Before we get started discussing how I chose a Skyla IUD as my form of birth control, a disclaimer: If you don’t want to hear anything about my vagina or uterus, please skip this blog post. Male family members and co-workers, this means you! If you’re interested, okay, keep on, just don’t let things get weird between us!
I contemplated not posting this, but it seemed kind of dishonest. When I was researching getting an IUD, I really enjoyed reading experience stories – they helped me make up my mind to go for it. And thus, I feel like I really should record mine for other ladies seeking information.
My history with birth control
I have been on hormonal birth control before I was ever sexually active, having my first “well woman” exam my third year of college. I wanted something to help with extremely heavy and crampy periods, and I knew I would eventually need birth control anyway. I would menstruate for days, and my cramps were terrible. The only things that seemed to help were Midol and a hot bath. Come to find out, it’s a genetic thing – my mom also had really tough periods, and my great-grandmother nearly bled out in the emergency room from hemorrhaging. I had heard that birth control could give some relief.
Murray State provided free exams, paps, STD testing, and oral contraceptives. I was originally put on Ortho Tri Cyclen Lo, which was excellent. It severely lessened my “shark week” and made cramps nearly non-existent. I had been borderline anemic before, but now I could donate blood if I wanted to! Yay!!
I stayed on OTC-Lo for a few years until I had a missed period. I was in the process of losing weight and knew that skipping a period could be a side effect, but when I honestly reported that I’d missed a period during my yearly checkup, the nurse practitioner immediately determined that meant OTC-Lo was not working properly and switched me to Ortho Cyclen. Going from a low-dose tri-phasic to a higher-dose steady pill really threw me out of whack.
Like… seriously out of whack. I went nucking futs. I gained a shit ton of weight because I was refusing to eat anything other than fried chicken and chocolate chip cookies, and I got extremely hormonal and moody and depressed. I remember that I was laying in the bathtub, debating whether or not I should just drown myself, when it popped in my head that I wasn’t psychotic and my pills were fucking with me. I stormed downstairs, covered in suds and bubbles, screamed at my ex and threw my bag of unopened pills at him. I never took another one and I leveled out within a week.
My NP didn’t want to put me back on OTC-Lo and told me I was probably actually severely depressed. I demanded the old pills back and she capitulated. I continued on OTC-Lo until I lost my insurance, and couldn’t afford the $50/pack price point. My new NP looked at the ingredients in OTC-Lo vs. OC, and prescribed me Alesse, which had a $4 generic named Aviane.
Ah, Aviane. I loved it so. Much like OTC-Lo, I used it for years and it was excellent. So, what changed? I got insurance again. And this insurance has unfortunately been grandfathered in since before the Affordable Care Act, and refuses to cover oral contraceptives unless they deem them “medically necessary.” They denied my prescription for Aviane because apparently not wanting to procreate doesn’t count as a medical necessity. They did, however, cover non-oral contraceptives… or so I was told. So I had a serious discussion with my doctor about the implant and intrauterine device. I went into that conversation leaning more towards an IUD anyway, because I am planning on having surgery on my arms soon (brachioplasty – arm lift, because I have horrible sagging skin there now that I’m down 85+lbs). She told me she doesn’t do the implant anyway, but has tons of practice with IUDs.
There are two very popular forms of IUDs – Mirena and Paragard. The first is hormonal and the second is copper. I had no desire to get a Paragard because I’ve read that they really increase your flow. Mirena, on the other hand, often stops your periods altogether. Tons of my friends have the Mirena and love it! But I was more interested in getting Skyla, which is marketed as “Mirena’s little sister.” Originally, years ago, I asked that first NP about an IUD. She told me I was not a candidate because I’d never been pregnant. Both Paragard and Mirena are recommended for women who have had children, because they’re supposedly less likely to reject and expel it. However, Skyla is slightly smaller, and was tested extensively in women who have never been pregnant. It is FDA-approved for use in nulliparous women. It is also only good for three years instead of 5 like Mirena.
My doctor and I decided that Skyla was right for me.
(There is also a brand new IUD called “Liletta” that has had more extensive testing than any of the others – it’s been tested in different races, ages, and weights of women – it’s approved for the morbidly obese, which is something that neither Mirena nor Skyla can claim. It also has an excellent discount program, theoretically only costing a woman with insurance $75 out of pocket! However, at the time I consulted for my IUD, it was not yet on the market, having just been approved in March).
During the consult, my doctor asked me a lot of questions to determine that Skyla would be best for me. She asked me if I was married. I was kind of taken aback by that – what does it matter? – but I figure it was probably to determine if I am monogamous. That question kind of raised my hackles, because I was almost expecting questions about my husband, since the doctor’s office is a religious practice. She just left it at that, though, so no big deal.
She also asked if I wanted children. I have never wanted children, but I responded with “no time soon,” because I don’t know if I’ll change my mind in the future. That’s why I haven’t asked for sterilization (which, btw, our insurance 100% covers vasectomies. So fair.) Skyla is good for three years. I told her that if we do have children, it’ll be after I’m 35, to give us time to buy a house, get financially secure, let me go through grad school, etc. So three years would be perfect.
She asked me that question a couple of times before finally settling that I was really serious. That was kind of annoying, but I guess she wanted to be thorough since Skyla is such a long-term birth control, and let’s be real here, I’m getting past the age that most women of my generation want to have children. I know if I ever do reproduce, I’ll be an “old mom.”
We figured that it was the norgestimate in OC that had given me such trouble, since it had a higher dose than OTC-Lo, and Aviane didn’t have it at all. Skyla has levonorgestrel, just like Aviane, so I should be fine on it.
She inquired about my general vaginal health – had I ever had a pelvic infection? That can impact insertion. Fortunately, the worst I’ve ever had was a yeast infection, so I was good to go!
Once we settled that Skyla was it, she demonstrated the insertion for me. She had an “example kit” of a Mirena, and she let me handle the IUD, and then loaded it into the gun and mimicked popping it into me. I got to feel the strings and see how the whole thing worked. It was pretty cool. I found out that I would be her first Skyla insertion, but she assured me that it was basically identical to the Mirena, just slightly smaller.
I asked how many Mirena she had inserted, and she said “hundreds.” I also inquired about complications. She said that a couple of her patients had theirs move upwards a little, so that when they came in for removal, she couldn’t grasp the strings and pull it out. They had it safely removed by a gynecologist who used an ultrasound to find it (she also told me that she hadn’t installed those – another doctor had before they became her patients). She’d never had a patient expel one, or get a perforated uterus, or any of the “severe risks” that they have to put on the warning label since like one of the subjects out of the hundreds in the test sample experienced it.
My doctor told me she’d order Skyla and they’d call me when it came in, which usually takes 1-2 weeks. She wanted me to make my insertion appointment for the week I would be on my period, since it is easier to insert at that time.
A week later, I hadn’t heard anything from the office. I had a hunch that something had gone wrong with my insurance yet again. Sure enough, it had. I called my insurance only to find out that the prescription was denied because… they don’t cover birth control at all unless it’s for a medical necessity!!! The last woman had been completely wrong!! ARRRRGHHHH!! This one explained the whole grandfathered thing to me, and admitted that our network is one of two in all of Blue Cross Blue Shield!!! that is still grandfathered!!! She predicted they will lose that status soon, but could not tell me when (because that’s up to when they decide to stop being stubborn and actually update some shit… ugh). I think right now the absolute end date is set for 2017, but it HAD been 2015 and got pushed back, so who the hell knows.
Anyways, I called my doctor back, and spoke to the nurse. I explained the situation and she appalled (how fast we have gotten used to the wonderful norm of the ACA!). She asked me if I could give any reasons for medical necessity. I explained that before BC I had really heavy and painful periods and was borderline anemic, and described a family history of hemorrhaging, ablations, and hysterectomies. She called me back the next day and told me that my doctor had written in a prescription for the Skyla to control my “menorrhagia” (exceedingly heavy period). I waited until that afternoon, and called my insurance back. They approved it!!
Unfortunately, since they’re not ACA, they don’t have to cover the entirety of the price of birth control. I found out that a three year’s supply of Aviane would cost me roughly $300, whereas my co-pay on Skyla would be $200. I went ahead and paid the pharmacy and ordered my IUD!
I really like my doctor, but I’m not too happy with her office. The administration doesn’t really seem to have their shit together. When I called to make my appointment, I asked what I should do to prepare for insertion. I had already read a bunch of insertion stories by then, and learned that most doctors recommend their patients to ingest about 800mg of ibuprofen an hour beforehand. I’d also read varying accounts of the efficacy of misoprostol as a cervix softener. I specifically asked the nurse, “Do I need to be prescribed misoprostol to soften my cervix, or should I take painkiller before coming in, or what?” She assured me that I did not need to do any of that, but that the doctor would “spray me with an anesthetic before insertion.”
This turned out to be wrong. I wish I’d asked my doctor during the consult for directions on how to prepare.
Since I was still taking Aviane, I scheduled my appointment for a day I knew I would be ragging. I also chose a day that I knew my mom would be off work, so she could take me. Some accounts I read said they were able to drive just fine, whereas others said the insertion knocked them on their ass and they needed to be chauffeured home.
I knew I still had some percocet at home from my MRSA/Darren’s appendix, so I knew in a worst-case scenario, I would have some excellent painkiller that would also knock me out. I debated taking one beforehand since I knew it would make me woozy and relaxed, but decided against it in case the doctor didn’t want to insert the IUD when I was drugged. Instead, I took 400mg of ibuprofen just in case. I am glad I did.
When I arrived, the nurse already had the room set up. There were sterilized tools laying on the tray, some long swabs, and a cup of betadine. She took my vitals – my blood pressure and heart rate were elevated, but that’s apparently quite normal in face of an IUD insertion.
The doctor arrived shortly after, and asked if I wanted to see an example insertion again. I declined, and then she asked me if I’d taken 800mg of ibuprofen. WTF! I told her that the nurse told me not to, and that she’d spray me with an anesthetic. She was confused and said she NEVER does that and that it wouldn’t be very effective anyway (which is what I’d read, so I had kinda figured that anyway…). Ugh! I asked whether or not I could take the percocet when I got home, and she said that would be perfectly fine since it wouldn’t interact with the ibuprofen I had taken.
She and the nurse then left the room so I could undress from the waist down. I laid a paper blanket over my lap and sat on the table until they came back. They then got me into position in the stirrups and she explained step-by-step what she was doing. First, she put on surgical gloves. Then she performed a manual exam to make sure my cervix was where it was supposed to be. That entailed her lubing up and feeling inside me with two fingers while pressing on my abdomen with her other hand. After that, she broke out the speculum.
I dislike the speculum because it always seems to “pinch” on the sides. This was no exception. So that was the first bit of pain. I just tried to focus on my breathing and stared at the ceiling while she continued.
Next, she disinfected the internal area thoroughly with the long swabs and betadine. This wasn’t uncomfortable, just… weird. Paps always felt slightly crampy and I expected the same with this, but it wasn’t painful, just odd. She said that the swabbing was making my cervix move, and she was going to grasp it with an instrument to hold it still. I felt her insert the tenaculum – it was metal and cold! – and she said I should expect a pinch. I didn’t really feel a painful pinch, just some slight pressure.
I thought she continued swabbing me, but she actually sounded my uterus at this point to make sure the IUD would fit. I felt some small cramping. Then she told me I would feel some “big cramps.” She was right!! OWW! This was the worst part – I felt what seemed to be extreme cramping, and I know I cried out and asked her to stop. She quickly responded “almost done!” and then there was an immediate cessation of the cramps. What I thought was her sounding me was actually her inserting the IUD! I’m not going to lie, it was extremely painful, but lasted literally something like 10 seconds. It also made me feel like I was going to shit myself, which is also apparently quite common. I blurted out “I’m totally going to fart on you!” and she laughed.
Spoiler alert: I didn’t. Fart OR shit, thank you very much.
As soon as she removed the gun, the cramps let up. I was still cramping, but they were nowhere near as intense. I just kind of lay there breathing as she informed me that she was now trimming the strings (couldn’t feel anything) and then she removed the speculum.
I suffered a common side effect of insertion, which is feeling light-headed and faint. She instructed me to lay still and breathe for a few minutes, and I requested a glass of water, which the nurse ran off to fetch.
After a few minutes, I felt better and was able to stand up and get dressed without issue. I was told that since I had Skyla inserted during my period, after just finishing a pill pack, that it would be instantly effective and I would not need a backup form of birth control.
48 Hours Later
I was still cramping by the time mom took me home, so I popped a percocet, cuddled up to my husband, and took a nap. I slept for about six hours, and when I woke up, the cramps were almost totally gone.
By Saturday morning, the cramps were completely gone, and I was no longer bleeding. Woot!
It’s Sunday night now, and I am feeling perfectly normal. Occasionally I’ll get a small cramp, but they have become few and far between. I felt one earlier this morning, but that’s it.
Skyla could make my period go away completely. Mirena often does, but fewer Skyla test subjects had that side effect. We’ll see. For the first time in ages, I have to track my cycle since I won’t have pills to remind me when things are supposed to happen.
I have a followup in one month so that she can check to make sure it’s still in place and teach me how to feel the strings. I am supposed to check it monthly to make sure it hasn’t moved. I attempted earlier, but couldn’t really feel anything. I’m pretty sure it’s still in place and I just don’t know how to feel them.
I will update further down the line, once I see how my body reacts to Skyla. I hope I don’t get the constant periods and spotting that usually happen for the first 3-6 months. That would suck, but most women report that it goes away and is absolutely wonderful after that.
(As a disclaimer, the products are linked to my Amazon Affiliate account. I’ve never used this before but I’m going to give it a shot and see how well it works. In theory, I should get a small kickback if you purchase the product through that link. Product costs are not increased for you, just Amazon gives me a tiny percent of the profit for sending you their way. Maybe I’ll get rich and can retire from this life of crime.)