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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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In early twenties, on microgynon as birth control pill. Want to use Copper IUD with BCP. Is it advisable?

Hello, I am a 20 year old sexually active female, never had children, currently on microgynon as BCP ( Ethinylestradiol 30 micrograms, levonorgestrel 150 micrograms). It is working wonderfully for me. However, I am seriously considering getting a copper IUD implanted, and continuing my BCP alongside this. My main concern is the periods - I have heard that they can become VERY heavy on the copper IUD. I already have anaemia , and so far my periods are very manageable. But I was wondering how manageable would they be if I were to continue taking my current BCP as well as having an IUD? Also, what are the chances of an ectopic pregnancy with an IUD? If my periods became heavy, would a combination of mefenamic acid whilst I m on the week s break from my pill help lessen them? What are the chances of pregnancy with the IUD and BCP? It seems to be the best form of long term contraception that is not hormonal (previously I HAVE been on depo and microgynon together for three months, but I found the depo to have had too many adverse side effects for me). Thanks in advance! Edit - I am now considering the Mirena instead, but I wanted to know whether any nulliparous woman can actually get it or not... the WHO guidelines and several studies etc said they can, but I know some doctors are iffy to do so.. Why is this?
Tue, 8 Jul 2014
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OBGYN 's  Response
Hello and welcome,

I understand your issue.

However there is no need to use two types of birth control measures together.
If an IUD is in place then BCP are not needed. If heavy bleeding is a cause of concern then other options like mefenamic acid can be used. Also heavy bleeding does not occur in every patient and many women tend to get used to the IUD after a few cycles and the bleeding returns to normal. One needs to try it first to actually know if it suits you or not. So there is no need to take BCP. If you are using BCP regularly then IUD is not needed.

So choose any one method as both are equally effective if used correctly and regularly. The advantage of IUD is that there is no need to remember and take any medication daily. Once it is inserted no other BCP measure is needed.

About the risk of ectopic. The IUD does increase the risk of ectopic marginally. However as it decreases the risk of getting pregnant, the risk of having an ectopic pregnancy is actually lower than the risk in a woman not using the IUD. Women not using IUD are more likely to get pregnant and so as the number of pregnancies is more the risk of ectopic pregnancies is also more. So the risk is actually lower than the general population.

About Mirena, it has hormones in it so it either causes irregular periods or missed periods in some women. The return to fertility after removing it is also good and most women are fertile in the first cycle after removal. Many doctor believe that it is not a good way to have intrauterine devices in place before testing fertility by having atleast one pregnancy. The risk of infections is slighlty higher with devices and so doctors are a bit reluctant to prescribe them in nulliparous women.

Hope this satisfies your query.
Thanks for using HCM.     
Feel free to ask any more questions that you may have.
Dr Madhuri Bagde
Consultant Obstetrician and Gynecologist
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