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

[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.