Uncategorized

My decision

Recently I posted that I was debating a new form of contraception and asked for opinions. Well I made that decision and thought that it might be helpful to post just exactly what I went through.

Since you are on this site – you already know that I have two disorders, Lupus and Antiphospholipid Syndrome.  While there has been much debate on whether estrogen could be a cause of flares in women with Lupus, it is well-known that using  estrogen-containing contraceptives is a big no-no after being diagnosed with APS.  Which leaves options limited to progesterone only methods (IUD, Implanon, Mini-pill), barrier methods (diaphragm, condoms), or sterilization (tubal ligation or vasectomy)

*side note: the IUD Paragard is a non-hormonal option as well*

So after much discussion with all of my doctors – Ob-Gyn, Rheumatologist , and Primary Care. I decided that since I was in a long-term committed relationship that the IUD was the best bet for me.  I was interested in the Paragard (non-hormonal) IUD but after consulting with my doctors decided against it because of the fact that I am on coumadin.  Paragard can increase your monthly bleeding and since I am already on blood thinners the doctors did not want to risk it.

The Procedure:

I will admit that I was extremely anxious before the procedure about the pain and even though I live only a few blocks from the hospital and doctor’s offices I arranged for someone to pick me up and delivery me home after the procedure.

I was on day 2 of my period when I went in to get the insertion done. First, the doctor had me take a pregnancy test which is common (even if you are on your period).  After that it was off to the examination room to wait for the doctor.  The nurse took my vitals and it was then that I asked for a cervical lidocaine gel or a paracervical block – which would numb my cervix.  The doctor then came in a talked to me a little about the procedure… this didn’t take very long since I had already talked with her in previous appointments. But it is here that I suggest that you talk to your doctor about the lidocaine numbing or any other questions that you might have.  It was recently brought to my attention that IUD can possibly increase the chance for infection.  So I spoke with my ObGyn about this possibility – since I am NOT on immunosuppressant drugs my doctor thought that my chances for infection would be similar to the average woman (she also said that in her 8 years of inserting IUDs, she had only one case of infection).

The Insertion:

After installing myself in the stirrups, the doctor inserted the speculum.  After this she prepared the paracervical block, which is an injection via needle into the cervix.  She warned me that I would feel a slight pinch and then inserted the needle. It was a twinge of pain and then minimal burning sensation.  The shot is given on both sides of the cervix but after the first shot the second was not as bad (I guess the numbing was already going into effect).

After a few moments to let the block take full effect, the doctor inserted the sounding rod. This for me was the worst part but to be completely honest I was expecting MUCH worse. The pain is weird and hard to describe. Like a cramp but located lower than normal – located in the cervix.  At this point and gasped and said “ow” a few times but within seconds it was over.

Next was the insertion of the Mirena IUD. There was a light twinge (painful, but not as bad as the sounding) from the doctor inserting the device into my cervix and then stronger cramping when she released the device and it started to open the T shaped arms. * Here is where I ran in to the only problem with insertion. * The cramps caused the Mirena to be expelled.  The nurse ran out to get another Mirena to insert and the doctor and I had to wait a minute or two. She explained that what happened was probably a contraction of my uterus and Mirena was most likely not completely open at the time – causing it to be expelled. The nurse returned and the doctor inserted the 2nd IUD.  This time there was less pain and cramping AND the IUD stayed in.  The doctor trimmed my strings and then gave the rest of the length to me so I could feel them and then stopped the bleeding with a silver nitrate stick. Neither of which I felt.  She removed the speculum and told me that I needed to come back in a month for a quick checkup. I was shaky, sore, and crampy but otherwise ok after the procedure. I went home and laid down with a heating pad for a couple of hours and was alright.

The following night and day I was constantly crampy but the bleeding from my period began to taper off.  The cramps I would say are comparable to my normal period cramps just prolonged. And a half of a Percocet, a Tylenol and a heating pad kept me comfortable.

It has been 5 days since the insertion and I am having  mild cramps off and on. So far today, nothing that even requires medicine.

I will keep posting about my experiences with the IUD and Lupus and please feel free to ask me any questions that you might have.

For more information about the IUD:

I recommend visiting a site called IUD Divas (http://iud-divas.livejournal.com/) it was very helpful in answering most of my IUD questions.

or this post at the American Family Physician site: http://www.aafp.org/afp/2005/0101/p95.html

For more information about IUDs and Lupus please visit: 

Lupus.org:

http://www.lupus.org/webmodules/webarticlesnet/templates/new_communitywebchats.aspx?articleid=4064&zoneid=93

Lupus International:

http://www.lupusinternational.com/Living-With-Lupus/Overview/Contraception-what-s-safe-.aspx

New England Journal of Medicine:

http://www.nejm.org/doi/full/10.1056/NEJMc060035

Medscape:

http://www.medscape.com/viewarticle/537963

Other Resources:

http://rheumatology.oxfordjournals.org/content/32/3/227.abstract

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s