Wednesday, March 28, 2012

O.M.G. What's an I.U.D.

Many times, I have felt that when I write, I vent and I don't necessarily want that to become a habit. I think because in my day to day life, I am always the one smiling or laughing and so when I am alone with my thoughts and writing about cancer, I think I write about what frustrates me or makes me sad or scared.

What's been on my mind a lot lately is the lack of options that cancer has provided me with. Cancer has robbed me of a lot and has limited what I have control over anymore. Many things that most young women get to decide have been decided for me. The bra shops that I go to are predetermined; the average bra is about $80 now and they are pretty generic (the word 'sexy' hasn't quite hit the mastectomy world yet), having children may not be a decision that we can make because it may have been made for us, if I do get pregnant, breastfeeding is not an option (or a choice) and contraception is extremely limited because of my hormone receptive cancer.

When it comes to birth control, I can't use anything that releases hormones so that means no pills, no rings, no shots, and no implants. We are limited to abstinence, condoms, diaphragms, and IUDs. Let's just cross abstinence off the list, male condoms have a variety of drawbacks and have you seen the size of the female condom, you could fit a small elephant in those suckers. Diaphragms need way too much preparation and IUDs require a 'procedure' to put it into place. So what's a girl to do who wants to get pregnant but can't get pregnant until she's done her 5 years of Tamoxifen? She goes with an IUD.

After chemo was over, I knew I had to do something about contraception but really, the odds of me being able to have a baby are as low as 40% so what are the odds of getting pregnant? And then I thought, the odds of me getting breast cancer at 26 years old were less than 1%, right, so, contraception it is. The thought of an IUD really grossed me out, and between my breast implant, my PICC line and all the chemicals that have been put through my system, I didn't know if I was ready to be poked and prodded once more.

I looked into it and really, everything I read said that there was some initial discomfort but the pros seemed to outweigh the cons. An IUD (Intrauterine Device) is a 'T' shaped device that is inserted into your uterus by a physician that kills sperm and prevents pregnancy. There are two different kinds of IUDs, one that releases hormones (that my family doctor assured me would be fine because it releases progesterone and my cancer was estrogen receptive but I don't want any extra hormones of any kind if I had an alternative, thank you very much), and one that is wrapped in copper (sperm apparently hate copper) which is the one I chose.

So after squirming through the thought of going through another procedure that cancer has cornered me into, I went to my family doctor and said 'I want an IUD'. Let me tell you the benefits first. It cost $68 (not covered by our drug plan) and it lasts for 5 years. That's a cost of about $1.11 a month. If for some reason you want it out before 5 years, it can easily be taken out by a physician. And, you can start trying to conceive a child after your next period once it's been removed. Another great thing is that I never have to remember to take it (or take it out), I don't have to stop what I'm 'doing' to put it on, and there are no hormones associated with it. Oh and once it's in, you can't feel it, I'd have no idea it's in there, it doesn't move, etc. etc. etc.

Luckily, my family doctor does it in her office (apparently not all family doctors do this). So, I made an 'insertion' appointment and mentally prepared myself for going through another procedure. I 'googled' IUD insertion and although many people advise against googling things like that, I always like being prepared. Google and I have been best friends since last March and I seem to be able to weed through the garbage and find the credible information. I would rather know every symptom that could happen and experience nothing than not know any symptoms and experience everything. The information that I found mostly discussed extreme cramping and the pain during the procedure. All I kept thinking was 'if I can make it through chemo, I can make it through this.'

So my doctor wrote 5 prescriptions at my consultation appointment that I needed to get filled before my next appointment. They like to insert the IUD the day after the last day of your period. The IUD is a prescription that you need to fill and bring with you to your 'insertion' appointment. My 5 prescriptions consisted of an IUD, 2 antibiotics (to prevent and 'cure' any infection the IUD may cause), 1 to prevent a yeast infection from the antibiotics and the last one was a pill that I had to insert vaginally to soften my cervix... You know, every know and again as I'm writing these blogs, I picture one of my brother's reading it and wonder if either one of them ever think 'You know, I know more about my sister's boobs/uterus/cervix than I ever wanted to.' But then I think about how many times I wish I could have found information about the 'stuff' that I write about from a real person's perspective and it makes it all worth it. So, if I'm your sister, daughter, aunt, niece, etc. etc., I'm really sorry.

Anyway, the day before the insertion, 3 vaginal pills are inserted (by you), one in the morning and two at night. The next day I went into the doctor's office, my name was called, I went into one of the rooms, disrobed, and before I knew it the car jack was in place. Now, I am 6'0 tall so I have longer everything. It never fails that my doctor inserts car jack #1 then says 'I can't see your cervix, I need to get the longer spreader-opener'. I call it Bazooka Joe but who really knows what it's called. ANYWAY, she props me open, does a pap-test (I mean, might as well make a day out of this and have 'the works' done while she's down there), and then she really cranks me open. She said 'Oh I can finally see your cervix.' I don't really know what to say so I think I may have said 'Oh, good' as if I thought it had fallen out or something.

So, from there she was trying to talk to me to distract me (I'm an expert at identifying when a medical professional is trying to distract me as I am a self proclaimed needle-phobic and distraction is the number one technique for them to try to calm me down) but I was just trying to focus on my breathing. She said 'this is going to pinch a little bit' and I know what 'pinch' and 'little bit' means in the medical world so I closed my eyes and bit my own finger to try to localize the pain somewhere else but nothing happened - I didn't feel anything. And then she said 'You have to be very still right now, this is the crucial part' and so my eyes slammed shut again and my teeth sunk into my finger a little more and then she said 'Ok, I'm done'. Huh? Isn't it supposed to hurt? I didn't even feel it. I asked if I could sit up and she said 'Sure, if you want to'. So, I started getting dressed and although for about 6 hours afterwards I was walking around with my legs kinda closed (I may have been a little nervous that it was going to fall out), it was entirely pain-free.

I did experience some cramping for about 48 hours but that was it. And since I've gotten the IUD, I have found out some interesting facts.
1. The IUD is the most effective form of contraception (the fact that there isn't any responsibility on you or your partner to take a pill or insert a device, etc. is taken into account here too).
2. North America is the only part of the world where the IUD isn't the most common form of birth control. We are a whole bunch of pill poppers.
3. An IUD was a form of birth control that was meant for women who have had children but in the past ten years that approach has changed and more and more childless women are using IUDs as their form of birth control.
4. All the cool kids are doing it.

So, the downside you ask? Well, the only main downside that I've read about but have not yet experienced is heavier, crampier periods (that's with the copper IUD, with the hormonal IUD, your periods can sometimes disappear). I have not yet had a period since I've had the IUD so I can't attest to that quite yet. Hopefully it's nothing a little Advil can't cure.

So now, I have made it my mission to spread the word about IUDs especially for breast cancer survivors who are still in their reproductive years. I wanted to let women know about IUDs because I didn't know much about them and what we don't know usually scares us. There is always talk amongst us young breast cancer survivors about the pill and whether it did have an impact on us getting breast cancer so young and many times my girlfriends ask me if I think there is a correlation between the pill and breast cancer in your 20s. To be honest, I have no idea and if I hadn't have gone through what I just went through over the past year, I would probably still be on the pill but now my train of thought is, if there is an alternative, why chance it? Even if the pill has nothing to do with breast cancer, is it a good idea to be pumping all those hormones into our systems? I guess the same could be said for leaving a copper device in my uterus for 5 years, maybe that's a bad idea too, so who am I to say?

8 comments:

  1. Angie Bryan (Bell)March 28, 2012 at 6:36 PM

    You rock. I am a nurse and I am wayyy more informed about IUDs after reading this than I ever was before.

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    1. Thanks Angie! I find like no matter what point I am at in my cancer 'journey' there are always new things to learn and I sometimes find it difficult to find the 'right' information about it. So, I have started to write about it myself.

      Thanks again,

      Katie

      P.S. I think you rock too.

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  2. My doctor said ten years for mine, but it may be a different one with different.. uh.. copper? Hm.

    In any case, I can attest that my periods were worse on the copper IUD, sometimes debilitating; however, that got better with time and it's hardly any different anymore. Of course everyone's different so you may have it a bit easier. I definitely don't regret a thing!

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    1. I think I could keep mine in for 10 years, but because I only want it in for 5 years (when I am finished my Tamoxifen and we can start trying to have a baby), my doctor kept quoting me for 5 years. On the IUDs' website, it did say 10-12 years.

      Glad to know that your periods get better (if mine is rough - won't know for a few weeks). So far, no regrets either!

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  3. I will print your blog and give it to all my OCs patients : )

    But remember the procedure may have been painless because you have a well trained physician , sometimes we get IUD Rx and physician don't advice patient to take any antibiotics or vaginal pills, probably i will take your MD name to refer anyone looking for well trained physician for IUD insertion .

    Stop blogging and come back to work , we miss you , you can blog in your breaks if you want : )
    Moe

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    1. Haha! Moe!! Please do print my blog and give it to patients. Haha!

      Check your e-mail, I am going to send you one tonight.

      Thanks for the message,
      Katie

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  4. Katie,

    I don't know if you're at greater risk for endometrial cancer or cervical cancer after breast cancer but I DO KNOW that the IUD *LESSENS* the risks for both of these.

    So...another plus!

    Thanks for your post.

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    1. I had no idea!! Thank you for that!

      I am at a higher risk for endometrial because of the Tamoxifen so that's handy to know.

      Thanks again,

      Katie

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