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Mirena? Nuvaring? Cost and other questions

post #1 of 11
Thread Starter 
Just wondering about the cost of Mirena and Nuvaring.
I've decided I really should go on hormonal bc. I'm scared of hormonal bc, but even more scared of getting pg (complications with ds...)

I'm thinking Mirena would be ideal, because it's progestin. That's what's in Depo, and I did just fine on depo for 6 years. Of course, it screwed up my fertility (I started ttc over a year after I stopped getting it, and it took us 2 years to get pg). I wouldn't want to do depo again, because of what I've learned about it, but I'm thinking a lower dose (like in Mirena) would work well. I didn't have AF for YEARS on depo. Not sure how healthy I think that is, but I liked it at the time.

But I've read it's expensive. How expensive are we talking here? I have no health insurance right now. I'll have Canadian ins. in about a year.

What about Nuvaring? Is that more affordable? From what I've read, it's low dose. I also like the fact that your body gets a break from it for a week every month.

I guess my cheapest option would be Lea's Shield. I don't need a prescription to get it here in Canada. But I'm getting freaked out about getting pg, and it doesn't seem as effective as the others. We've been lucky- 2 years of w/d and haven't gotten pg (ds is 3 and I didn't get AF until 13mos pp).
I guess the Shield in combo with w/d and spermicide would probably be pretty darn effective though...
post #2 of 11
The cost of Nuvaring and Mirena depend on your insurance, of course. My insurance covered only a very small portion of the Mirena IUD. I had to pay about 500$ out of pocket for it, total. (US$) Some insurances cover it totally, though. And I believe you can get it through Planned Parenthood, depending on your income, for nearly free.

Nuvaring was about 30$ for me monthly when I used it about 4 years ago for a couple months.

So if you know you want b/c for 5 years or so, Mirena really pays off.

post #3 of 11
Thread Starter 
I'm an idiot...geez. I just realized that when I was on depo, I was depressed, and so sensitive to touch that I didn't want my dp to touch me at all, ever. hmmm... interesting...

I have an appointment tomorrow, and I'm planning on the nuvaring. I can get it for $15/month at a Planned Parenthood type place.
Something about iud's still wierd me out. But it's not out of the question for when I get insurance... I'm sure I'll want it long term, so mirena does seem most cost effective (after I have insurance)
post #4 of 11
The dose of progestin in depo vs Mirena is like night and day. In depo, it's a very high dose designed to be dissipated slowly over time. Even though you're only protected again pg for 12 wks at a time, it can take depo waaaaay longer to get out of your system. I'm a family planning nurse and I've heard enough horror stories (including my own) to steer clear from depo. The progestin in the Mirena is there for a completely different purpose. Women tend to have heavier, more painful periods when using non-hormonal IUDs. The mirena has low doses of progestin to help you have lighter, less painful periods. The progestin decreases the amount of lining you build up in your uterus which is shed each month that you don't get pg (AF). FWIW, over 20% of women on the mirena have no AF at all. It's not necessarily a bad thing, you're just not building up your endometrium enough for a period.

The NuvaRing has both estrogen and progestin but the doses of estrogen are much lower than most birth control pills and the patch. This makes you less likely to have side effects. It also has a higher effectiveness rating for typical use since you only have to remember to deal with it twice a month instead of every day or every week. I used the NuvaRing before we realized that we suffer from infertility and I loved it.

Here's some questions my clients typically ask me about the ring:

Will it get in the way of having sex?
No. Most guys can't feel it and the ones that do tend to like it (like feeling a cervix). If it does bother either of you, you can take it out, have sex, and then put it back in. As long as it isn't out for more than 3 hours, it's just as effective as if you had left it in the entire time. Just don't forget to put it back in.

Will it get lost in my vagina?
No. Your vagina is a closed system. Most women's vaginas are no longer than their longest finger. If you reach in and can't get to the ring, just push like you're pushing a baby or trying to poop really hard the the vaginal muscles will push it down where you can reach it.

Will it get funky in there?
No. It will come out in the same condition you put it in. Some women do have more vaginal secretions but it isn't a bad thing if you don't mind and it doesn't happen with all women. The ring actually helps to maintain a steady vaginal pH which can help reduce the incidence of yeast infections and bacterial vaginosis in some women.

How do I put it in?
You just pinch it to shape it like a torpedo and push it in. As long as it's in your vagina, it's working. It doesn't have to be in any special position or location. You shouldn't feel it when it's in (like a tampon). If you do, it's probably sitting too low in your vagina; try pushing it up a little higher. You can also take a tampon out of its applicator, put the ring in, and insert it like a tampon.

How do I take it out?
Reach in, snag it with your finger, and pull it out.

You can get most birth control methods for a discounted cost at most Planned Parenthoods, health departments (that's where I work), and community clinics. If you live in WA state, there's a great program called Take Charge that will pay for your birth control for you.

This is what I do all day long so LMK if you have any more question! I hope I didn't bore you!
post #5 of 11
Thread Starter 
Thanks for that info! I really appreciate it. I do have one more question though (I'll research this too, but if you have time for a quick answer...)
I seem to remember some type of birth control being not recommended for women with breast cancer in the family?
There has been breast cancer on both sides of my family. My maternal grandma, and my paternal aunt and other more distant relatives.

Off to research that...
post #6 of 11
If you had had breast cancer youself, you should probably NOT use the NuvaRing. If you have a family history of breast cancer, you should weigh the benefits and risks of using the NuvaRing. You'll want to discuss it with your MD and they may decide to just follow you more closely while you use the ring because of your family history.

Breast tissue is the target for female hormones (estrogen and progestin). How the breast responds to these hormones depends on the receptors in the cells of the breast tissue. Most breast cancers in women under 35 are estrogen receptor negative. A study of was published that looked at cancer risk in women over 35 who were either current or past users of the combined pill (same hormones in the ring). THey looked at 4575 cases of breast cancer and found that there was no excess risk seen in all the groups studies up to age 64. The study also found that duration of use, age of first use, type of pill, type of hormone, and family history of breast cancer did not have an impact on risk. There is still a question about risk in women under age 35 but since the majority of cancers in younger women are estrogen recpetor negative, the concern may be unnecessary.

There isn't as much data that I could find on the Mirena specifically (it's relatively new like the ring) but I did find some stuff on depo which is a higher dose of progestin. Several studies showed a non-significant excess risk of breast cancer with depo. Although there seems to be some possibility of risk for women under age 35.

If it were me, I would opt for the Mirena. I don't think the risk is worth it with the estrgen but I might be jaded because I just lost my mom to cancer 2 weeks ago. The dose of progestin in the Mirena is so low that I would assume that it would pose the lowest risk of any of the hormonal methods. Even though I suffer from infertility, I plan to get a Mirena after I have my second child. My periods are crazy heavy and I'd love to see them disappear!
post #7 of 11
Thread Starter 
I'm so sorry about your loss. s Cancer is a scary thing.

Thanks for that information. I'm so torn! Gah. I guess I'm debating nuvaring and diaphragm (or Lea's Shield, if I can find it) right now. I'm so bad about decisions. I have to imagine that between w/d, spermicide, and a diaphragm, we'd be pretty protected.
I think I'll wait for the Mirena until I get insurance, just in case it perforates my uterus or something else that requires attention like that.
post #8 of 11
Thread Starter 
Well, the doctor seemed a bit concerned about the Nuvaring with my family history of breast cancer. soo.....

She recommended Mirena (it sounds like that's what you'd recommend too), which I'll get when I get insurance in about a year. The up front cost isn't the biggest concern (they'd insert it for $50, plus the cost of Mirena which isn't covered by insurance anyways). But I was thinking, what if something crazy happens, like it perforates my uterus. I'd really like to have insurance if that happened!

So, I guess it's a diaphragm for now. I'm going back in a week to get it fitted.

Thanks again
post #9 of 11
Good luck with the diaphragm! Some women who end up not liking the diaphragm do well with the sponge. It's available over the counter and pretty reasonably priced. I'm glad I could help! :
post #10 of 11
Who will you be insured under in Canada? I assume you're moving here or already have and just waiting...or something, lol.

My partner had Standard Life (I'm in Canada) and I had my Mirena covered 100%.
post #11 of 11
Thread Starter 
Originally Posted by laprettygurl View Post
Who will you be insured under in Canada? I assume you're moving here or already have and just waiting...or something, lol.

My partner had Standard Life (I'm in Canada) and I had my Mirena covered 100%.
oh, cool. I'll have to try to remember that... Thanks!
Yes, we're here, but we've been really slow in getting my permanent resident application in. It takes a year to be approved once it's in. : We're just waiting on one final document to send it in. Sometimes they'll give insurance before the approval process is totally done, so hopefully I'll have ins soon!
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