It wasn't easy for my husband (then my boyfriend) to decide to get a vasectomy. When he finally made that decision, it was very disheartening when he learned at his appointment that his vas deferens were too inflamed to allow the procedure to be done that day. He would need a referral to a urologist to find out if a vasectomy will be possible at all for him, and it might need to be under general anesthesia.
In the meantime, we were still using condoms as our birth control method and were thoroughly unhappy with that. I am peri-menopausal and have issues with vaginal dryness. He is larger than average and finds even large sized condoms uncomfortable. It got to where we were having vaginal intercourse less and less often. Anal sex became our preferred form of intercourse, with oral sex, pegging, mutual masturbation, and various forms of "outercourse" available for variety. Obviously, we wanted to put vaginal intercourse back on the menu!
I wrote in Part 1 that I haven't been able to use hormonal birth control for years, but this isn't precisely true. It is the combined birth control pill - the pill that uses both oestrogen and progestogen - that causes me to have migraines. There is another hormonal option, which is to use progestogen only in various forms - injection, IUD, implant, or pill.
The reason I hadn't considered any of those seriously before was because of the delivery method. The injection lasts about three months - which means if that were to cause me problems, I'd be stuck with those symptoms for that long. I've previously had problems with a non-hormonal IUD. And I had heard that the Progestogen only pill (also known as POP or mini-pill) had to be taken at the same time each day - a level of consistency that I would not trust myself to manage.
That left the implant. I wasn't thrilled with the idea of an implant, because I knew there would be at least two appointments to get it - one to advise, and another to do the procedure. And if I wanted it removed because of side effects, then there would likely be two appointments for that as well. But since my husband's urology referral would take even longer, it seemed worth at least learning more.
We phoned the Family Planning Clinic for an appointment and were able to be seen within a week. If you know much about England's NHS, then you'll understand my surprise. I'm used to waiting much longer for anything that isn't an emergency. We were seen by a nurse practitioner who seemed very knowledgeable. He seemed pleased that we had done our research before we arrived and knew about the various types of contraception available.
But then he suggested something I had not heard of - a progestogen only pill known as Cerazette. (Unfortunately for most of the readers of this article, Cerazette does not seem to be available in the US.) It uses a form of progestogen known as Desogestrel, which works not only by thickening the mucous lining of the cervix to prevent sperm from entering, but also works to prevent ovulation. Because of this dual mechanism of action, Cerazette has a twelve hour window for taking the pill every day. This is much more forgiving than the standard POP, which only has a three hour window.
This sounded ideal for our needs. If it gave me difficulties, I could stop taking it right away, without having to make any appointments. And if it worked, I could stay on it until my husband's vasectomy was complete. After a little more discussion, my husband and I decided to give it a try. After two weeks of use, I have noticed that it affects my mood, but so far it hasn't caused migraines.
The combined Pill is usually taken on a rhythm of three weeks on, one week off, with the period occurring during the off-week. The POP is different. It is taken continuously, and the menstrual flow often subsides to light spotting, or ends entirely. Some women may find it a bit disturbing not to have a monthly period, as they feel that it isn't natural, or worry that if an accidental pregnancy occurs, they won't learn of it. But most women are delighted not to have to deal with the inconvenience of menstruation. Unfortunately, the spotting can be irregular and unpredictable, which can introduce its own issues.
It isn't without risks. If a pregnancy were to occur anyway, perhaps due to a missed pill or something else that interfered with its action, then the chances are higher that the pregnancy would be ectopic - a life threatening situation for the mother, and one in which the pregnancy cannot be salvaged. More concerning to me is that desogestrel has been linked to an increased risk of blood clots compared to other versions of progestogen. If I intended for this to be our final contraception choice, then I would need to discuss this further with my GP, as I have other risk factors for blood clots. However, this is meant to get us through the next few months while we await my husband's urology referral. We still hope that he will be able to get a vasectomy.
If it turns out he can't, then we'll have a new decision to make: whether I should stay on Cerazette, switch to an implant, or re-consider surgery. But we both hope it won't come to that, and that my next article on this topic will be about male sterilization again.