk factors, outline symptoms to look out for, check my blood pressure and weight every 6 months.
They also talked to me about weight gain/increase in appetite, cancer risks increasing and decreasing, common side effects and side benefits (increased/reduced PMT type symptoms, acne increase/decrease).
Oh and the importance of condoms!

OP, there’s a great youtube channel by an ObGyn called Mama Dr Jones who has good videos on different types of contraception. Might be a good thing for your DD to watch so she has some ideas about what she might like to try/questions ready for the dr/nurse when you take her to her appointment. I think you should encourage her to go in to the appointment alone while you wait for her in the waiting room. It’s good practice for when you she’ll need to arrange and attend appointments without your input as a young adult.

If things have changed in 20 years, that's fantastic.

Did you really think that the world has remained exactly the same as it was 20 years ago? What a strange viewpoint.

I had a coil fitted at 24, and have never had children. The insertion pain was so bad I've never got another one.

Please look at less invasive options for your daughter.

Ask for cervical anaesthesia.

For contraceptives, I didn't expect much to change. I've been donating to Vasalgel research for about 15 years and that seems to be glacially slow. The only innovation I've seen has been Fibroplant, now stalled because of Dirk Wildemeersch's death, and some new latex-free condoms hitting the market.