YEP Youth & SHBBV Sector Blog Post – Megan Elias, SHQ: “Me and my ovaries Part 2 – So can you tell me a bit more about that…”

What questions do you want to ask your health professional before you decide on the right contraceptive for you? These are the 10 questions I wanted answered…and the answers I got.

If you need a reminder of why I wanted to change my contraception from the pill to something else, read my last blog Me and my ovaries Part 1: my journey through the world of contraception here

I wasn’t too sure what to expect from my appointment at the SHQ clinic, so I read up a bit on my different contraception options before I went (here is a good overview of the options). I’d pretty much narrowed it down to either an IUD (intrauterine device) or an implant (aka Implanon®, the rod) before I got there because they last for ages and require me to do absolutely nothing. But when I got into my appointment we talked about all of the other options as well, just to make sure I had all of the info.

The appointment really felt just like a chat. The doctor asked me some pretty general personal and family medical history questions to check which contraceptives I’d be able to have. Then we talked a bit about my lifestyle and what methods would fit with it, and then we talked about what I want from a contraceptive. What I want is definitely no babies but also as little bleeding as possible – I would love no period!

When I was looking at all my contraception options I started to realise that I have some questions I want answered before I decide which one is for me…so here is my list of 10 important questions to ask your health professional about your contraception options. I’ve also put in the answers for the implant and IUD because they were the two I was tossing up between.

There’s a lot of info here, so bear with me!

  1. What is it?

Implant: Small, flexible plastic rod (size of a match stick) inserted under the skin of the upper arm. Sometimes called the rod or Implanon NXT®

implant

 

IUD: There are two different types of IUDs, one is hormonal (sometimes called the Mirena®) and the other is copper. Both types are small, plastic devices that are inserted into the uterus. IUDs have fine nylon strings attached that come out through the cervix (entrance to the uterus) into the top of the vagina to help check that it’s still in place and make it easy to remove.

IUD

 

  1. How does it work?

Implant: Releases progestogen (a hormone) into the bloodstream which stops eggs being released from the ovaries, and thickens the mucus in the cervix to stop sperm getting through to the uterus.

Hormonal IUD: Releases progestogen into the uterus, which thickens the mucus in the cervix to stop sperm getting through, and changes the lining of the uterus so an egg can’t implant. It can also affect ovulation.

Copper IUD: The copper IUD is a small plastic device that has tiny copper wires wrapped around it. The copper affects sperm movement to stop the sperm from fertilising the egg. It also changes the lining of the uterus to make it less suitable for pregnancy.

 

  1. How effective is it?

I’ve been using the pill, which is 91% effective in typical use, so both options I’m considering are more effective at preventing pregnancy than the pill. YASSS! 

Implant: 99.9% (the most effective method we have)

Hormonal IUD: 99.8%

Copper IUD: 99.2%

 

  1. How do I get it? What happens?

Implant: It has to be inserted and removed by a trained health professional.

First there is a local anaesthetic injection in the arm, and then the implant is inserted just under the skin using a special applicator.

IUD (hormonal and copper): It has to be inserted and removed by a trained health professional. Usually you will need two appointments- one for a chat about the IUD, an examination and an STI test to make sure you don’t have an existing infection, and then a second for the insertion.

The insertion appointment usually goes like this:

First, the doctor will do an examination by inserting two fingers into the vagina and using their other hand to feel the internal organs. This is just so they can check position and size of the uterus. Then they will hold open the vagina with a speculum (the thing that looks like a duck beak that they use for Pap smears) and use a special IUD inserter to push the IUD through the cervix into the uterus. When the IUD is in the right place, the inserter is removed and the doctor will cut the thin nylon strings to the right length. The strings aren’t visible from outside the vagina, but are long enough to be felt by inserting a finger into the vagina- this is how you check the IUD is still in place. The doctor will then explain how you feel the strings. Then you go back for a check up a few weeks later.

 

  1. When can I get it? Does it have to be a certain time in my cycle?

Because I was already on the pill, I could get either the implant or IUD put in at any time.

Ideally an IUD or implant is inserted in the first week of your cycle (the week starting on the first day of menstrual bleeding) to make sure you’re not pregnant. But both can be inserted at other times, you just need to have a chat with your doctor.

Both IUDs and implants are suitable for women who haven’t had any kids.

FYI…I haven’t had kids yet!

 

  1. When does it start working? 

This is a bit tricky because it depends on your current contraception and when you get either an IUD or implant inserted. It’s really important to talk to your doctor and make sure you know if you need to use back-up contraception (like condoms) for 7 days after you get an IUD or implant put in.

 

  1. How long does it last?

Implant: 3 years, but can be taken out at any time.

Hormonal IUD: 5 years, but can be taken out at any time

Copper IUD: 5-10 years depending on which type you get, but can be taken out at any time.

With all 3 of these contraceptives, fertility goes back to normal as soon as it’s taken out i.e. you can get pregnant immediately after they are removed.

 

  1. Does it change my menstrual cycle? 

Implant: Yes. Changes to menstrual cycles vary, but bleeding is often lighter and less painful. With the implant, roughly:

  • 20% will have bleeding stop completely
  • 60% will have irregular, but light bleeding (spotting)
  • 20% will have long bleeds, or frequent bleeding.

If you have questions or concerns about your bleeding, talk to your doctor.

Hormonal IUD: Yes. For the first few months after insertion you might have frequent and irregular bleeding between periods. After the first few months, periods might be shorter, lighter and less painful. About 50% of women stop bleeding all together. 

Copper IUD: Yes. For the first few weeks after insertion you might have irregular bleeding between periods. After the first few weeks, your periods might be heavier, longer and more painful. But it is a good long term option for people who can’t have or don’t want hormones.

 

  1. Are there any other side effects? 

The short answer is maybe. It all depends on the individual. But here are some possible side effects…

Implant: There might be some swelling or bruising where the implant is inserted for about a week.

IUD (hormonal and copper):

  • The insertion might be painful, but that depends on the individual (paracetamol or anti-inflammatory medication can help)
  • There might be some bleeding or cramps after the insertion
  • Some people may feel lightheaded or faint after insertion
  • There is a small risk of infection at the time when the IUD is put in and for the first 2-3 weeks. Having an STI test before it’s inserted reduces the risk of infection
  • There is a small risk of the IUD falling out
  • Rarely the IUD can perforate (make a small hole in) the wall of the uterus.

Implant and hormonal IUD: like with other kinds of hormonal contraception, some women can experience a range of other side effects. Luckily, because the hormone doses are very low, the risks are low. These side effects can include:

  • acne
  • mood changes
  • libido decrease
  • breast tenderness
  • nausea

If you have any questions or concerns about side effects, talk to your doctor.

 

10. How much does it cost*? *all costs correct at time of publication

Implant:  The implant itself costs around $35 if you have a Medicare card. Then there is usually an insertion fee and consultation fee, which can vary depending on where you get it inserted. 

Hormonal IUD: The hormonal IUD costs around $35 if you have a Medicare card and around $6 if you have a Healthcare Card. Then there is usually an insertion fee and consultation fee, which can vary depending on where you get it inserted.

Copper IUD: The copper IUD is not covered by Medicare. It costs around $110 with or without a Medicare card. Then there is usually an insertion fee and consultation fee, which can vary depending on where you get it inserted.

At SHQ, the consultation fee is $10 for all appointments and the insertion fee is $30 for an implant and $50 for an IUD.

Other things to consider (important bits that didn’t fit anywhere else)

  • None of the options I’m considering will protect me against STIs so I’ll still need to use condoms for that.
  • The doctor suggested I give my new method a try for 3 months and if I don’t like it, I can just get it taken out and try something else. For a reminder of all the other options, have a look here

So with all of that somewhat overwhelming information, I’ve decided I’m going to get an implant. I ended up choosing the implant because it was easier to get it put in and I really want light or no bleeding. If I don’t like it after a few months, I’ll try the hormonal IUD. I feel a lot better knowing that I’ll have the most effective method of preventing pregnancy…I’m not ready for a kid just yet!

Stay tuned for my next blog Me and my ovaries Part 3: is this going to hurt? for a run down of what getting the implant is like (pictures included…)

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