Modern Medical Birth Control - Risks

 Sometimes people wonder why I go through all the trouble of charting to avoid pregnancy when women have so many other birth control options. 

I just wonder why they put themselves through medical birth control methods. 

Let's look at the risks of some of the modern methods. By the way - It concerns me that I had to do extensive searches on each website to find this information. Some even hide the full side effects from the FAQs portion of their site.

Hormonal birth control pills and patches

Taken from the pdf file (download here) for OrthoTriCyclen - "The use of oral contraceptives is associated with increased risks of several serious conditions including myocardial infarction, thromboembolism, stroke, hepatic neoplasia, and gallbladder disease, although the risk of serious morbidity or mortality is very small in healthy women without underlying risk factors. The risk of morbidity and mortality increases significantly in the presence of other underlying risk factors such as hypertension, hyperlipidemias, obesity and diabetes."

OthroEvra (the patch) contains almost identical wording. 

Seasonique (the three-month no-period pills) -  "Vascular risks: Stop Seasonique if a thrombotic event occurs. Stop Seasonique at least 4 weeks before and through 2 weeks after major surgery. Start Seasonique no earlier than 4 weeks after delivery, in women who are not breastfeeding. (5.1)
• Liver disease: Discontinue Seasonique if jaundice occurs. (5.3)
• High blood pressure: Do not prescribe Seasonique for women with uncontrolled hypertension or hypertension with vascular disease. (5.4)
• Carbohydrate and lipid metabolic effects: Monitor prediabetic and diabetic women taking Seasonique. Consider an alternate contraceptive method for women with uncontrolled dyslipidemias. (5.6)
• Headache: Evaluate significant change in headaches and discontinue Seasonique if indicated. (5.7)
• Uterine bleeding: Evaluate irregular bleeding or amenorrhea."

Depo-Provera Shots - "Thromboembolic Disorders: Discontinue Depo-Provera CI in patients who develop thrombosis (5.2)

Cancer Risks: Monitor women with breast nodules or a strong family history of breast cancer carefully. (5.3)

Ectopic Pregnancy: Consider ectopic pregnancy if a woman using Depo-Provera CI becomes pregnant or complains of severe abdominal pain. (5.4)

Anaphylaxis and Anaphylactoid Reactions: Provide emergency medical treatment. (5.5)

Liver Function: Discontinue Depo-Provera CI if jaundice or disturbances of liver function develop (5.6)

Carbohydrate Metabolism: Monitor diabetic patients carefully. (5.11)
----------------------------------ADVERSE REACTIONS---------------------------
Most common adverse reactions (incidence >5%) are: menstrual irregularities
(bleeding or spotting) 57% at 12 months, 32% at 24 months, abdominal
pain/discomfort 11%, weight gain > 10 lbs at 24 months 38%, dizziness 6%,
headache 17%, nervousness 11%, decreased libido 6%. (6.1)

To ensure the patient is not pregnant at the time of the first injection, the first injection should be given ONLY during the first 5 days of a normal menstrual period; ONLY within the first 5-days postpartum if not breast-feeding; and if exclusively breast-feeding, ONLY at the sixth postpartum week."

Mirena (IUD device) (This was by far the most difficult to find information on. While others listed their "prescription inserts" with a bit of searching, Mirena asks that you talk to your health care provider for a full list of possible side effects) - "Call your healthcare provider right away if you think you
are pregnant. If you get pregnant while using Mirena, you may have an ectopic pregnancy. This means that the pregnancy is not in the uterus. Unusual vaginal bleeding or abdominal pain may be a sign of ectopic pregnancy.
Ectopic pregnancy is a medical emergency that often requires surgery. Ectopic pregnancy can cause internal bleeding, infertility, and even death.
There are also risks if you get pregnant while using Mirena and the pregnancy is in the uterus. Severe infection, miscarriage, premature delivery, and even death can occur with pregnancies that continue with an intrauterine device (IUD). Because of this, your healthcare provider may try to remove Mirena, even though removing it may cause a miscarriage. If Mirena cannot be removed, talk with your healthcare provider about the benefits and risks of continuing the pregnancy. 

Life-threatening infection can occur within the first few days after Mirena is placed. Mirena may become attached to the uterine wall. If embedment happens, Mirena may no longer prevent pregnancy and you may need surgery to have it removed. Mirena may go through the uterus. If your uterus is perforated, Mirena may no longer prevent pregnancy. It may move outside
the uterus and can cause internal scarring, infection, or damage to other organs, and you may need surgery to have Mirena removed.
Common side effects of Mirena include: Pain, bleeding or dizziness during and after placement. If these symptoms do not stop 30 minutes after placement,
Mirena may not have been placed correctly. Your healthcare provider will examine you to see if Mirena needs to be removed or replaced."

 

Essure - permanent placement of coils within the tubes - "The most frequent adverse events and side e ffects reported as a result of the hysteroscopic procedure to place the Essure micro-inserts were as follows: cramping (29.6%), pain (12.9%), nausea/vomiting (10.8%), dizziness/lightheadedness (8.8%), and bleeding/spotting (6.8%). Hypervolemia occurred in <1% of cases. During the rst year of reliance on the Essure micro-inserts for contraception (approximately 15 months after micro-insert placement), the following episodes were reported as at least possibly related to the Essure micro-inserts: back pain (9.0%), abdominal pain (3.8%), dyspareunia (3.6%). All other events occurred in less than 3% of women." A number of women had to undergo a second surgery because the initial surgery failed to properly place the devices or they became dislodged."

Tubal Ligation - difficult to find direct information since this is not a device or pill, but a procedure. Some general information may be found at webmd - "Minor complications include infection and wound separation. These affect about 11% of women after mini-laparotomy, and 6% of women after laparoscopy.³ Major complications include heavy blood loss, general anesthesia problems, organ injury during surgery, and need for a larger laparotomy incision during surgery. These affect 1.5% of women after mini-laparotomy, and 0.9% of women after laparoscopy. Although fewer complications occur with laparoscopy than with other kinds of tubal ligation surgery, these complications can be more serious. For example, on rare occasions, the bowel or bladder is injured when the laparoscope is inserted. The general risks of surgery are greater if you have diabetes, are overweight, smoke, or have a heart condition."

I encourage women to embrace their fertility. I wonder why so many doctors (and women) feel that loosing a period - and therefore fertility - is a fine or even good thing (think about those "unnecessary period" commercials). Fertility has long been feared by some men and now by some women.

I've heard it said that bottles were invented by men to separate the woman from her child. Don't allow men to separate you from your fertility.

Another Care Provider in Pregnancy - Chiropractor

I was unfortunate enough this weekend to pull out my back again (and follow that up with church nursery), so I was at the chiropractor's today. It reminded me of when I pulled my back out during pregnancy, so I thought I'd share.

I feel there is no reason a pregnant woman should have to deal with "regular" backaches during pregnancy. We all act like this is totally normal, but it isn't. 

Backache during pregnancy is easily treated (or at least managed) by a chiropractor. I pulled my back during the second trimester. Once it was remedied with a few trips to the chiropractor, I had no more back pain the rest of the pregnancy - even putting on those fifty pounds. (And reminder, I'm only 5'2"!)

Chiropractic care in pregnancy will help return your body to proper alignment. A good chiropractor will also help you with posture and sleeping positions that will help your body to stay pain free. The adjustments aren't painful.

At the start of the injury, you may find yourself at the chiropractor's office a few times the first couple of weeks. This is pretty normal as your body takes the time to settle into the new alignment. The chiropractor will then start to spread your visits out more. After my back was feeling great, I saw the chiropractor once a month as a check-up and slight adjustment. 

I recommend pregnant women not wait until the injury is severe, or even until there is an "injury." Back pain should be looked into immediately if possible to lessen the number of adjustments needed for health.

See a good chiropractor that you feel you can trust. It's preferable (in my opinion) that you see one who has an in-house massage therapist or two; massage helps the adjustments settle in and take hold rather than moving back into the painful position. 

Also, see a chiropractor who is experienced with pregnant patients. A good chiropractor will tell you if they are or not. When I was going to have the Webster technique (a chiropractic technique to assist in turning a breech baby), my chiropractor told me that while he was trained in it and comfortable seeing pregnant women for other therapies and adjustments, he hadn't done the Webster technique since college. He helped me find someone in the area who was trained and experienced in the technique - and I respect him greatly for being honest with me and helping me. 

You might be surprised that your insurance will usually cover chiropractic care. My current insurance, as well as the insurance I had while pregnant, cover up 20 visits a year with my co-pay. You may want to check with your insurance to see if these visits need to be preauthorized, or ask the chiropractor's office staff when you call to make an appointment.

Please feel free to contact me if you'd like to see a chiropractor in the Charleston, WV area. I've seen a few and am happy to recommend them! I have no affiliation with any offices other than being a satisfied client.

Research regarding heparin in pregnancy

Had to do a quick post on this because I am very excited!

As you all know, I had a stroke at 20. In the following months, I underwent a lot of bloodwork and tests to attempt to determine the cause. In the absence of any other risk factors, it appears that chronic migraines and birth control pills were the cause. (Did you know that chronic migraines in women increase the stroke risk? I didn’t.) I tested negative for every single known clotting disorder.

However, I was still on prophylactic heparin during pregnancy and post-partum. I don’t mind the shots; you get used to them. I mind that it forced me into OB care. (Prophylactic – giving a medication or treatment as a preventative or just in case. It’s not treating any problems already there; it’s simply trying to prevent them.)

I just found a slew of articles against prophylactic heparin therapy during pregnancy!

I’m not pregnant again (yet), but I am so excited to have these at my disposal. I wonder where they were two years ago when I needed them and searched and searched. But I’m sure glad to have them now.

Links:
Thrombophilia and pregnancy complications: cause or association? http://www.ncbi.nlm.nih.gov/pubmed/17635737

Anticoagulant therapy for deep venous thrombosis during pregnancy http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD007801/frame.html

Aspirin plus heparin or Aspirin Alone in Women with Recurrent Miscarriage (http://www.nejm.org/doi/full/10.1056/NEJMoa1000641)

Safety of Withholding Heparin in Women With a History of Venous Thromboembolism http://www.nejm.org/doi/full/10.1056/NEJM200011163432002

A Personal Story of Postpartum Depression Part Two

I finally decided to get treatment in April 2010, while we were in Mexico attending my brother-in-law’s wedding. I had several breakdowns on the trip and finally had the opportunity to really talk to my husband about it.

When we got home, I called a local therapist for an appointment. The first meeting went well, and she suggested I go to my family doctor for a prescription since that had helped me in college. I did, and things seemed to get better for awhile.
 

I stopped attending the therapy sessions though for a couple of reasons. I knew that the stresses of life and of my marriage certainly had contributed to the problem of my depression, but I didn’t like feeling that I was defending my husband during my counseling sessions. If I said that I trusted him, that we were working together, and that things were getting better, I felt that should be enough. Pushing him to come to counseling as well would not make things any easier for either of us if it wasn’t something he was comfortable with or ready for. Beyond that, it was difficult for me to get childcare and a way of getting to the therapy sessions. In the back of my mind I kept thinking about the cost, as we were already struggling to pay bills.
 

I continued to do well for awhile without therapy, relying on my own coping skills and the medication. I was on a fairly low dose, but looked forward to doing well without medication.
 

I’m not there yet.
 

In the past few weeks, my symptoms have reemerged. I found myself up at night, either forgetting to eat or binging, snapping at my husband constantly, and sitting on the recliner all day. It took me a couple weeks to notice the problem, but I quickly got in to see my doctor again. He suggested a medication increase or medication change. I asked to have blood work done first to rule out thyroid problems or anemia, which he was happy to do.
 

Fortunately, my blood work was clear, so last night I increased my dose as directed.
 

Unfortunately, I was up half the night.
 

Without sleep, I feel much the same. I can’t get anything done during the day due to exhaustion. I eat constantly, or forget to eat, because my brain is half down trying to cope. I’m irritable because I’m tired. I understand that medications can take 2-4 weeks to adjust, but this is madness. I don’t like being on medications either way, and being on a medication that I feel causes just as many problems, well, it doesn’t work for me.
 

I resolved one thing last night while I was lying awake – to look into alternative therapies for postpartum depression. That’s my goal for the next couple of days.