of bleeding and pregnancy (kind of)

[shyshutterbug.livejournal.com]

(I couldn't think of a title for this entry to save my life. Thus, it is lame. Please forgive this.)

This is kind of a weird question - not really one of "I don't know what to do," but more along the lines of "hey, my solution to this kinda sucks; does anyone have a better one?”

I'm one of the unlucky ones whose ovaries have it in for her. My periods are impossible to predict, even after almost eight continuous years on HBC (I've been on, by my count, at least a dozen different pills). When they get around to showing up, they are heavy, painful, and long. Today was, I believe, the final day of my period - which ends 19 days of continuous bleeding and cramping. This period was seven days early; the one before that was almost three months late. I've been having workups to determine the cause of my innumerable GYN problems since I was in kindergarten, and we've pretty much concluded that, save cancer, everything that can be wrong with my reproductive system is wrong with it.

I am not now nor have I ever been sexually active, and I highly doubt I will become so for at least the next several years. However, I've been thinking more and more lately about how many women rely on getting their periods as their surefire indicator that they aren't pregnant, and how, with my cycle as unreliable as it is, I will not have that indicator.

Now, granted, I have no intention of having unprotected sex until I feel ready and able to handle the potential consequences of doing so, and given my preexisting conditions, it may be difficult for me to conceive even when I try to, let alone while actively trying to prevent it. But I’ve heard way, way too many stories that end in “...but I got pregnant anyway” to not be wary of trusting my chosen methods to work as intended without the reassurance of a bleed.

(I just realized that I probably sound batshit paranoid, especially for someone for whom pregnancy is not an immediate concern. Please forgive that. I work for an abortion provider, so I think about unintended pregnancies and how to prevent them...er, slightly more than the average person, lol.)

The only real solution to this that I can come up with is to take a pregnancy test every month and ensure it comes out negative. I’m not necessarily opposed to doing so; as I said, I work in gynecology and probably will very long-term, so my access to pregnancy tests is reasonably unrestricted. However, I’d prefer to avoid the panic of doing so once a month until menopause – and if, for whatever reason, I stopped working in gynecology, that’s something that could get really expensive really fast.

So, my question would be: for those of you with hopelessly wacked-out periods like me who can’t rely on a bleed for anything, how do you reassure yourself that you’re not pregnant?

(Good Lord, did this post make any sense? So sorry if it didn’t; it strikes me as a little discombobulated. Feel free to ask me for clarification of just what in the world I’m talking about, lol.)

Comments

[leedlekay.livejournal.com]

in the u.s. you can buy pregnancy tests for $1 at dollar tree. that is, if you live in the u.s.

[leedlekay.livejournal.com]

actually plus tax a little more than a dollar but it's cheap nonetheless.

[shyshutterbug.livejournal.com]

I'm aware. Still would prefer to avoid the proverbial panic attack once every four weeks.

[leedlekay.livejournal.com]

I know what you mean because i was on depo for 9 months and i'm just now getting off of it. granted i've been bleeding for the past 6 weeks so that's kind of a sign that i couldn't be pregnant but before that i was always really paranoid. other than getting the pregnancy tests i don't really know what to tell you.

[shyshutterbug.livejournal.com]

If it were just a temporary thing, I'd have no problem with it; it's the fact that I'll probably have to do it for the rest of my reproductive life that sucks :/

[kilted.livejournal.com]

Man, some of this stuff is on my mind ALL the time. I have a super irregular period, though I'm not on birth control and once I do get it, it's about the same flow and time wise each time. But there are times when I'll go three months with out one and then I'll have one every month for a few months in a row, and then nothing for like 4. So I feel you there. I'm not sexually active, so that's not really an issue at the moment, but yeah... I've thought of the same plan myself for when the occasion should arise... Yarg.

[shyshutterbug.livejournal.com]

Pain in the ass, isn't it? :/ Here's hoping it works out for both of us...somehow, lol :)

[kilted.livejournal.com]

TOTAL pain. And here's hoping indeed. Stupid random body things...

[pretty492.livejournal.com]

During any of your exams has your doc ever suggested that you may have PCOS?

[shyshutterbug.livejournal.com]

I do have PCOS. It's one of the most recent additions to my laundry list of reproductive issues.

[pretty492.livejournal.com]

I know that not every remedy works for every body BUT, I know a few girls with PCOS who have been helped a lot be Metformin. (Not sure of the spelling.) My closest friend has had irregular periods since the beginning. She was underweight until she was in her twenties and is now twenty-six, slightly over-weight and still they were crazy irregular, like three to fourteen months irregular. This Spring she was put on Metformin, has been mensing every six weeks and lost twenty pounds.

[shyshutterbug.livejournal.com]

Due to the "borderline" nature of my case of PCOS (for example: I have multiple ovarian cysts, but all are a few millimeters too small to classify as "typical" PCOS), my doc does not want to put me on Metformin. Personally, I think it's worth a shot - the side effects are often hellish, especially as the dosage increases, but I'm willing to put up with them if I could get some relief on this end. For the time being, however, it's not a possibility.

(My doctor is also my boss, so getting a second opinion is, shall we say, a matter of some delicacy, lol.)

[pretty492.livejournal.com]

What about the other symptoms, abnormal hair growth, weight gain, diabetes... It does make my friend pretty damn naseaus if she doesn't eat the right things when she takes it. Can I ask what else you've been diagnosed with and what your future plans for your reproductive organs are?

[shyshutterbug.livejournal.com]

While my fasting glucose is normal, I do show signs of insulin resistance, and I am overweight (have been for years). I don't have much in the way of hirsutism, however.

In addition to PCOS, I have endometriosis (I had surgery to lyse adhesions almost five years ago), and the combination results in (occasionally debilitating) chronic pelvic pain, which is not always necessarily related to menstruation. I underwent precocious puberty (breast development at roughly 5-6, menarche at 9), which kinda started the ball rolling on trying to figure out what all was wrong with me. I have reasonably severe vestibulodynia, which is always worse during my periods, and have demonstrated evidence of vaginismus.

Not my personal history, I realize, but I also have a very strong family history of ovarian, cervical, and uterine cancers.

As far as the future is concerned, I do desire pregnancy one day - when, and if that will even be possible, remains to be seen.

[pretty492.livejournal.com]

I also suffer from The Endo!! My first doc (a woman) said that I was a hypochondriac and a drama queen. Family history is important, I know nothing about my dads side at all, my mom only has one half sister and never really knew her mother. My little sister seems to have no problems but she's also pretty tight-lipped.
Mom has a deformed pelvis, it's twice as big on the inside so she couldn't give birth to a lemon. Her mother was given thalidomide(?) that drug that caused all the birth defects. I read an article in which the person who wrote it suspected that the grandchildren of the woman who used it generally have endo. Something about the drug effecting genes in the original embryo and the eggs that embryo contained... I wish I'd have bookmarked the article.
My doctor let me go on continuous birth control until I was willing to make more permanent decisions about my organs. That was when I was nineteen (and very, very scared!). Now I'm 26, getting married, have insurance and a Plan. Which is basically try hard to have two babies, know when to call it a day, possibly adopt and definitely have everything removed.

[shyshutterbug.livejournal.com]

I would kill to be able to tolerate continuous HBC. I tried it once, the summer I was 17, and I became so nauseated and so profoundly depressed that I could barely function. Called my doc after three months and literally sobbed at her to get me off that crap and let me bleed so I could regain my sanity. Mercifully, it worked, lol.

[pretty492.livejournal.com]

I went through three different pills before we found one that worked for me. Did you only try one pill? I would imagine that you are incredibly hormone sensitive and finding the perfect fit on the first try would be something of a miracle.

[shyshutterbug.livejournal.com]

I was just trying to count them up as I was making my OP...while I can't be certain of the exact number, I believe I'm currently on my eighth pill brand. In the HBC's defense, many of the pills I tried were multiphasic, which explains a lot - multiphasic pills and I do NOT get along, and I've avoided them like the plague since I was...16, maybe?

[pretty492.livejournal.com]

My drug of choice is levlen-28 or it's generic levora-28. It says that it has levonorgestrel .15 mg and ethinyl stradiol .03 mg. I'm not terribly sure what that means, but it is exactly right for me.

[shyshutterbug.livejournal.com]

I recently switched from Femcon to Yaz. Drospirenone allegedly is extra-beneficial for women with PCOS (though I had little improvement when I was on Yasmin, but that was among the first HBC I ever took, so it's been a while). Offhand, I know I've been on Ortho-Novum, Ortho Tri-Cyclen, Ortho-Cyclen, Yasmin, Estrostep, Ovcon 50 (holy God, never that much estrogen again for me, thank you), and Ovcon 35, which eventually became Femcon. I feel like I'm missing something in that list, but just to give you a general idea.

[pretty492.livejournal.com]

I was on one of the Orthos in the beginning... Boy did that mess me up!!!! It was like a roller coaster everyday, I was up, I was down, I was angry...

[frolicnaked.livejournal.com]

Slightly off topic, but I'm glad there's someone else on here who can spout off the long-ass list of HBC brands she's been on. ;)

[shyshutterbug.livejournal.com]

LOL. Odd thing to find solidarity in, but you're absolutely right. *high-five*

[loonylupinlover.livejournal.com]

Well, it's considered normal on birth control to miss a period, and they recommend only testing if 2 periods in a row are missed. That would at least cut down the worry to every 2 months instead of every month, if nothing else.

Consider the fact that there are methods like Seasonale out there where users are only supposed to have periods once every 3 months. Those users aren't expected to have to see their period every month, or assume that they're pregnant. It sounds stupid, but maybe just thinking about how they don't *need* to see a period every month to still be protected from pregnancy might make you feel a bit better about it too. And I'm sure you already know this, but BC works by preventing ovulation, thickening cervical mucus, and thinning the endometrial lining, all factors that help to prevent pregnancy, so unless you had a major user error, you would have absolutely no reason to doubt your protection beyond your missing period -- and you already know that that is quite normal for you. Someone who had very regular periods and missed one entirely would definitely have reason to worry, but someone who got them sporadically and continued to do so would have no reason to suspect that something was wrong.

Personally I wouldn't like not getting my period at all, for the same reason you mention. However, I'm fine stacking birth control for two months to avoid a period, or something like that, and don't worry about pregnancy because I know there's been no slipups in my use. Hopefully between going over the multiple ways BC works, and remembering that you are using it perfectly and that you have irregular periods on or off BC, will be enough to cut down on the anxiety and maybe you'll only need to test every couple of months, or not at all.

If just HBC just isn't enough for you, there's always using condoms and/or withdrawal on top of it -- lowering the chances of pregnancy, even in a perfectly normal-cycled woman, to almost entirely zero. With multiple methods you'd have even less reason to suspect at all you were pregnant, since you know that you have irregular periods anyway, and that you used a whole ton of protection to boot.

[shyshutterbug.livejournal.com]

Oh, trust me, there's absolutely no way in hell I'd be having sex minus HBC and condoms, so that's in the bag right there, lol.

I think a huge percentage of my concerns are related to what I see in practice - women who come in with extremely advanced pregnancies who've had no reason to suspect they were pregnant in the first place, for example. It's easy for me to see myself in the same position, birth control or no.

[loonylupinlover.livejournal.com]

In regards to the other women... it sounds to me like you are much more informed than the average woman about birth control in general. Mightn't it be true that they were less informed and so had no reason to suspect pregnancy simply because they were missing information that you have? For example, many women don't know that some antibiotics can affect birth control, or that vomiting/diarrhea too close to taking one's pill can cause it to be lost from the system without being absorbed (and if these were isolated incidents, they could well have forgotten them by the time they came into your office; heck, when I was a kid I temporarily forgot how I severely sprained my ankle, so I can definitely see someone forgetting they had vomiting or diarrhea once). In their mind there was no reason to suspect they could be pregnant because as far as they knew they were doing things perfectly. Of my friends I know things about HBC they had no idea were true, because they don't go to places like VP and they only go off what a harried doctor tells them, and I suspect that this is true for a large number of women. Informing yourself 100% about any method you used makes the "I was pregnant with no reason to suspect it" possibility far smaller.

[shyshutterbug.livejournal.com]

A valid point. Thank you :)

[loonylupinlover.livejournal.com]

I think it's human nature to assume that people are privy to the same amounts of knowledge that we possess, but sometimes it really is shocking to see the disparity in people's knowledge levels. Good methods of birth control just spontaneously failing is extremely rare; user error, known or not, is far more common. And sadly, sometimes people really are just not fully informed on things, even things as big as pregnancy and birth control. Hopefully this thought, while a bit depressing in some ways, will be a comfort to you in other ways -- that you are better informed and thus would be able to identify user error on your part right away, and take appropriate measures.

[shyshutterbug.livejournal.com]

I wholeheartedly agree - human error is something that just does not get half as much credit as is due to it, and the degree of ignorance and misinformation out there is staggering.

[queensugar.livejournal.com]

We see this too. And in addition to what loonylupinlover said, a quick thought --

It's tough to word what I'm about to say correctly, so I'll just repeat what my trainer said. (Who, I assure you, is the most feminist and non-judgmental woman I've ever met.) In many cases, there is either a lot of denial, body disconnection, or some other extenuating life situation that is behind why the client did not realize she was pregnant until that point, or why the pregnancy was able to occur.

Obviously, there are some cases where those factors don't play into it. But while we absolutely never second-guess our clients, we also recognize that we don't always get the full story. That's fine -- we don't have any right to know anything other than what our clients choose to tell us -- but we do keep in mind that often there are reasons a client will not tell us everything, or is not even ready to recognize the circumstances.

As one example that I do know of, we saw a client once in the situation you describe -- shocked and stunned, had no idea she was pregnant, reported regular periods. The client reported that in the last year she had only been sexually active once, about two months prior, and was taking HBC regularly and used condoms. We 100% believed her, and referred her for a pre-procedure physical exam.

After the ultrasound indicated that the client was closer to 24 weeks, the client confided to us that the real story was much, much different. I won't get into that, but the point is that I would never personally base my fears off of what I see in the clinic -- while women often share with us the entirety of their situation, others are either not ready to do so, or not psychologically able to do so, or may have some kind of very serious (even life threatening) situational reason why they cannot do so.

[queensugar.livejournal.com]

Oh, and to this I'll add -- a lot of women feel a lot of pressure when going in for unplanned pregnancy support -- actually, any medical support where contraception use is asked about -- to report perfect use, or even use that didn't exist.

I'll admit one thing, for instance -- to this day, when a doctor who isn't my personal doctor asks if I'm sexually active and, if so, what kind of contraception I'm using, I tell them HBC. (I used to also say condoms, which I've used... twice in my life.) I haven't taken the pill in five years and never will again. I haven't used condoms in seven years.

I'm not proud of that, but it's a knee-jerk. At this point, if I became pregnant unexpectedly I'd just pretend it was planned, but a couple of years ago I'd bet good money I would have stuck to my other story.

Even in the most non-judgmental environment possible (in my case, a feminist women's clinic), that pressure definitely still does exist. It's not created by the clinic or their standards, but by society -- this nasty and pervasive idea that if a woman becomes pregnant, it is her "fault" for not using better protection. Asserting correct contraceptive use is an emotional shield against that kind of incoming judgment.

So many clients are terrified of that judgment. To them the idea of disclosing that they were not using contraception, or not using it correctly, to a medical professional is far too threatening to consider. It may even be threatening enough that they convince themselves that correct use was the case.

Anyway, just more food for thought when it comes to balancing out the many failed contraception stories we see.

[shyshutterbug.livejournal.com]

Oh, I agree with you - we see only a slice of their histories, and only what they're willing to show us. I suppose it's just a circumstance I can so easily see myself being in (given my medical issues), and so readily want to avoid, that it's making me paranoid.

[frolicnaked.livejournal.com]

I just realized that I probably sound batshit paranoid, especially for someone for whom pregnancy is not an immediate concern. Please forgive that.

One person's "batshit paranoid" may be another's "excellent advance planning skills." ;) There's no harm in wanting to avoid as much panic as possible, you know?

Things that have helped me in the past:

Monitoring fertility signs, though depending on your particular ovary issues, this might not work for you. And if you're on HBC, it likely won't work anyway. But when I'm not on HBC, I have cycles that are pretty sensitive to stress (particularly stress involving travel and/or seeing my mother) -- and therefore prone to becoming anovulatory and long. It was a big help to me to be able to determine that I had not, in fact, ovulated during that time -- and so the length was due to my body going, "Must. Not. Ovulate. Now." and not going, "Whee, bay-beez!"

Choosing a contraceptive method that's very reliable and very difficult to "mess up." When I had an IUD, it was pretty nice knowing that as long as I didn't, you know, reach into my crotch and yank it out, it was going to keep working, without any kind of daily requirements from me. And it was going to keep working at an effectiveness rate of over 99% out in real life. Besides IUDs, methods like Implanon and depo would probably fall into this category (and sterilization, which may or may not be something you're looking for).

Choosing a contraceptive method where light or absent periods are a "standard" side effect. When I switched from my ParaGard to HBC, the reduction in my periods was drastic, and it's become more drastic over time. (I'd regularly bleed heavily for 10-12 days without HBC, with or without a ParaGard in place. On my last withdrawal "bleed" from HBC, there were cramps, but there was no blood at all.) It probably would have freaked me out if I hadn't known that this was a run-of-the-mill kind of effect. It can be hit or miss with pills, patches, shots, rings, and rods, but it seems to be a pretty reliable side effect of Mirena.

Combining contraceptive methods and doing the math. I've never used this one on myself, but I've often done the math for folks on VP. For instance, if BC pills have an 8% failure rate with typical use, and condoms have a 15% failure rate with typical use, then the combined rate is 8% X 15%, which is 1.2%. If an IUD has a typical use failure rate of 0.8% (or less, depending on source and type of IUD), the same IUD + condoms works out to a typical use failure rate of 0.12% over the course of a year. There are certainly folks who will get pregnant anyway, but in terms of statistics, it's incredibly unlikely.

Like I said, I'm not sure if any of these are feasible options for you, but they are things that have helped me not to worry when I don't bleed as much or as often as expected.

[shyshutterbug.livejournal.com]

You make excellent points, but unfortunately, I don't know how well they would work for me personally. Fertility signs are, as you mentioned, kind of a moot point - I have reason to believe I ovulate extremely rarely, and my body can trip me up in that area often; and I have tried stacked or continuous-effectiveness HBC previously, and the continuous stream of hormones made me profoundly sick, so I have been unable to try this again. (Paragard might actually be an ideal solution for me, if not for the vestibulodynia, which makes simple pelvic exams impossible, let alone an IUD insertion!)

The last section would be by far the hardest for me to get behind, but it is probably all I have to go on. As I mentioned to loonylupinlover above, I see more than my share of birth control failures, and it's made me extremely wary of really trusting BC methods. (That's probably me getting too deep for the practicalities of this post, but just so you see where I'm coming from.)

[jennifer0246.livejournal.com]

I wonder if the spotting and extremely long period is due to the Yaz - due to the low dose and extended dose that's a pretty commonly reported side effect. I'd probably try for something slightly higher, a 30mcg something or other, if this doesn't work out in the adjustment period.

I'd also seriously consider going under for a Mirena insertion, or having Implanon put in. Have you ever done progestin-only bcp? a 3 month trial on Micronor might be in order, to see the effect on the pain levels and such. I worry that not controlling your bleeding is going to put you at (even more increased) risk for hyperplasia, and with a fhx of uterine ca (was it endometrial?), you don't need that.

more two dollars than two cents, but you know how it goes ;)

[shyshutterbug.livejournal.com]

Psh, give ten dollars, I don't mind :)

I'm sure the most recent bleeding is due to the Yaz - I was wary of going on a pill with such a low dose of ee in the first place, but wanted to give the drospirenone a shot for the PCOS. I'm also keeping in mind that this was my first bleed since starting Yaz (mid-August), so I'm unsurprised that my bleeding is currently screwy. (I transitioned from Femcon to Yaz, and I'd been on Femcon for...at least three years, I believe...so I've tried the higher ee dosages too.)

I confess that I completely and utterly forgot about Micronor. I tried that MANY moons ago, with no effect on my cycle, but I'd sure be willing to try it again. I'm wary of Mirena or Implanon because of the constant release; I can't tolerate continuous hormonal doses sans break.

ETA: And yes, it was endometrial. My aunt (maternal) was dx with cervical CA in 2001-02, tx with chemo/nuclear medicine, clear x 5 years. Started bleeding last Christmas; endo bx in January confirmed CA was back. She had a TAH in February that dx endometrial and ovarian CA, for which she's now in treatment.

[angie-aubergine.livejournal.com]

not much to add, just wanted to wish you well in sorting this out!

about HBC, i seem to have better luck with nausea if i take them right before bed as opposed to sometime throughout the day.

[shyshutterbug.livejournal.com]

Thanks :) I've always taken my pills at 9 p.m. sharp, so no nausea for me - I only have nausea if I stack my HBC, and in that case it's near-disabling.

[atalanta0jess.livejournal.com]

I'm planning on getting an mirena IUD in the near future, and if it causes me to lose my periods, I definitely will get some of those pregnancy test strips they sell on amazon (cause they're cheap) and testing each month. A friend of a friend just ended up pregnant on depo, and had no idea for MONTHS - like the girls that come into your clinic that you mentioned. She went in for an abortion...and came home six months pregnant. So I'm definitely just gonna test. I think if you THINK about it in the right way, it can become no more stressful than waiting for your period each month. The strips are less than a dollar apiece...not expensive at all. :)

[shyshutterbug.livejournal.com]

Hmm. You may have just brought up a very good point as to why I'm so worried about this. (And this will come out worded very poorly and you'll likely not understand what I'm trying to say, so I'll just say thanks for posting this.)

I think if you THINK about it in the right way, it can become no more stressful than waiting for your period each month.

I probably have not given it adequate consideration that testing each month for me would be roughly equivalent to waiting for your period each month for a woman with regular periods. Doesn't necessarily mean I would freak out any less if my periods were like clockwork, but still. And given that I've never had to wait for my period to confirm I'm not pregnant, or take a pregnancy test, it'd probably be easy for me to overlook that.

[atalanta0jess.livejournal.com]

No, I know what you're saying. :) I'm glad it was helpful...I imagine that's something I will have to overcome if I do get the mirena.

[imnotyourstarx.livejournal.com]

hmmm... i no longer bleed due to my mirena. i was sort of nervous at first and bought a few pregnancy tests to have laying around the house, but now i just dont bother. i can feel my iud strings if i stick my fingers up there. i just trust that it will do its job. i sort of have to, if i dont want to drive myself crazy with worry. i guess you could say the i rely on faith.

[shyshutterbug.livejournal.com]

I wish I could trust BC to function as intended that much.