Family Practice Part 3: The Long View

For the third and final chapter of the Family Practice series (Part 1, Part 2) I want to talk about the long view on contraception and family planning. How does parenthood (or the desire to never have kids) change our goals regarding contraception? And what about that ubiquitous question: When are you having another baby?

According to the Guttmacher Institute, the two leading forms of birth control are The Pill (28%) and sterilization (27%). Women in their teens and 20s typically prefer contraception that is easily reversed — such as condoms or The Pill. By contrast, sterilization is the preferred choice of women who are any one or combination of the following: 35 years or older, have two or more children, previously been married, below 150% of the federal poverty line, those who have less than a college education. (Interesting that Hispanic and black women more commonly use sterilization while white women use The Pill.)

It makes nothing but sense that younger women who may want children (or who haven’t decided if they want children) would opt for contraception that is not permanent. Likewise, it seems logical that women who are done having children or who cannot afford to have any/more children would decide to go with a tubal ligation sterilization.

But what about the middle ground? What about those of us in our 30s who may not yet have a child (but want one) or who have just one child and can’t decide if there are more in the future?

Certainly, The Pill can still be an option if it agrees with you and you have no health or lifestyle (smoking) concerns. From friendly chatter and my non-scientific poll, condoms are quite popular. (Curiously, they come in third in the overall Guttmacher results at 16%. I would have pegged them higher considering what I hear from women.)

Personally, I was on The Pill for most of the time since I became sexually active. (I have also used condoms, tried Depo-provera and sponges.) But since my daughter was born 8 months ago, I’ve been trying to decide if staying on The Pill is really my best long-term option. I will turn 35 this year — the benchmark age for increased risks with The Pill (as well as the official start of automatic “high risk” pregnancy years). To be honest, I’m not that in love with The Pill. For me, it exacerbates my allergies and asthma, heightens depression and moodiness and causes acne. It’s not without pros: lighter, consistent periods with less cramping and one of the lowest risks of pregnancy of many birth control options. I can’t say it doesn’t work for me. I was married 12 years before I got pregnant!

But a few weeks after my baby was born my doc put me on the mini-pill (suitable for breastfeeding moms) and I haven’t had a day without nausea since. So, we’re talking about approximately 7 straight months of nausea (which leads to insomnia, problems with appetite, etc.). The mini-pill is the only one approved for breastfeeding moms, so I couldn’t try other types until I weaned. Now, I’m sure that there may be another kind of pill for me. In fact, I’ve been on many different types over the years and was using The Pill before I got pregnant. (I stopped in order to try, don’t think that I got pregnant while still on it.) But I’m at the point in my life where I don’t feel like I have the time (while chasing a very active baby around) or patience to play roulette with pills and side effects until we (hopefully) dial it in just right. I’m just over it!

So, I started asking around and doing some internet research on IUDs (the 5th most popular contraceptive, after vasectomy, according to Guttmacher). There are two forms of IUDs (intra-uterine-devices). The ParaGuard is a copper IUD that is hormone-free and good for 10 years; however, it is known to cause longer, heavier periods. The Mirena IUD is good for 5 years and contains a low dose of progestin (a hormone found in birth control pills). The hormone level in Mirena is considerably lower than even the mini-pill and it does not contain estrogen. It can help some women have shorter periods or have them stop all together.

IUDs are small, flexible, plastic devices (they look like a T) that are inserted into the uterus. According to the Feminist Women’s Health Center, it is not known exactly how IUDs work but they are shown to be 99.2-99.9% effective (slightly higher than sterilization). It is possible that IUDs prevent implantation of fertilized cells. All forms of IUDs come with risks such as: expulsion (spontaneously coming out); embedding in the uterus; piercing the uterus and moving into the abdominal cavity where it can damage other organs. It can also increase the chance of ectopic pregnancy. And in some cases lead to infertility or even death. Because they do not protect against sexually transmitted infections, IUDs are typically not recommended for women with multiple partners. They are also not necessarily recommended for women who have not been pregnant (but it’s not impossible, as many of the stories on IUD Divas show).

When I informally talked to friends and people I know, I was surprised to find so many have used/are using one of the kinds of IUD. Of my friends who are mothers, the majority have used the IUD. (The other top contender was sterilization.) And of my friends who have or are using the IUD, the majority love it. This was not my sole method of deciding what I was going to do, but it certainly helped to talk to real women who are/have used it.

Here are some of the things my friends told me (keeping them anonymous to respect their personal privacy):

From a friend in her mid-30s who has one child:

I was on the pill for seven years and the month or so I was off it before I got pregnant was the most normal I had felt in a while. The IUD is nice because it’s effective, much cheaper than the Pill, I don’t have to remember to take anything on a regular basis and after about six months I stopped getting my period.

From another friend in her mid-30s who has one child:

I had some initial fears of an implant just because it’s a weird thought to have something stuck up in your uterus. I wanted to go with a hormone free option because I’m still nursing and I also didn’t want it to mess with my system. I haven’t had a rough time with periods in the past so I thought the Copper T would be a good option. It’s also good for long term 5-10 yrs so if/when we make the decision to have more kids then it can come out.

From a friend in her late 30s with one child:

I have one and love it. My favorite BC by far. Don’t have to think about it all the time. It’s not icky. I have fewer side effects than the pill. And some excellent side effects, like shorter periods. [Mirena]

A friend with two kids approaching 40:

[I had it] twice. Loved it (had the Mirena both times). My BFF has had two as well… Our [manager] here at the office has had the copper coil for more than five years and loves it.

But of course, not everyone has a good story. This story was shared by ReadinginAK (who I know has one child) in the comments for Part 2:

I’ve tried both IUDS (copper one implanted in my uterus after 16 months) and the Mirena made me depressed (all hormonal BC seems to do that). So it’s the Trojan Horse (so to speak) for us, until we’re looking for a “gift from the Greeks” (again, so to speak) once more. I’ve done Depo, the patch, Yasmin, and both IUDs. Sigh.

And I do not claim that my social group is a scientific or statistically accurate sampling of all experiences. Just Google IUDs and you can find plenty of scary stories about terrible complications. Even on IUD Divas, a site that is not affiliated with any corporations or medical/insurance companies that promotes IUDs but offers real stories and fairly accurate information, there are some bad stories (this one comes from nanookie_08):

I’ve had quite a few yeast infections and episodes of bacterial vaginosis. It’s to the point now where it’s every 6-8 weeks or so. This isn’t disclosed in much of the literature, but a quick search of online communities shows that it’s pretty common. It negatively affects our sex life and makes sex difficult. It’s a HUGE annoyance for me and pretty frustrating. I would also say that I’ve had a few more ovarian cysts come and go since I had it inserted.

This one comes from twomojitos:

Well I’ve had my Mirena for almost 7 months and while I love having an IUD, I’m not so sure that I love Mirena. …I was cautious about Mirena because of the hormones but decided to try it because of the chance of light periods vs. possible heavy/painful periods (which I am used to before I was ever on the pill or got Mirena). The reasons I am considering breaking up with Mirena are:

- Acne – noticeable increase in breakouts. I hardly ever broke out before Mirena. The is including being on the pill and no birth control. I am trying to live with this but I really don’t like it. Makes me feel very self conscious.

- Stomach issues – major stomach bloating, stomach aches, constipation around my “PMS” time. Never experienced this before Mirena.

- No sex-drive – this is one reason why I wanted off the pill, thought Mirena would help since lower dose of hormone but I actually think it has gotten worse.

and the major reason:
- Hair loss – for the past three-four months I thought I noticed more hair coming out in the shower and just more of my hair **everywhere** but I just wrote it off as my imagination/paranoia but last week I went to my hairdresser for a haircut and she commented on how my hair “feels much thinner than normal” and that confirmed what I had been thinking. Not cool!

I also just want to just be myself and not have sort of extra-hormonal influence. I am very interested in switching to Paraguard because I do love having an IUD but I do have the usual concerns.

There are a lot more stories out there. Some good. Some horrible. Most I find are in a middle ground (much like any other form of contraception): love some aspects and hate others. And it’s a lot to take in. I talked to my doctor. I read over the materials for both types of IUDs. And, of course, I talked to my husband about our options before making the decision to try Mirena.

Unlike some of my friends who’ve recently had their first baby and are already contemplating the next one, I’m not sure I’m ready to go another round. I feel happy right now the way things are and I don’t feel like I would be happier with another child. Having grown up the oldest of five in a blended family — in which some siblings barely speak to each other  and some are best of friends — I am not particularly concerned with the notion that you must give your baby a sibling. (In fact, recent research suggests that only children are more intelligent and empathetic than those with siblings.) And I really don’t feel that excited about going through pregnancy, postpartum healing, and breastfeeding again. I feel like I just got my body back all to myself! But as I wrote about in my Exploring Feminist Motherhood series on The Tired Feminist, I can’t deny that 35 is right around the corner for me and with that come more risks and potential complications with pregnancy and fetal development. (That is, if there are no fertility issues that crop up as well.) The question is there for discussion but the window is rapidly closing.

With all that in mind, the IUD seemed like the best interim answer. It buys my husband and me time to think about what we want next for our family (grow? one and done?). We already know that sterilization is the answer for us when we are sure we are done having children (unless we adopt, I suppose).

So I got my IUD a week and a half ago. So far, the jury is out. I have had a lot of cramping and spotting/bleeding, some nausea (but less than the mini-pill) and some dizziness. All of these symptoms are common after insertion and my doctor has said that these symptoms should subside in time (it can take weeks to months, depending on the person). But even with this initial discomfort, I’m going to give it more time to see how it goes. Since the IUD can be taken out easily in an office visit, I figure it’s worth trying. If I end up hating it, I can always remove it. Or, if I love it, I can keep it until/if I ever want to get pregnant again.

What do you think? Have you tried the IUD?

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