Women's Health

Birth Control After 40? And the Long Road to Sterilization.

March 13, 2019

This has been a long road for sure. I’m 43 year old and still on “the pill.” Welcome to my journey. Sorry if this is TMI in spots.

Back to the pill. It hasn’t always been this way. For the last 10 years, I was content with my Paragard copper IUD. It worked very well for me. In the beginning I struggled with some severe cramping that reminded me of when I was in labor. Ouch! After one or two cramps it would subside, so I was able to tolerate it. The severe cramping eventually went away and I was left with regular dull cramps each month during the week leading up to my period.

The one side effect that persisted for the full 10 years, was a 24 hour period each month when I really wished I never had to leave the house. The bleeding was so heavy, I’d soak a tampon and a pad within an hour or two. This would go on for about a day, then subside to light bleeding for the rest of the week.

My only saving grace was the discovery of the Diva Cup. While not perfect, and a bit messy to maintain during my heavy days, it was the only thing able to withstand the onslaught for more than an hour so I could leave the house in relative comfort.

Other than the two symptoms above, my experience with the IUD was wonderful. No problems at all for 10 blissful years. Periods like clockwork even without the aid of hormones. Worry free and spontaneous sex with my amazing husband. I couldn’t ask for much better.

In the months leading up to my IUD’s expiration, I began discussing my options with my doctor. From the start, I requested sterilization. I’m in my 40’s. My husband and I do not want any more children. We have four between us from previous marriages and no desire to have any together at our age. My youngest is now 14. I’m way past the baby/toddler stage. So is he. Do I really have to justify my decision at this point?

My doctor was less than receptive. She cited my age and my experience with the IUD. She recommended a new IUD because I’m probably only 10 years from menopause anyway, and the IUD carries less risk than surgery.

While her point was valid, I was disappointed and a little angry that she would try to talk me out of what I really wanted.

I’m not the argumentative type, so I took her advice and decided I’d try the Mirena IUD. Same hassle free protection with the added bonus of maybe stopping these horrendous periods.

Mirena IUD Attempt # 1

This is a very short story. It was not a good experience.

The staff at the doctor’s office did not handle the order well at all and I had to call them multiple times to keep the process moving. I felt as if they simply forgot about me

Two months after ordering the IUD, it was finally delivered. I dropped everything, including leaving work on a moment’s notice, to accommodate their ridiculously small window of opportunity they allow me to get the IUD inserted (day 2 of my period).

I settled into the lovely stirrups with three other women in the room tag teaming the removal of my Paragard and insertion of the Mirena.

The whole experience felt awkward. I was hyperventilating through the discomfort and pain of them clamping my cervix to hold it steady and yanking the Paragard. Thank God, I’m halfway there.

Then I waited. And waited. Waiting for the sonogram to become available so they can see what they’re doing when they insert the Mirena.

After a while, I think they just wanted to go home for the night because they decided to complete the insertion without the sonogram. One of the three proclaiming that it’s ok, “I know how big her uterus is.”

Hyperventilating through the pain once again, the insertion was finally over. I reminded myself that it will be worth it for another 5 years of worry free birth control.

As they reached in to clip the strings, out popped my shiny new Mirena. I didn’t even feel it. I didn’t cramp. She just popped right out.

Mirena IUD Attempt # 2

I decided I’d like to try one more time. I really wish I hadn’t. More on that later.

Back on the mini pill and my periods are now a little irregular. 6 weeks pass before I convince them to go outside their comfort zone and insert the Mirena at a time other than day 2 of my period.

This time, the surgeon herself did the insertion using the sonogram and one nurse to assist. It felt much more professional. There was less pain and less waiting. She made sure it was securely in place, clipped the strings and sent me on my way. I was to return in 6 weeks to check to make sure everything was still properly in place.

During the first week, I was pretty obsessive about finding my strings. At first I couldn’t. They were MIA. Then I expelled a small (1 inch) piece of string and I’m panicking at this point. Something is surely wrong.

I called the doctor’s office, and they told me if I’m still concerned, to come in for a sonogram. Figuring I was just panicking, and not wanting to pay $70 in co-pays to set my mind at ease, I waited. The next day I found my strings. They felt like stubble poking out of my cervix. Different than the Paragard, but I’m ok and happy I found them. I can relax (and save $70). All seems to be going well.

I was having weird symptoms at this point. I wouldn’t call it pain, but rather a feeling of almost constant pressure. Sometimes I’d feel it in my vagina, or sometimes on one side. I’d check the strings and everything seemed fine. I considered the possibility of a settling in period as my body got used to the hormones and the foreign object inside me.

My first post-insertion period came and I did another string check. I can really feel them now. A lot more than stubble. Alarm bells are ringing, but I keep telling myself I’m just panicking. Maybe they were curled up inside and my period just brought them out and all is well.

A week later I go in for my check-up. $100 and another sonogram later (new year, new insurance plan with higher copays and a deductible), they’re yanking my new Mirena. Sure enough she was sitting too low. Mirena # 2 failed.

Sterilization Please!

My doctor asked me what I wanted to do next. Without hesitation, I told her I want the operation, and I want to sign the consent form right then and there.

I don’t know why she seemed shocked. This is what I asked for 4 months ago and she talked me out of it. I wasn’t having it this time.

I knew that once I signed the form, there was still a 30 day waiting period before I could schedule the surgery. You know, in case I changed my mind.

I’m 43 years old. I’m pretty sure I don’t want any more kids. If I told her I wanted to conceive, I’m willing to bet she’d try to talk me out of that too because of my age. A woman can’t win it seems.

A month after my 30 day waiting period ended, after weekly calls to my doctor’s office, they finally scheduled my surgery. I go under the knife in 7 days.

But wait! There’s more! Insurance woes.

I receive a call yesterday from the hospital’s business office to inform me that this procedure will have an out of pocket cost of about $1700.00.

Under the ACA, female sterilization procedures are not supposed to be subject to copays or deductibles. Turns out, the code they are using for bilateral salpingectomy (or removing both tubes) is NOT under the voluntary sterilization umbrella.

So, do I opt for a less effective but guaranteed covered procedure, or prepare to fight with my insurance company because of the code they will likely use? Hoping for the best. Prepared for the worst. Fearing the bill more than the surgery itself. Had I had the procedure done when I first asked, I had better insurance and wouldn’t have to worry about it.

To be continued.

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