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Birth control Choice - Rollercoaster Ride
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jmille74 posted:
I am trying to decide on a change of birth control to talk to my healthcare provider about. I have tried the nuvaring, but had to stop due to getting to many UTIs. I was on yaz prior to that and I felt depressed, anxiety, bloated, nauseous and just plain "YUCK". Well lastly I have been on the Depo shot for 8 months and as they warned me before I would gain weight and I have gained 20 lbs in 6 months. I changed my lifestyle hoping this would help shed the pounds but yet it's been difficult. The biggest issues I've had is my libido has decreased. I have no interest in sex and nor do I have pleasure with it. This is causing a strain on my 3 year relationship.

On another note I have endometriosis and no children so my doctor was anti IUDs. I would like to know if this is common to try so many different types of birth control. I have a concern about estrogen pills causing a higher risk of endometrial cancer. I'm finishing up grad school and plan on having children within the next 2-3 years. Any suggestions would be great. I know there are so many with mono, tri, combo.....birth control pills.
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Jane Harrison Hohner, RN, RNP responded:
Dear jmille: You have mentioned several important considerations:

1. Known endometriosis & a desire to have children---For this you would want a progestin/progesterone dominant method of birth control. Estrogen can make endo flourish; progestins will attenuate endometriosis.

2. Concern about risk of endometrial cancer---As you likely know, endometriosis cells are similar to endometrial cells. Thus use of progestins can decrease risk for endometrial cancer.

3. Decreased libido---Methods of contraception which suppress ovulation have a theoretical risk for dampening libido. Specific products seem to have more of this effect, therefore women frequently switch around until they find something that works best for them.

Bottom line, it is very reasonable to continue to try other products or formulations. A GYN should be very supportive of this. Some other methods which you might want to research would be the progestin only "mini pill," the progestin only Implanon, the progestin containing Mirena (it is an IUD but if that is the one thing that works for you there is a risk/benefit balance to consider).

The hardest thing is to try and predict what will work best for someone else. It would be great if there was a reliable way to eliminate the trial and error involved in contraceptive choice. Also, women may make very different choices at various stages of life. Go back and reopen the discussion with your GYN; you are asking the right questions.

Yours,
Jane


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