IUD Insertion with Abortion?

[as-she-melts.livejournal.com]

Hey, so a couple weeks ago I had asked about using an IUD as emergency contraception (here).  In the end, I went with Plan B, despite already having had the IUD consultation.  So now, I'm roughly 75% sure I got knocked up.  After counting back the days, I'm fairly sure I had already ovulated before taking the Plan B (fuck).  Also, I had very, very light spotting today, 12 days after the sex in question--possible implantation bleeding.  But, I can't pee on the stick until Sunday*, which will be five days before my missed period.  My life is pretty kickass right now, and kids just aren't in the cards at the moment (even though I want an army of them... years from now).  My question is this:  If the test turns up positive and I schedule a surgical abortion, would the doctor, likely at Planned Parenthood, be able to insert a Mirena during the same visit?  Have any of you done this, and if so, were there any negative side effects from messing with your uterus so much at one time?  Mostly I'm looking for experiences, especially at Planned Parenthood.

Thanks, yo.

And to vent a bit, feel free to skip:  SHIT.  I only have sex like twice a year, just to make sure that my vulvodynia/vaginismus combo of doom didn't magically disappear!  It didn't, by the way, so if there's some fetus who's decided to hang out in me for awhile, it's not even like I got good sex out of the deal.  WTF, how did I let this happen?  I seriously hope they'll give me an IUD, I don't want to be in this situation EVAR again, plus, if some old white dude decides to take away birth control, I want something firmly planted in my uterus that they will literally have to rip out of me.  Also, can I rent a friend to come with me to the appointment?  I'm all alone in a new city and all I have to say is :(  Listen to me whine, vagpag!

(edited for weird typos and then again because I post too soon, always.)

*edit again:  I just opened the package and it says FOUR days on the inner instructions and FIVE days on the outer packaging.  Lies, I say to you, outer packaging.  Lies.

Comments

[imnotyourstarx.livejournal.com]

if some old white dude decides to take away birth control, I want something firmly planted in my uterus

hell yeah! i will be more than pleased to squeeze out my first kid in 5 years... but not a moment until then. i am terrified that at the rate this country is going, i may not have many choices soon. hence my new mirena, which is seriously amazing. i am all set for 5 years, no matter what crazy laws are passed.

oh, and ps - not only was i allowed to bring my guy with me for my consultation, but he was also allowed to come in for the actual procedure.

[as-she-melts.livejournal.com]

Yeah, regardless of how this all turns out, I'm definitely getting an IUD. Glad to hear you're enjoying yours!

[queensugar.livejournal.com]

Well, remember that spotting can be a side effect of Plan B.

Anyway -- the long story short is that when pregnancy tests say "first day of your missed period," what they really mean is days past ovulation, or DPO. Most pregnancy tests can reliably detect a pregnancy by 14 DPO, and some of the more sensitive ones can detect pregnancy starting at 10 DPO, or roughly five days before a missed period. However, those tests are only about 60% accurate at 10 DPO.

Out of curiosity, why are you fairly sure you ovulated, and how are you charting an expected period? Are you monitoring fertility signs, or is it only based on dates?

Looking at your timeline you give here, if your next expected period isn't for another seven days, and it's 12 days after sex already, then that would strongly suggest that you hadn't ovulated on the date of the sex in question -- 19 days is very long for a luteal phase. Not impossible I suppose, but at any rate it would be unusually long -- the normal luteal phase range is 12-16 days.

That said, of course it's possible to have a shorter follicular phase and have ovulated on the date in question. (In which case, your period would be theoretically due sooner than five days from now, but as mentioned above that's sort of irrelevant because pregnancy tests aren't based on period dates, but DPO.)

[queensugar.livejournal.com]

Oh, I re-read your previous entry. Honestly... given that you are on hormonal birth control, I strongly doubt you're pregnant. Missing one pill should not have put you that much at risk (fertile family or not), even if it was a bit early in your pack.

I'm going to go ahead and put $20 on this bleeding being some breakthrough bleeding due to the double dose of hormonal birth control and Plan B.

[queensugar.livejournal.com]

And just to keep adding (cause it's late and I'm only thinking in small chunks at the moment) -- ignore all my above rambling about cycle lengths and soforth, as that stuff is a bit irrelevant when you're on HBC.

[as-she-melts.livejournal.com]

I think that in my bit of panic, I got the dates wrong. My last period would have been August 13-19, with the aforementioned sex occurring on the 23rd. I took the Plan B the morning of the 24th. If I'm not mistaken, the 23rd would have been prime time for the fetus-forming, yes? I believe I had missed the pills for the 21st and 22nd, and realized my mistake on the 23rd, when I made them up. Uhh, after the sex. There's a reason why I've been considering an IUD so long. I know this list of facts, but not really what to make of it. Any advice? Also, <3 to you for being so awesome.

[queensugar.livejournal.com]

If I'm not mistaken, the 23rd would have been prime time for the fetus-forming, yes?

If you weren't on hormonal birth control, it'd be possible that ovulation would have occured on Cycle Day 10, though not necessarily probable unless you knew it for a fact via fertility-sign monitoring.

Cycle day 10 is often within the fertile window (within 5-7 days of ovulation) and can be an ovulation day, but I wouldn't automatically assume it was, unless I was actively monitoring my fertility signs.

But -- and this is a big "but" -- when you're on hormonal birth control, dates and soforth are irrelevant. Breakthrough ovulation, if it occurs due to improper pill usage, does not necessarily occur when it "should" occur if you weren't on the pill. It basically happens whenever the ovaries manage to squeeze enough time in to ovulate, and the cervical mucous (which is thickened on HBC, preventing sperm from entering) fails to stay thick.

Missing two pills in a row, especially in the first week, is certainly a bigger risk than missing only one pill, and usually back-up is recommended for seven days. But it still doesn't necessarily mean that you were likely to be ovulating, just that it would be more possible than if you hadn't.

Remember that even with "typical use," which includes stuff like this, the pill is 94% effective over the course of a year.

Really, I don't want to say "yes" or "no" to anything (though I guess I kinda did above when I bet $20), but what I'm hoping to get at is that I wouldn't assume anything one way or the other just yet.

You didn't have optimal protection when you had sex, but you also didn't necessarily have zero protection, and taking Plan B could well have occured prior to ovulation even if an ovulation had been in the cards due to missed pills.

So honestly, I guess my advice is to hang in until it's been 14 days after the sex in question (so Saturday) and test then. It will likely be accurate.

[as-she-melts.livejournal.com]

This is all quite reassuring (at least enough for me to calm down for a couple days before I test). Thank you again so so so much!

[queensugar.livejournal.com]

Yeah no problem. Don't kill me if I'm wrong, but... I just like to be balanced about everything wherever possible, heh.

[corrupted-muse.livejournal.com]

I asked about an IUD after my abortion, and I was told that the doctor (at PP) wouldn't put it in the same day as the procedure, but if everything checked out at my follow up appt, they would. I was offered my choice of a birth control pill or DepoProvera if I wanted something the same day. Their reasoning was that they didn't want anything that needed to be inserted like the Nuva Ring, IUD, etc. It may differ where you're at, I don't know. Each Planned Parenthood seems to be a little different.

I totally sympathize with your 'old white dude' logic. When I think of how many people could suffer because someone decided to force their personal beliefs into law...it's just...grrr. It's horrifying and rage inducing all at once.

[frolicnaked.livejournal.com]

If the test turns up positive and I schedule a surgical abortion, would the doctor, likely at Planned Parenthood, be able to insert a Mirena during the same visit?

I can't say how likely it is that any provider will or won't do this, but the sources I'm finding do say that it's safe:

http://www.ihs.gov/MedicalPrograms/MCH/M/ifaqs.cfm#IUDinsert
http://www.cochrane.org/reviews/en/ab001777.html
http://www.who.int/rhl/fertility/contraception/nncom/en/index.html

While there is an increased rate of expulsion if it's placed post-abortion (even more so after a 2nd trimester abortion, but that doesn't seem likely to apply here), but practically speaking, that looks to be the biggest issue.

I suspect, though, that individual providers might have their own personal preferences. (Health care professionals have pretty varied opinions and practices with IUDs in general, to the extent that it's tough to predict what any one person will want to do.) Should the time come when you need to schedule an abortion, your best bet might be asking the clinic directly. But it definitely sounds to me like it would be worth it to ask.

[mud-faerie.livejournal.com]

Yuh I was offered an IUD after my abortion (in the UK, 4ish years ago). I didn't take them up on it right then but as far as I know it's considered safe to do. And also, having had the IUD inserted since - I should have got it then as it frickin HURT.

Also, of course you can't know exactly right now, but it sounds pretty unlikely that you've got foetus growing, what with the pill being in your body and taking Plan B. I got funny bleeding for like two months after I took the morning-after pill.

[ghost-of-freud.livejournal.com]

I am also in the UK, and I had a mirena inserted under general anaesthesia following a surgical abortion. I didn't experience any major side-effects from it; I was offered the chance to have the mirena inserted at the same time as the abortion, and I went for it because I am a complete wuss when it comes to any kind of gynecological interference.

[wickey29.livejournal.com]

plan b can cause breakthrough bleeding in some women (this is probably what you had), which is like a period but lighter than normal. it also takes 14 days after unprotected sex for the pregnancy hormone to show up in your body, and if you had missed two pills in your cycle, but then backed up your BC (with the plan B), there's a good chance you're not pregnant. your cycle is going to be wonky now that you've taken plan b, and it might take a month or so for your cycle to come back to "normal," but i'd say you did everything right.

as for the iud, i worked at pphood for a year, and normally after a surgical AB, NPs/docs recommend not inserting anything into the vagina for 7-10 days after a procedure. however, during the follow up appointment, am IUD could be inserted if the woman wanted one. in the interim, they could leave with the pill if they wanted, but most women i spoke with were going to abstain from sex for a little while. i hope this helps!

also, plan b also has a phone number you can call for questions - 1-800-NOT-2-LATE

[pinkdramon.livejournal.com]

2nd paragraph is one of my rather large fears. What a rip-off!

Do you know if yours is aggrivated by hormones? If it's aggrivated by hormones you might want to get the just plain copper one.

[as-she-melts.livejournal.com]

Pssh, if I'm pregnant it might be the second coming, because for someone with vulvodynia/vaginismus to get pregnant would be a damn miracle. This is ridiculous, I will be FURIOUS if I get pregnant before ever being able to enjoy sex. Mine doesn't seem to respond to hormones at all, plus I'm super allergic to nickel. I've read about people who have allergic reactions to Paragard, and that's the last thing my poor vag needs. I really hope the Mirena works out, because I'm clearly in need of something other than the pill. Are you super sensitive to hormones?

[pinkdramon.livejournal.com]

Appearantly. No moar hormonal birth control for me ever. It messed me all up.

It's weird cuz my elder sister is just perfectly fine with it, but we know my mom got messed up by HBC when she tried it for a few months too.

If you know you're not sensitive to hormones then I guess a hormonal IUD would be alright. Then you never have to worry about condoms or anything ever again. For 5-10 years. But then you still gotta worry about the actual insertion dealie. That sounds so hard because by nature they'd have to hold you open somehow.