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I take Postinor pills (2) after each sexual act, but now I have irregular bleeding. What can I do to stop this? #418/12

He does not ejaculate inside me, but I always take Postinor (2 pills) just to be safe.  Two days before my regular period days, I had sex and took the Postinor pills.  My period came as normal.  The last day of my period I had sex again and took the Postinor pills again.  I had sex again 5 days later and the sex was rough.  I noticed a whitish discharge on my undies about 27 hours after the sex. Then I started bleeding about 3 hours later, but I had taken the Postinor 2 pills.

 

I’m really stressed now and afraid.

 

Thanks


You have been fairly well protected, but I would definitely suggest that you consider a method that you do not need to use with each act of intercourse (actually you consistently use two contraceptive methods each time you have sex).  Consider switching to one of the 3 long-acting reversible methods – the ParaGard IUD, the Mirena IUD or the contraceptive implant.

 

Using emergency contraceptive pills several times in a cycle leads to totally unpredictable bleeding and this is most likely what is causing your pattern of bleeding.

                                                           

Her email reply on 4-7: “Thank you very much for the information.  However, I am still concerned about the pattern of bleeding and my question is how long should this bleeding last.  It is the 6th day and I’m still bleeding, but just not heavy, it’s lighter now.  I just want this horror to end.

 

Please advise!”

 

It will end if you will use contraception OTHER THAN repeated doses of emergency contraceptive pills.  They lead to totally unpredictable bleeding.  If you find your pattern of bleeding horrible, than change what you are doing.

 

Here is lots and lots of info about the 3 most effective methods of contraception.  ALL ARE REVERSIBLE WHEN A WOMAN WANTS TO STOP CONTRACEPTION AND BECOME PREGNANT

 

Read all the following and get back to me if you have questions:

 

Please consider one of these approaches if you want to avoid an unwanted pregnancy:

 

Get it and Forget it

 

Now may be the time for you to look at Get it and Forget it birth control.

 

How often do you want to have to think about your birth control?

·        Every time you have sex? 

·        Once a day? 

·        Every week? 

·        Every three months? 

·        Every 7 to 12 years?

·        Never again?

If you don’t want to have to think about contraception all the time, now may be the time for you to consider an intrauterine device, or IUD, or a small implant that is placed under the skin of your arm.  

 

There are two IUDs available in the United States.  Both are small plastic devices easily inserted into the uterus by a clinician and work for a long, long time and can be taken out any time you are ready to become pregnant.  The ParaGard IUD, or Copper T IUD, is effective for 12 years and is the most effective form of emergency contraception (much more effective than emergency contraceptive pills).  The Mirena IUD, or levonorgesterel IUD, or hormonal IUD, may be used for up to 7 years for contraception and reduces menstrual bleeding, pain, and cramping.

 

1. The two IUDs and the two implants, Nexplanon and Implanon, are the most effective methods of birth control ever developed that allow a woman to become pregnant as soon as they are removed.  These methods are called Long Acting Reversible Contraception, or LARC methods.  We like calling them “Get it and forget it” methods.  IUDs are as effective at preventing pregnancy as having a tubal sterilization (“getting your tubes tied”) or relying on a man’s vasectomy.  Women experience 16 TIMES as many contraceptive failures if they use contraceptive pills, patches, rings or injections compared to using an IUD or implant. This is explained largely by the fact that once you have an IUD or implant placed you don’t have to think about it for years.  GET IT, AND FORGET IT!  

 

2.  The IUD is the most commonly used method of birth control in the world and its use is increasing in the United States.   Only about 5% of women in the United States choose the IUD.  However, 18% of women who are Obstetrician/Gynecologists use IUDs, suggesting that women who know the very most about birth control choose and use IUDs many times more commonly than the general population.  In St Louis, 75% of women who are given the choice of using any contraceptive method for free are choosing to use an IUD or implant as part of the Contraceptive CHOICES project.  This program is already demonstrating a reduction in teen pregnancy at the Barnes Jewish Hospital. 

 

3.  Over time, the IUD and implant are the least expensive reversible methods of birth control available.  For many women there is an initial cost of purchasing the IUD or implant and having it inserted in a medical office, but over time IUDs and implants cost much less per year than pills, patches, rings or injections.  Some women who do not have insurance that covers birth control pay up to $90 a month for each package of brand-name birth control pills!  Several thoughts about getting around the high cost of having an IUD or implant inserted:

·        If you want an IUD or implant but can’t afford it, start saving today! 

·        Some hospitals, physician’s offices, college and community clinics as well as IUD and implant manufacturers offer financial help. 

·        The websites on the back of this pamphlet can help you find a Get it and Forget it method provider.  Some of them may be able to help you find other ways to lower the cost. 

·        Keep in mind that the most important cost of any contraceptive is the cost to you should your method fail. Given the extremely low failure rate of IUDs and implants, a person using these methods is far less likely to have to deal with the emotional and financial expenses associated with an unwanted pregnancy. 

 

When considering a GET IT AND FORGET IT method of birth control, please do not forget that correct and consistent use of condoms is the only way to protect yourself from sexually transmitted infections.  All women, regardless of contraceptive choice, who are at possible risk of infection, should use condoms every single time they have sex. 

 

There are 2 types of IUDs available in the United States, one with a hormone and one with copper.  They are both small, flexible, plastic, T-shaped devices that are placed inside your uterus by passing them through your cervix.  After a pelvic examination, the actual process of placing an IUD takes 3 to 5 minutes.  After appropriate training, doctors, nurse practitioners, physician's assistants, and midwives can all insert IUDs.

 

Who can use IUDs?  Almost everyone!  You can use an IUD if you:

  • Never have had a baby
  • Want to have a baby someday, but not now
  • Have had a baby
  • Have been diagnosed with endometriosis
  • Have painful periods or heavy bleeding
  • Have had a pelvic infection in the past
  • Have a history of a sexually transmitted infection like gonorrhea or chlamydia
  • Think you don’t want to have any more babies, but you’re not 100% sure

 

Also, you can have an IUD placed immediately following a cesarean section or vaginal delivery, or immediately after a pregnancy termination (abortion).

 

Both types of IUDs are estrogen-free.  Because of this, IUDs can be used by women who have medical conditions such as a history of blood clots like deep venous thromboses (DVT) or pulmonary emboli (PE), strokes, serious migraine headaches, complicated type 1 diabetes, and those who take certain medications like anti-seizure drugs.

 

IUDs are a safe and effective choice for the vast majority of women.  However, if you have unexplained vaginal bleeding suspicious for a serious condition, or current conditions like cervical cancer, endometrial cancer, pelvic inflammatory disease, cervical infection like gonorrhea or chlamydia, or pelvic tuberculosis that have not been completely treated, talk to your provider about whether IUDs are the best choice for you. (Author’s note: smaller font in a side box?)

 

If you and your provider decide that the IUD is best for you, you will need to choose either the hormonal IUD called Mirena or the non-hormonal copper IUD called ParaGard

 

 


True-to-size graphics of uterus, and/or two real size uteri with Mirena and ParaGard in place

 

The Hormonal IUD:  The Mirena IUD releases small amounts of a progesterone-like hormone called levonorgesterel every day. The hormone released by the IUD causes cervical mucus to thicken.   Sperm is prevented from reaching the inside of the uterus and fallopian tubes.  This means that fertilization of a woman’s egg does not happen.  The Mirena IUD provides pregnancy protection for 5-7 years but may be removed at any time should a woman desire to become pregnant.  

 

WHAT ARE THE ADVANTAGES of the hormonal IUD called MIRENA?

·         This IUD may be left in place for at least 5-7 years.

·         Mirena decreases menstrual cramping and dramatically decreases menstrual blood loss.  In fact, the hormonal IUD is the most effective medical therapy for heavy menstrual bleeding.  Women using this IUD experience a reduced flow by more than 50%.

·         About 20% of women experience an absence of menstrual bleeding after one year of using the hormonal IUD.

·         Mirena prevents ectopic, or “tubal”, pregnancies.  In fact, women using Mirena have a 10 times lower risk of ectopic pregnancy than women who are not using any contraception.

·         Use of an IUD is convenient, safe, and private.

·         It is well documented that IUDs are the most COST EFFECTIVE REVERSIBLE CONTRACEPTIVES ever developed!

·         Mirena does not contain estrogen, and may be used by women who cannot use estrogen–containing birth control pills, patches or vaginal rings.

·         Mirena IUD may be used by women who are breastfeeding.

·         Mirena IUD may be inserted immediately following the delivery of a baby (vaginally or by cesarean section) or immediately after an abortion.

·         Once a Mirena IUD is removed, fertility returns right away.

·         Mirena appears to have a 50% protective effect against pelvic infections.

·         Endometrial cancer- the most common reproductive cancer in women (?) – can be prevented if postmenopausal women on estrogen therapy use Mirena.

 

Mirena IUDs are often prescribed for women with:

  • Heavy menstrual bleeding
  • Cramping or pain with periods
  • Endometriosis
  • Adenomyosis
  • Anemia
  • Dysfunctional uterine bleeding (DUB)
  • Fibroids

 

Will it be acceptable to you if you periods change?  If you choose to have a Mirena IUD placed, they WILL change.  Do NOT start this method of birth control unless you will find it acceptable to have your periods change (for example, become irregular initially, then become much lighter) or to stop having periods completely.   Be patient for the first 6 to 8 months, your spotting and bleeding WILL decrease over time.  The good news for many women is that 20% of women will stop having periods altogether after 1 year of Mirena IUD use.  This is an expected side effect of this IUD, and is not "unhealthy".  However, if not having periods is unacceptable to you, the hormonal IUD may not be the best choice.

 

Side box:  Mirena can cause cramping and increased days of bleeding at the beginning, but this gets better over time.  Women considering Mirena may find the advice of a North Carolina Nurse Practitioner who has inserted 200 IUDs in the last year helpful:  “I tell women, you may not like it for several months, but you’re going to love it for many years!”

 

Mirena contains a hormone and while most of this hormone remains in the uterus, a small amount can make its way into the blood stream and cause side effects.  These may include acne, hair loss, mood changes and even depression. These side effects occur in VERY FEW women.  The vast majority of women feel the benefits of Mirena, most importantly its superior effectiveness at preventing an unwanted pregnancy; far outweigh the low risk of these side effects.  (look at CT for menstrual disorders for quote by Speroff, Darney)

 

The Copper IUD, called ParaGard:  ParaGard is a flexible T-shaped plastic device with three sleeves of copper wrapped around the IUD.  ParaGard prevents pregnancy because the copper ions released by the device act as a spermicide.  Sperm are therefore unable to reach the fallopian tubes, and unable to fertilize the egg. ParaGard is FDA-approved for 10 years of use.  Excellent research shows that ParaGard is highly effective for 12 years.  It may be removed any time a woman desires to become pregnant.  

 

WHAT ARE THE ADVANTAGES OF PARAGARD?

·         The copper T 380 A IUD is effective for at least 10-12 years.

·         ParaGard may be used as emergency contraception if inserted within 5 days of unprotected intercourse.  If 1000 women have a copper IUD inserted as an emergency contraceptive, only 1 will become pregnant!  This is the most effective emergency contraception available to women.

·         It is well documented that IUDs are the most COST EFFECTIVE REVERSIBLE CONTRACEPTIVES ever developed!

·         ParaGard prevents ectopic, or “tubal”, pregnancies.  In fact, women using ParaGard have a 10 times lower risk of ectopic pregnancy than women who are not using any contraception.

·         Use of an IUD is convenient, safe, and private.

·         The copper IUD has no hormones.  It may be used by women who cannot use estrogen–containing birth control pills, patches or vaginal rings.

·         ParaGard IUD may be used in women who are breastfeeding.

·         ParaGard IUD may be inserted immediately following the delivery of a baby (vaginally or by cesarean section) or immediately after an abortion.

·         Once a ParaGard IUD is removed, fertility returns right away.

·         Here is a fascinating and unexpected advantage of copper IUDs: A number of studies of women with copper IUDs have shown a decreased risk of uterine and cervical cancer.

Bleeding patterns after ParaGard IUD insertion:  Most women who have a ParaGard placed will continue to have regular periods.  For some women, having a monthly menstrual period is particularly important and the ParaGard IUD is an excellent choice for them.  However, women may experience up to a 35% increase in average menstrual blood loss while using ParaGard, as well as increased menstrual cramps.  If you already have heavy, painful periods and want an IUD, ParaGard may make these symptoms slightly worse and may not be the best choice for you.

 

HOW ARE IUDs PLACED?  (Author’s note:  smaller font, side box)

 

Whether you choose the Mirena or ParaGard IUD, they are inserted the same way.  An examination is performed to determine the size of your uterus, and its position in your pelvis.  A speculum is then placed in the vagina in order to see your cervix, similar to when you have a pap smear performed.  For some women, a local anesthesia may be injected to numb the cervix before the cervix is dilated, or opened.  The IUD is gently passed through the cervix and into the uterine cavity.  The IUD insertion itself takes 3 to 5 minutes.  There will be soft strings that are attached to the IUD and that are left long enough to extend into your vagina (but not outside of your vagina).  These allow you and/or your provider to check periodically that the IUD is still in place, and also allow your provider to remove the IUD.  Most women feel mild to moderate discomfort during the IUD insertion.   A woman may want to take an anti-inflammatory such as ibuprofen one hour before her appointment and then every 6 hours the day of placement. (check with Jeff- what is routine practice with CHOICE project?)

 

Your provider may ask to see you for a return office visit 4 to 6 weeks after the IUD was placed in order to check that the IUD is still in place, and to address your questions and any concerns you may have.

 

Approximately 2 percent of women will expel the IUD in the first year.  This means the IUD may be spontaneously pushed out of the uterus.  Women who have never had a baby, who have heavy and/or painful periods, or who have the IUD placed immediately following delivery of a baby or after an abortion have a higher risk of expulsion.  Symptoms include cramping, unusual vaginal discharge, bleeding, absence of the IUD strings, or the presence of the hard plastic of the IUD at the cervix or in the vagina.  Because expulsions can also happen without symptoms, your provider will discuss how to check the IUD strings so you know the IUD is in place.

 

HOW IS AN IUD REMOVED? 

If at any time you decide to have your IUD removed, your provider will place a speculum in your vagina to see the cervix, and grasp the IUD strings with a small instrument.  With a gentle pull the IUD can be removed in SECONDS, with minimal or NO cramping.  You can get pregnant right away after IUD removal.

Be sure to have a clear plan for switching to another contraceptive if you do not want to become pregnant.  

 

VERY, VERY important myths about IUDs:

 

1.  MYTH: IUDs cause abortions. NO, this is not true. IUDs work in several ways to prevent pregnancy. The hormonal IUD, called Mirena, works primarily by blocking passage of sperm through the cervical mucus.  This prevents fertilization.  Mirena occasionally prevents ovulation.  Finally, Mirena may block implantation of a fertilized egg.  The copper IUD, called ParaGard, primarily prevents pregnancy by preventing fertilization.  It acts as a spermicide within the uterus.  ParaGard can block implantation of a fertilized egg in the rare instances where fertilization occurs.  Major organizations in reproductive health throughout the world, and textbooks in reproductive health, strongly state that IUDs do not disrupt an implanted pregnancy and therefore do not cause abortion.

2.  MYTH: IUDs cause cancer.  Definitely Wrong!  The hormonal IUD called Mirena prevents endometrial hyperplasia and endometrial cancer. The copper IUD called ParaGard has been shown to prevent both endometrial and cervical cancer. 

3.  MYTH: Women with fibroids cannot use an IUD.  In the vast majority of women this is not true.  In fact, the Mirena IUD can be used to treat bleeding and pain in women with fibroids.  In rare cases, a fibroid can cause distortion of the uterine cavity and it may not be possible to insert an IUD. 

4.  MYTH: Women cannot use an IUD until they have had a baby. SIMPLY NOT TRUE!  Both the World Health Organization (WHO) and the Centers for Disease Control (CDC) consider the IUD an acceptable choice for women who have not had a baby.  In addition, adolescents who have never been pregnant CAN USE IUDs!  This is an excellent method for long term pregnancy prevention for adolescents.

5.  MYTH: IUDs are just too expensive.  They may cost more initially, but, over time, IUDs are definitely the most cost effective reversible contraceptives. Some insurance programs cover the cost of IUD insertions and so do some college and community health services.

6.  MYTH: IUDs cause pelvic infections.   Actually, women using Mirena IUDs in research studies were found to have a lower risk of pelvic infection, or PID, compared to women not using an IUD.   Inserting an IUD does involve a very small risk of infection, about 1 in 1000 in the two weeks following IUD insertion.  Thereafter, there is no increased risk of infection using either type of IUD. 

 

Pelvic infections are serious, sometimes causing chronic pain and infertility.  Infections cause infections, IUDs do NOT cause infections.  These infections are usually sexually transmitted and can be prevented by correct and consistent condom use.  All women, regardless of contraceptive choice, who are at possible risk of infection, should use condoms every single time they have sex. 

 

(Insert tiers of contraceptive effectiveness graphic)

 

If you are considering an IUD or a contraceptive implant, and would like help finding a provider who will help you GET IT AND FORGET IT:

-Call the office where you receive your general health care or birth control to see if they provide IUDs and implants, too. 

-Health departments and community health organizations often also provide IUDs and contraceptive implants. 

-Visit these websites, which provide lots of information about birth control methods including the GET IT AND FORGET IT methods, and also can help you find a clinic close to you that provides birth control services:

plannedparenthood.org

bedsider.org

 

1/21/2012, Camryn Chrisman Robbins and RAH

       

 To learn more about the advantages and disadvantages of emergency contraceptive pills, the ParaGard IUD, the Mirena IUD and the Implanon implant, go to our website: www.managingcontraception.com and click on Choices.  You can also order this wonderful new educational book from our website or by calling 404-875-5001.  Do you have your copy yet?


Key Words:  ejaculate, Postinor emergency contraceptive pills, period, sex, rough, whitish discharge, bleeding, protected, method, switching, long-acting reversible contraceptives, ParaGard IUD, Mirena IUD, implant, cycle, unpredictable bleeding, Get it and Forget it methods, advantages and disadvantages

Posted 4-19-2012, Updated 5-2-2012


Robert A. Hatcher MD, MPH
Emeritus Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA
---2012-05-2


Contraceptive Technology 20th Edition & Managing Contraception
  


Managing Contraception for Your Pocket 2013-2014
  


Choices, English
  

The directors and owners of this website and any publications and information concerning health matters offered here advise a person with a particular problem to consult a primary-care clinician or a specialist in obstetrics, gynecology, or urology (depending on the problem or the contraceptive) as well as the product package insert and other references before diagnosing, managing, or treating the problem.
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Suggestions, recommendations, questions, comments, data from the literature, interpretation of laboratory tests and other information provided on this site are for informational purposes only and are not intended to be relied upon as advice from or implied to be a substitute for the professional advice of a physician, nurse practitioner, nurse midwife, counselor or other healthcare professional. Always seek the advice of your clinician or other professional for any questions you may have regarding your health, medical condition, method of birth control and other family planning or personal/social issues. Periodic references to costs of birth control methods on this website are estimates only and your actual cost for any specific method of birth control may be more or less than the stated amount. Emory University School of Medicine, Bridging the Gap Foundation, and Bridging the Gap Communications Inc are not responsible for any damage or loss you may incur as a result of your use of or reliance on any material or information provided through this website.