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Mtx and Birth Control

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Posted 7/17/2006 5:27 PM (GMT 0)
For the ladies of child-bearing age, please.  Now that I've started mtx in addition to the enbrel, I'm forced to use some kind of birth control.  Me and my husband have never even worried about birth control because we have infertility issues.   I went to my primary this morning to discuss various options.  It turns out there are 3 options I can choose from:

1) hormone based therapies--not a great option because I have a strong family history of blood clots

2) IUD

3) tubal ligation (vasectomy is not an option as my father-in-law died of prostrate cancer).

My sister had an IUD, and not only can it impair your fertility permanently, but she had an incredible amount of pain and other issues with it.  She had it taken out after about a year.  I'm seriously considering a tubal ligation, but it's such a permanent and scary decision.  I'm 38 years old, and I have twin daughters (4 years old today).  To get pregnant, me and my husband would most likely have to go through fertility tx again (no thank you).  We've decided we will not have more children, but a tubal ligation really burns the bridge, you know?  I talked to my husband this morning, and he supports a tubal ligation; he says we can always adopt if we want another child (which I think is very sweet and a great idea).  I guess I'm just looking for advice from those of you who have come to this crossroads already.  How did you decide the path you took? 

Thanks!

Elcamino

 

Posted 7/17/2006 7:49 PM (GMT 0)

To be honest with you, I have not gone thru mtx treatment, however I worked for an OBGYN for 8 yrs (very hands on & knowledgable) Do the BTL. It will be much safer and reliable then BCPs or the IUD. For a small % of women do well with the IUD. Most women I have seen though, usually have it removed within the first 2 yrs. Taking BCPs along with steroids is not my idea of fun either nono The tubal ligation will take you only a few days to recover (if you have a good surgeon) Good luck with what ever you do!!!!

melsy

Posted 7/18/2006 2:01 PM (GMT 0)
This is what burns me as well! I personally wouldn't want either 3. So what do we do in that case?
Cannot rhythm method & barrier protection be enough?????
El I hope you find the right choice for you.
I was suppose to start MTX but this was the turn off.
If one cannot do either 3...what are the options?
Posted 7/18/2006 2:57 PM (GMT 0)

Erin, I hear you about the mtx turn off!  That's exactly why my rheumy skipped me over it and graduated me to tnf-inhibitors.  Unfortunately, the tnf-inhibitors are not sufficient alone (for me anyway).  In my case, though, I have two beautiful daughters and I think I'm ready to call it quits.  I feel for your situation; I'm sure there are tons of women out there that have faced the same thing (women who have undergone chemotherapy, etc... prior to having any children).  In answer to your question, I would not trust the rhythm method + barrier method, at least with a drug like mtx.  My primary told me yesterday that it is something to take very seriously.  She knew a young woman who did get pregnant taking mtx, and did not end up miscarrying.  She carried the baby just about full-term, but the baby was so deformed and disabled that it didn't survive.  Because of my past history of infertility, this absolutely breaks my heart--I could never put a baby at risk (not that I'm judging this woman--hey things happen even with appropriate birth control). 

Other options for temporary birth control?  I don't know, but I do plan on talking to my GYN doctor about it.  I would not recommend the IUD for you because that can permanently impair your fertility and decrease your chances of ever having a baby.  Perhaps others have some more to share.  This is a very tough situation.

Elcamino

Posted 7/20/2006 2:08 PM (GMT 0)
Condoms? Do you want to try for kids someday? Since you're considering tubal ligation, I'm guessing that's a no. But I'd say condoms.
Posted 7/20/2006 5:06 PM (GMT 0)

eyes  I wonder if I swore abstainence to em'....would that be good enough?

mad  Oh, and I got a "That's not enough protection." when condoms were brought up.

Ya know...I feel like I'm frickin' 5 years old! Being told what & how to conduct my personal life???????????

Posted 7/20/2006 8:54 PM (GMT 0)
Dear friends, there are two methods I would like to mention. There is the Depo-provera shot. It lasts 3 months and then you get another one. As I understand there is not estrogen in this method only progestron. I know this is still hormones we're dealing with. Also, just last night in the news I saw another method that was just approved. you have one rod inplanted under your skin and this lasts a year. Its somewhat like the norplant was if you remember that. But this one the docs have to be trained to insert it and they have been using it in Europe for some time with very good luck. If anyone needs the name I can find it for you. I hope this may have helped someone. Sincerely, Nic
Posted 7/20/2006 9:08 PM (GMT 0)

Thanks much Nic!

Don't know which of the synthetic hormones causes my nausea & vomiting & swelling (most likely ertrogen...pretty sure that's why pregnant women get morning sickness, the surge in estrogen).

Tried oral BCPs 3 times and no good on any of the 3.

Do these depoprovera shots cause edema, nausea & vomiting as well?

Don't typically get sick on any drug except prednisone & BCPs (and alcohol if I imbide over the limit, LOL tongue )  So I'm guessing that my bod's a wee tad sensitive to shifts in hormones.

Take care,

erin

Posted 7/20/2006 11:38 PM (GMT 0)

My primary discussed depo shots, and consequently I had a couple when I was first married (12 years ago).  Depo can cause the same problems as BCP because it, along with norplant and derivatives, has hormones in it.  I had bloating, cramping, irregular periods, and was stuck with it until the injections wore off.  Also, it can take an average of 18 months to get pregnant after using depo (8 years for me, but that's a different story:)).  If you're going to do the hormone thing, you might as well do BCP; they have gotten a lot better over the years, and my primary told me the other day that they come in all different strengths.

As far as condoms are concerned, my primary told me to definitely use a condom until I get something more permanent.  Personally, though, I wouldn't trust them while taking mtx.  But that's just me--I feel very strongly about intentionally exposing a baby to a known toxin.  In my case, abstinence will probably be best until I can figure out what to do.  It's not that hard when you have 4-year-old twins and you work two jobs!

Erin, I'm sure there's an answer for you out there.  Perhaps you should talk to your gyn doctor (rheumy will probably not know a whole heck of a lot about BC--mine didn't).  A low dose BCP may be perfect for you.  Primary told me the lower doses don't cause the same side effects; you simply may have to take it at the same time every day, etc... But hey, you take so many pills, what's one more?  The problem with the implants is that once they're in, they're in and if you suffer side effects, you're pretty much stuck with them until you can have the implant taken out.  Same with depo.

I guess every method has its pros and cons.

Elcamino

Posted 7/21/2006 3:42 AM (GMT 0)
Erin, If you believe its the estrogen that makes you so sick, my daughter is on a bcp that is strictly progesterin. If you would like the name I can get it for you. Hope this helps. Luv, Nic
Posted 7/21/2006 3:54 AM (GMT 0)
Heck yeah, from knowing a bit about chemicals and hormones & the things they are most likely to cause...I'de bet my best pair of panties that it's the estrogen component.
I've "lightly" discussed this issue with my boyfriend...he's not really too keen on BCPs, injections, etc...and quite honestly I'm finding out that neither am I.
Never been faced w/ the issue so it's one that's foreign to me. The only reason I ever was on BCPs was to shrink ovarian cysts.
We don't use anything...and unfortunately never a pregnancy in 3 years. So perhaps "the want" for children pulls on my heart chords? I don't know. But I think all things will work out accordingly.
Besides, after today's doc appt...he doesn't want me adding ANY dmard, antirheumatic, or anything really until I see the GI (he's really up on the latest & is super smart). immune system is in bad shape...so gives me time.
so El...what are you thinking of? LOL...I feel like I'm doing a "No...YOU GO FIRST!" lol. Please, if you find or try anything out let me know how it goes. I swear I'll be a guinnie pig for something else in the future...you have my word. ;)
ugh!!!!!!! times like this, being female is hard.
Posted 7/21/2006 11:19 AM (GMT 0)

Erin, please don't follow me.  I'm seriously considering a tubal ligation since me and my dh are not planning any more children.  You don't want to do that!!!  Plus, you probably wouldn't find a doctor who would be willing to tie your tubes because you're so young and you have no children.

Honestly, in your situation, you might want to discuss with your gyn doctor a progesterone based BCP.  My primary mentioned the nuva ring (you may have seen commercials about it), which is a vaginal ring that you just leave in; there's also a BC patch.  She said neither one of them are very good, though.  The ring falls out, and the patch causes lots of side effects (blood clots only one of them).  A low dose BCP may be perfect for you.  I know it's another pill to take, but honestly I would rather take a pill than using a barrier method.

Elcamino

Posted 7/21/2006 4:38 PM (GMT 0)

confused  Oh NO NO NO el don't get me wrong...i totally know that i would by no means ever get a tubal ligation.  what i meant was if you had decided to go on a new BCP or shot or whatever the heck new thing is out there...i'de be very interested to see how you felt & made out on it. :-)

see, i'm in a not so ordinary relationship. :-)   not sure if ya'll know this but my lovey is 51! :-) and i'm 25...so do the math.... tongue it's a very Michael Douglas/Katherine Zeta-Jones situation as you may! LOL.  so this leaves me some touchy grounds you know, regarding starting a family.  he's never said a straight out, "I absolutely do not want children."  and when this whole thing about the rheummy bringing up MTX and discussing BCPs and all...my boyfriend has been sort of "warming up to the idea" so to speak.  so i have the whole..."if i go on MTX i have to wait a certain time frame for pregnancy & cannot get pregnant while on it, etc...etc..."

eyes  and he absolutely would want me to go on anything that would help the disease because all he cares about is me & wants what is best for me.  but he sorta looked & had sound a bit "sad" when i spoke about putting off conception if this is the route to take.

see how i'm a bit torn?

and knowing that MTX is used to induce abortion freaks me out.  i guess because it's been 3 years and "nothin'" has happenned (not actively trying...but not actively preventing neither)...and deep down inside i fear i can't conceive...so anything that would ruin my chances weighs on me.

this make any sense?

luv ya el!  thanx for listening.

erin

Posted 7/21/2006 5:13 PM (GMT 0)

Ah, I understand now.  Yes, you're in a sensitive situation.  Don't be alarmed that you haven't conceived in 3 years--especially when you weren't trying.  It's not all that uncommon.  If you and your partner had been actively trying for 3 years, you might want to consult a fertility specialist. 

If I go on BCP (or IUD), I'll let you know.  I'm pretty sure, though, that I want to avoid anythig with hormones, so if it's not a tubal ligation it will probably be an IUD.  At your age, though, I did the hormone thing (depo), and didn't have any problems with blood clots.  But see, I smoked when I was your age, so BCP were out of the question.  They also become more out of the question, the older you get. 

Erin, it sounds like you need a real heart-to-heart with your sweetie about children.  One option that is available to both of you is adoption, granted not an option for everyone.  Adoption has always been an attractive option for me (providing a home to a child that doesn't have one), and foreign adoptions are very popular.  The prospect of adopting if I get my tubes tied makes the tubal ligation decision much easier.  I KNOW that I don't want to be pregnant again (had first major flare while pregnant--that's how I know I don't have RA because you're supposed to go into remission while pregnant), but I may want another child, especially if I can provide a life to a baby that was "thrown" away in a 3rd world country.  Just something to chew on...

Your sweetie is not too old to conceive, and you certainly have plenty of time left.  Go on mtx, if you need to.  You will have time to work on conception later.  I know my clock started ticking at around 32, but jeez, these days women are having their first children in their early 40's!

Have you ever thought of pregancy to induce remission? 

Elcamino

Posted 7/21/2006 10:02 PM (GMT 0)
hi everyone .... been there done that! iud's, patches, pills, inserts, condoms, rythmns, and fear! one thing i know i have enjoyed the very best and this girls can only work when you are ready to quit having kiddos is sending my hubby to the vet! snip snip no pain or problems for me! hehehe again not good if your in the child bearing years but great when your done... didnt hurt me one bit hehehe ....~*yalinda
Posted 7/22/2006 12:48 AM (GMT 0)

Yalinda, I would love to hear the snip snip of my husband's vasectomy.  Unfortunately, his father died of prostrate cancer, so they will not do a vasectomy on my dh.  If anyone gets the snip snip, sadly, it's me.

Elcamino

Posted 7/22/2006 12:54 AM (GMT 0)

:-)  Thanks El,

Funny you mention that pregnancy/remission.  That's how he & I got started on the subject.  He read in the newspaper about a woman just like me...she got pregnant & went into a 10 year remission!  And he just rushed into the room & couldn't wait to blurt it out!

That was the 1st time in 2 years he even tiptoed around the idea.  So it made me happy that he might want children...I was convinced he was an absolutely "NO WAY" for kiddies.

Am I capable of withstanding full term right now?  No way, I feel so & my docs & family agree.  If I get stronger I definitely would love to.

Thank you so much for your insight. (I need it!) tongue

erin

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