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Is the Contraceptive NuvaRing Killing Thousands?
December 28, 2013 8:31 PM   Subscribe

"Danger in the Ring." According to Karen, a doctor in the emergency room asked her over the phone: “Was your daughter using birth control?” Karen said, “Yes, NuvaRing.” He removed the device and said, “I thought so, because she’s having a pulmonary embolism.”

...and a second in-depth article this month on NuvaRing, the FDA, and how effectively the increased blood clot risk (compared to other hormonal birth control methods) has or hasn't been effectively communicated to patients since its introduction.
posted by blue suede stockings (103 comments total) 16 users marked this as a favorite

 
This stuff is so scary. I've had so many issues with birth control and such a deep desire to not get pregnant I just find it easier to not need it. I'm aware that I'm lucky to have that choice to make.

It's really shameful that a product so many people rely on can be so.. "we-don't -really-know-if-its-safe". And it's not like it's all hormonal birth control, just 3rd and 4th generations, according to the article. Which really just says that these things need more time than is profitable.
posted by bleep at 8:46 PM on December 28, 2013


...note that there are two physician rebuttals in the comments of the Vanity Fair piece (first link) regarding the studies cited in the article on relative risk of NuvaRing compared to other hormonal contraceptives.

The back and forth between the FDA and Organon over labeling documented in the HuffPo piece (second link) is chilling, regardless.
posted by blue suede stockings at 9:08 PM on December 28, 2013 [5 favorites]


Have I mentioned lately that I am in awe of women? Stories like these remind me to occasionally remove my man-backpack and appreciate the other half of the human race.
posted by SPrintF at 9:21 PM on December 28, 2013 [17 favorites]


This VF article really only reiterates what we already know about thromboembolism in patients taking combined estrogen/progesterone birth control. The problem is most emphatically *not* the vaginal ring delivery system itself; see the article below for a very good comparison of thromboembolism incidence in a large prospective study of women with the Nuvaring and women taking combined OCP.
Obstet Gynecol. 2013 Oct;122(4):800-8. doi: 10.1097/AOG.0b013e3182a5ec6b.
Cardiovascular risk associated with the use of an etonogestrel-containing vaginal ring.
Dinger J, Möhner S, Heinemann K.
OBJECTIVE:
To compare the risks of short-term and long-term use of an etonogestrel-containing and ethinylestradiol-containing vaginal ring and combined oral contraceptive pills (OCPs) in a routine clinical study population.

METHODS:
This was a prospective, controlled, noninterventional cohort study performed in the United States and five European countries with the following two cohorts: new users of the vaginal ring and new users of combined OCPs (starters, switchers, or restarters). The study population included 33,295 users of the vaginal ring or combined OCPs recruited by 1,661 study centers. Follow-up of study participants occurred for 2 to 4 years. Main clinical outcomes of interest were cardiovascular outcomes, particularly venous and arterial thromboembolism. These outcomes were validated by attending physicians and further adjudicated by an independent board. Comprehensive follow-up ensured low loss to follow-up. Statistical analyses were based on Cox regression models. Primary statistical variable was the venous thromboembolic hazard ratio (HR) for the vaginal ring compared with combined OCPs.

RESULTS:
Study participants were followed-up for 66,489 woman-years. Loss to follow-up was 2.9%. The venous thromboembolism incidence rates for the vaginal ring users and combined OCPs users were 8.3 and 9.2 per 10,000 woman-years, respectively. Cox regression analysis yielded crude and adjusted HRs for the vaginal ring users compared with combined OCPs users of 0.9 and 0.8 for venous thromboembolism (95% confidence intervals [CIs] 0.5-1.6 and 0.5-1.5) and 0.8 and 0.7 (95% CIs 0.2-2.5 and 0.2-2.3) for arterial thromboembolism, respectively.

CONCLUSION:
Vaginal ring use and combined OCP use were associated with a similar venous and arterial thromboembolic risk during routine clinical use.
posted by The White Hat at 9:23 PM on December 28, 2013 [28 favorites]


The next time someone says "well but those ladies and their lady problems like pregnancy, birth control is cheap and easy and has zero side effects and it's up to them derp derp" I feel like the Internet should a) kick them and b) automatically fill in articles like this. Not because this is the end all and be all of the studies and research on this, but because hey, there isn't really a whole lot of long-term research on newer forms of birth control. My doctor refuses to prescribe the ring and the patch because of suspected blood clot risks, but where's the safety for other women with risky histories? For women whose medical teams prescribe them an inhaler when they still can't breathe?
posted by jetlagaddict at 9:26 PM on December 28, 2013 [21 favorites]


I feel like a cavewoman sometimes because I don't use hormonal birth control. More than one doctor has looked at me askance or hesitated after I answered the question in the negative, like they disapproved. But reading stuff like this—and a million AskMes about physical and mental health and relationship problems resulting from hormonal birth control—have steeled my resolve to avoid it. Granted, I also have family history that would probably preclude my using it, but that has never stopped doctors from giving me that look or pause, and every time, I feel like a total throwback, like they're thinking, "What are you, some kind of hippie or religious freak?" I'm not. It sucks. Like I think most women would, I'd love to have a magic something that keeps me from getting pregnant and dramatically reduces or eliminates my periods, but for me, for now, it's probably not to be.
posted by limeonaire at 9:49 PM on December 28, 2013 [16 favorites]


Perhaps I am outlier as I have always been the one to use a condom instead of my SO using pills or anything else, but I am at a loss as to why women do not insist that men use condoms?

Sure there is a difference but some of the stuff on the shelves today feels pretty much as good as not having any. From what I can tell it's slightly cheaper and has 0 side-effects.
posted by ding-dong at 10:13 PM on December 28, 2013 [8 favorites]


but I am at a loss as to why women do not insist that men use condoms?

There's a lot to unpack in that question. The tl;dr version is that women are not raised to have the same agency when it comes to sex that men are. Men are expected to be in control, and women who ask for/demand something are told they aren't as desirable, that men want compliant little fuckpuppets. So women are acculturated to not ask, or to acquiesce when a man says he doesn't want to use one. Like I said, it's a lot more complex than that, but that's the short answer.

Obviously this is a problem.

Also, while condoms may be cheaper, they don't necessarily have 0 side effects. Some people have latex allergies, and non-latex condoms are (in my experience, maybe different elsewhere) more expensive. Some people are allergic to Nonoxynol-9, the standard spermicide used on lubed condoms (a friend of mine didn't know he had developed this allergy until very recently, with tragicomic results).

And condoms, unlike say Norplant, are really easy to use wrong. Store them somewhere too hot or too cold, and they can break and tear. Snag one with your fingernail, torn. Etc. There's a reason why when it comes to contraception that two methods are always advised, so as to minimize being a victim of statistics.
posted by feckless fecal fear mongering at 10:22 PM on December 28, 2013 [28 favorites]


I mean there are a lot of reasons why women make the decisions they do. Some of the "side effects" are the reasons women are on birth control, even without being in relationships. Some women aren't in relationships where that kind of thing works; some people want backup options; some people are allergic to latex. I'm not against hormonal BC, I'm against the lack of information and publicized risks.
posted by jetlagaddict at 10:25 PM on December 28, 2013 [1 favorite]


I feel like a cavewoman sometimes because I don't use hormonal birth control. More than one doctor has looked at me askance or hesitated after I answered the question in the negative, like they disapproved.

I think this has changed a bit in the past few years now that IUDs are no longer contraindicated for women who haven't had children. When I first started having sex, they were very difficult to get. Now they aren't.

Also interesting thing I saw today– this reddit thread by a scientist who studies hormonal contraceptives: I recently published a study showing that birth control users have differences in the resting state of the brain.

I've been on several versions of hormonal contraceptives including Nuvaring and they were all very disappointing for me because I took them so I could have sex, but then they robbed me of my desire to have sex. And I'm allergic to latex. I'm glad IUDs have become more available.
posted by melissam at 10:35 PM on December 28, 2013 [8 favorites]


I am at a loss as to why women do not insist that men use condoms?

To be honest, I think that even if you're not a woman who engages in sex with men, it should be possible to imagine some reasons why.

I had a response typed up, but feckless's response is much better. Many men don't want to or don't think to use a condom, and many women don't feel comfortable insisting, because our society is still very fucked up regarding gender roles (especially in the bedroom). If society was less fucked up, you wouldn't have even asked this question. Women wouldn't even need to insist on a condom, because men wouldn't want to have sex without one unless it was also something their partner wanted.

That said, it's also the case that many people aren't aware of how effective condoms are when properly used (or how to properly use one). Abstinence-only education and other sex-avoidant attitudes are a big culprit, because to teach kids that abstinence is the only "safe" option, contraception is either not discussed or outright misrepresented.

The fact that many women also prefer to use two forms of birth control because no method is 100% effective is also a big deal.
posted by Kutsuwamushi at 10:47 PM on December 28, 2013 [1 favorite]


Perhaps I am outlier as I have always been the one to use a condom instead of my SO using pills or anything else, but I am at a loss as to why women do not insist that men use condoms?

There's many reasons. One is that it's not always birth control pills OR condoms, sometimes it's birth control pills AND condoms. Birth control pills are a form of contraception that women can control. Not to mention the various medical uses for birth control pills, like for women with polycystic ovary syndrome.
posted by inertia at 11:00 PM on December 28, 2013


Speaking as a woman, I do also find condoms uncomfortable. It's not just a question of not wanting to negotiate about it; I really don't like using them. It became especially bad after childbirth. I still have a sensitive area where my stitches were, eight months postpartum, and having a condom rub up against it is painful, no matter how much lube we use.

I used Nuvaring for seven years. I liked it for quite a long time, although it stopped agreeing with my body about two years ago. These stories were very disturbing.

I mean, read "very disturbing" with all the emphasis you can possibly muster. I had no idea my risk was so much higher. It makes me sick that none of the half-dozen doctors who prescribed this drug to me over the course of my seven years on it ever mentioned it to me.

The article asks the question, "Why did women choose to use Nuva Ring?" Because it was about a billion times more convenient than taking a pill, especially for a student on an irregular schedule. Because my student health insurance at one point charged me ten bucks for a three-month supply, just as cheap as the generic HBC pills that made me sick to my stomach, and I had no side effects on the Ring. Because I genuinely had no idea that there was any proven increased risk of blood clots. The package insert made it sound like the jury was still out. And my doctors told me over and over again, "Oh, young women love Nuva Ring, it's a great birth control option."
posted by town of cats at 11:02 PM on December 28, 2013 [9 favorites]


I am at a loss as to why women do not insist that men use condoms?

Hormonal birth control is used as a treatment for many conditions connected to hormones, or the reproductive system. I've known several women on it for that reason.

It's also more reliable. If you can't get an abortion for whatever reason, I can see taking the very low chance of thrombosis over the greater threat of pregnancy.
posted by Mitrovarr at 11:14 PM on December 28, 2013 [4 favorites]


I'm tempted to say this is the risk we run of letting clinical level pharmaceutical medical education be conducted by by drug reps parroting press releases but that would just be depressing. Nuvaring really was supposed to have less hormonal effect .. shame the lede seems to be buried. All hormonal contraceptives run the risk of clotting disorders.

All drugs have crazy side effects, it's scary how rarely that's communicated effectively to the people taking the drug, but everyone keeps saying how it's not their job or there's not enough time. What happened to the professional obligations, to medical culture in this country ...I'm not sure I want to hear the answer. I'd rather just be broke.
posted by hobo gitano de queretaro at 11:18 PM on December 28, 2013 [3 favorites]


I anticipate plenty of comments in here deriding a profit-seeking company that is quite blatantly trying to soft-pedal side effects of a very profitable medication it is selling. Fair enough.

But let's not forget that the publications who are raising a hue and cry over this story are after dollars too, in the form of your eyeballs, your ad viewing, and your outrage. Just look at that Huffington Post headline. "Side Effects May Include Death." That's sensationalist, if you actually read the studies and statistics at hand, as The White Hat demonstrates above.

These hormonal birth controls certainly cause an increased risk of blood clots and pulmonary embolisms, there's no doubt about it. And there's no doubt that women and their doctors should be properly informed.

But pregnancy causes an increased risk of blood clots and embolisms, too. In fact, pregnancy causes a higher risk than these birth control medications. Smoking, being overweight, having high blood pressure, and having hypertension are also factors that increase risk at comparable levels.

It would be rotten if irresponsible reporting results in women being scared away from having the option to use a convenient, statistically safe, and statistically effective form of birth control.

It would also be rotten if someone reads this article without really grasping the numbers at hand. To simplify The White Hat's post, here is the risk of a venous thromboembolism.

  • Oral pills: 8 per 10,000 women
  • Nuvaring: 9 per 10,000 women
  • Pregnancy: 17 per 10,000 women (per studies like this one)

  • I am all for the risks of medications being clearly and fairly stated. I am not in favor of companies trying to hide these risks, but I am also not in favor of sensationalist publishers magnifying these risks for the sake of getting you to read their website.

    Just as we all should be on the lookout for negligence for profit's sake, let's also be on the lookout for fear-mongering for profit's sake.
    posted by Old Man McKay at 11:19 PM on December 28, 2013 [122 favorites]


    Effective non-hormonal birth control for men should be available in 5 years.
    posted by Rubbstone at 11:25 PM on December 28, 2013 [5 favorites]


    Remember, as well, how unhealthy our culture of total denial of death here is in the United States. Terrible, awful shit happens for no reason all the time but we're always focused on these weird mental voodoo rituals intended to alleviate our own anxiety because nobody is willing to be ok with our inevitable and certain death. Avoiding hormonal birth control, taking aspirin, vitamins, statins, none of it is a talisman of guaranteed protection. I guess I'm the living embodiment of doctors being the worst patients because I sure as hell don't believe in this stuff saving me when it's my time. Then again, I'm also pretty sure I'm not going to sue myself.

    But to return to my initial point. You literally can't even talk about death, diplomatically in the appropriate setting (ICU, ventilator, brain death) without people getting wild eyed on you. We are all going to die, yet this is breaking news to most people all the way up until the last minute. I mean, just look at our absolutely insane cancer fetishization. Nobody's willing to draw the line and say, hey man, my life really isn't worth 100k for another two weeks of bed ridden delirium, do you have a heroin plan available instead ?

    No sir, it's all, "lets fight this."

    Might as well fight God himself for all the good it's going to do you.
    posted by hobo gitano de queretaro at 11:34 PM on December 28, 2013 [37 favorites]


    I am achieving the point in my 30s where friends are declaring their families complete and along with that goes a switch from the pill and pregnancy to him getting "the snip," as the pill, much as I love it, does have side effects and after 20 years of adulthood in control of the birth control, that gets wearing. So believe me, married men in your late 30s, all the women in your social group know if you are snipped, which freezer vegetable you used for pain, and if you are not snipped, many theories are offered as to why you've failed to complete your one minor duty w/r/t birth control. They're mostly not flattering, especially if your wife was on bed rest or delivered with no epidural.
    posted by Eyebrows McGee at 11:37 PM on December 28, 2013 [31 favorites]


    Effective non-hormonal birth control for men should be available in 5 years.

    It has ever been so.

    I have come to believe that male contraception is being deliberately withheld. Occam's Razor. That a male contraceptive has not yet been discovered is exceedlingly unlikely. That it has been judged unprofitable seems likely. With a very small side of hamburger.
    posted by five fresh fish at 11:45 PM on December 28, 2013 [5 favorites]


    FWIW, I've never personally had a relationship with any woman who seemed to have been acculturated to behave like a compliant little fuckpuppet, but I have with several who were kind, or who thought it right to take some account of a partner's preferences and difficulties.
    posted by Segundus at 11:53 PM on December 28, 2013


    I also need to add that I really don't care for the title of this post for the same reasons I've identified above.

    "Is the Contraceptive NuvaRing Killing Thousands" seems like something that was typed up primarily with the intention to get you to pay attention to this post, rather than to raise a plausible question based on the data at hand. (No offense meant, blue suede stockings, just trying to call it like I see it.)

    If Organon's estimates are right (and they have every reason to overestimate), there are somewhere around 1.5 million women using Nuvaring.

    According to the study above, that means that perhaps 1,300 may experience a venous thromboembolism during their years of usage in part because of the medicine, keeping in mind that many other factors increase risk, including weight, age, ethnicity, smoking, blood pressure, stress, hypertension, etc. Of those women who do experience an embolism or thrombosis, a small percentage die, depending on their age, the severity of the embolism, and other aggravating conditions like cancer. Given that most NuvaRing users are likely younger females, the risk of death is even lower.

    Of course, more studies would be welcome. But in the end, the data suggests to me that maybe dozens of women may be affected in that way, not thousands.
    posted by Old Man McKay at 12:02 AM on December 29, 2013 [5 favorites]


    five fresh fish: It has ever been so.

    I have come to believe that male contraception is being deliberately withheld. Occam's Razor. That a male contraceptive has not yet been discovered is exceedlingly unlikely. That it has been judged unprofitable seems likely. With a very small side of hamburger.


    Unprofitable? It would be incredibly popular! A lot of guys are really worried about causing accidental pregnancies, and you could sell it to them. Both partners could use birth control and achieve an almost 0% risk rate for pregnancy. Guys who have significant others who can't or won't use the pill could use one themselves, and ditch condoms. And whatever the actual risk is (or what it implies about their personalities), a lot of guys quietly worry about their partners screwing up with the birth control, quietly going off it on purpose, or lying about using in the first place. Well, here's absolute insurance against all of that.

    Until the patent wore out, it would be a license to print money. I can't imagine it being unprofitable. If you are going to bring up conspiracies, it seems more plausible to me that the powers that be won't allow it because it might dramatically lower the birthrate.

    Realistically, however, I think the most likely reason it's been slow to develop is because it's an intrinsically harder thing to invent. Women have two natural off-switches for their fertility, pregnancy and menopause, one of which is easily imitated with drugs. Men don't have any, so you have to make one from scratch. This is tricky, because evolution desperately wants your reproductive system to stay online no matter what.
    posted by Mitrovarr at 12:18 AM on December 29, 2013 [14 favorites]


    Men aren't as hard as you think. There are several internal barrier methods in development, some in late stages of testing. They're invasive, ish, but no more than IUDs or implants or even the NuvaRing. Vasectomies already exist and uptake is not really all that high if you consider the factors you elucidate above (the lack of reliable reversibility is, of course, the major impediment there).

    I don't think I'm being cynical when I anticipate that male birth control will not necessarily be that popular at least at first. I see the two major factors being anxiety about machismo/virility and the fact that pregnancy is fundamentally still considered to a woman's problem. Birth control for women, around for 50+ years in its current HBC form, has hella side effects that women risk because they really really really don't want to have to carry a pregnancy. In some ways, these significant side effects are kind of grandfathered in: we expect them because they were around at the inception of the technology and the need was and is so great. I doubt that most men would tolerate the side effects (increased risk of death, weight gain, sexual side effects/decrease in libido, changes in mate selection, mood swings, etc.) when the consequences of an unintended pregnancy are still pretty minimal for them.
    posted by c'mon sea legs at 12:57 AM on December 29, 2013 [13 favorites]


    c'mon sea legs: I doubt that most men would tolerate the side effects (increased risk of death, weight gain, sexual side effects/decrease in libido, changes in mate selection, mood swings, etc.) when the consequences of an unintended pregnancy are still pretty minimal for them.

    I dunno. Among the guys that I know, it's considered to be life-changing at best and life-ruining at worst, and it only slides further towards life-ruining as the economy worsens and the cost of raising children increases. 'Pretty minimal' is not a term I would use to describe it.

    That being said, I would certainly be concerned about those side effects if it was something I'd have to deal with. I hope, if they do develop something for men someday, the side effects are not so severe.
    posted by Mitrovarr at 1:29 AM on December 29, 2013 [4 favorites]


    That being said, I would certainly be concerned about those side effects if it was something I'd have to deal with. I hope, if they do develop something for men someday, the side effects are not so severe

    That's the thing. Contraception has been framed as a woman's issue for so long that women are expected to provide some sort of birth control option, never mind the consequences (fiscal, physical, or emotional). We view women's hormonal birth control as totally safe because it is the norm, not because it actually is. With men's hbc, there would be a huge shift in responsibility - not just of providing birth control, but for shouldering all the side effects that come with it.
    posted by dinty_moore at 1:43 AM on December 29, 2013 [4 favorites]


    Perhaps I am outlier as I have always been the one to use a condom instead of my SO using pills or anything else, but I am at a loss as to why women do not insist that men use condoms?

    Another answer: because many women don't experience any unpleasant side effects from hormonal contraception. They are possible side effects, not an inevitable consequence. My body reacts fine to the artificial hormones in the pill, the injection, and the implant - while reacting very badly to pregnancy (hello, 6+ months of being unable to keep down food or water without an ever-changing combination of drugs!), which is an added incentive to use the most effective contraception I can get my hands on.

    Plus, with hormonal contraception there's the option of longer-acting methods (implant, injection, IUD) which have less room for user error than the pill and condoms do.

    So for me, it's absolutely worth the slightly increased, but still tiny, risk over condoms of something severe like an embolism in exchange for the increased effectiveness and lower day-to-day hassle of, e.g., the contraceptive implant, which just sits in my arm getting on with things for three years and doesn't require me to buy anything, remember anything, or worry about anything splitting at an inconvenient moment.
    posted by Catseye at 2:13 AM on December 29, 2013 [2 favorites]


    I am at a loss as to why women do not insist that men use condoms?

    Well, for one, the only way you can use condoms to stop periods is if you poke holes in them.

    I'm actually at a loss as to why I'd trust a male contraceptive pill. I mean, I sometimes forget to take mine, and the potential consequence of that is having to cart around a fetus. My partner can't even remember our address; at least I can check if he remembered to put a condom on.
    posted by jaynewould at 2:18 AM on December 29, 2013 [10 favorites]


    (In case it wasn't clear: I am A-OK and totally in favour of insisting that men wear condoms, barring allergies etc etc, but that doesn't mean I can't see the many magical advantages of HBC in combination with male birth control. Such as: the ability to skip/delay periods, the lack of need to buy hygiene stuff for periods, the ability to pretend that my internal reproductive organs have gracefully retired from existence &c.)
    posted by jaynewould at 2:22 AM on December 29, 2013 [2 favorites]


    Well that settles it. Vasectomy as soon as I get back to the states. My wife can get off all this shit and stop it from fucking with her body.
    posted by Talez at 2:41 AM on December 29, 2013 [7 favorites]


    Be careful, Talez. Condoms are actually more effective than vasectomies (!) so you still might want to discuss it with her and use a barrier measure just in case.
    posted by E. Whitehall at 2:47 AM on December 29, 2013


    Non-hormonal IUD for the win.
    posted by Jacqueline at 3:16 AM on December 29, 2013 [5 favorites]


    Comic at my gynecology clinic:

    left side of panel, a woman at a pharmacy counter complaining loudly about birth control: "...injections make me sick, pills are forgotten, condoms wear, spermicidal jelly give me yeast infections - all I want is a simple birth control without nasty side effects!"

    right side of panel: two women holding hands, one saying quietly to the other, "Should we let her in on our secret?"

    -------

    On an actually serious note: pills are more convenient than condoms. Don't protect against stds, of course.
    posted by jb at 4:01 AM on December 29, 2013 [6 favorites]


    I don't understand why simple IUDs don't get more attention. They're miles better than hormonal birth control, given human forgetfulness, and they don't have the side effects. They're also pretty cheap, compared to daily pills.

    Sure, you still need condoms to deal with STDs. But the same is true for pills, and an IUD won't even kill a tiny fraction of its users.
    posted by anotherpanacea at 4:34 AM on December 29, 2013 [2 favorites]


    Why wouldn't anyone want to use a condom is like asking why wouldn't anyone want to use a dental dam while kissing. Can you really think of no other reasons than patriarchy?
    posted by crayz at 5:01 AM on December 29, 2013 [10 favorites]


    They're miles better than hormonal birth control, given human forgetfulness, and they don't have the side effects.

    Agreed on the first part, but IUDs definitely do have side effects. The copper ones often cause much heavier periods and worse cramping, the hormonal ones can make you very irregular, both can affect sex drive and vaginal lubrication. I like my IUD a thousand times more than I did my pill and I'm happy I chose it, but it definitely has an effect on my daily life.
    posted by oinopaponton at 5:19 AM on December 29, 2013 [7 favorites]


    I wish more people were aware that there are various genetic disorders that are rarely tested for but aren't that uncommon, and that increase the risk of blood clots especially for smokers or people who are taking hormonal birth control. A lot of the time these kinds of problems aren't diagnosed until you get a pulmonary embolism. (Luckily for me I had a family history, or I probably would've started hormonal BC a while ago for period troubles.)

    Because so often the discussion turns into "Hormones are unnatural and bad for your body in mysterious woo ways!" versus "Nonsense, if the pill was a bad idea would everybody be using it?"

    Good for some, terrible for others, and it's not a solved problem so it would be great if there were more options out there.
    posted by Jeanne at 5:21 AM on December 29, 2013 [2 favorites]


    I don't understand why simple IUDs don't get more attention. They're miles better than hormonal birth control, given human forgetfulness, and they don't have the side effects.

    Copper IUDs have possible side effects, too, and some nasty ones: chance of heavier/more painful periods, slightly increased chance of ectopic pregnancy if you do get pregnant while it's in place, small chance of pelvic infection or perforation of the womb. They're good, but nothing out there is perfect.

    Although tbh the reason I haven't tried an IUD is because I get irrationally squeamish at the thought of it. Much happier with the injection, or the implant even though it feels a bit cyborg-like when you can feel it under the skin of your arm.
    posted by Catseye at 5:42 AM on December 29, 2013 [1 favorite]


    I also need to add that I really don't care for the title of this post for the same reasons I've identified above.

    As an FYI, I got it word-for-word from the Vanity Fair link from their homepage--I should have used quotes. It was very interesting to see the doctor rebuttals in the comment section on that article (as mentioned in my first comment on the FPP, second one down)--and this has already been a very interesting on reproductive choices, the science of risk, and marketing. (For a less sensationalist, but maddening, walkthrough of how drug companies fight to deny even a statement like, "MIGHT cause increased risk of []", I recommend the second link as a standalone in its own right.) I'll look forward to following the rest of the discussion here on the blue.
    posted by blue suede stockings at 5:44 AM on December 29, 2013 [1 favorite]


    Be careful, Talez. Condoms are actually more effective than vasectomies (!) so you still might want to discuss it with her and use a barrier measure just in case.

    Condoms are required 4-6 weeks after but as soon as they confirm no negative sperm after 30 or so ejaculations you should be good. Especially with new techniques of tissue separation to deal with reconnection.
    posted by Talez at 5:50 AM on December 29, 2013


    I find it absolutely weird and surreal that there are men out there that won't use a condom as the default (ie, unless requested otherwise).

    Learn something new every day. today's something just happens to be deeply disturbing.
    posted by jpe at 5:56 AM on December 29, 2013 [1 favorite]


    Copper IUDs have possible side effects, too, and some nasty ones: chance of heavier/more painful periods, slightly increased chance of ectopic pregnancy if you do get pregnant while it's in place, small chance of pelvic infection or perforation of the womb. They're good, but nothing out there is perfect.

    Wow. I don't think I knew that. It seemed like a miracle cure only withheld because of Big Pharma's push on the pill.

    Oh, well, back to the world being too complicated to parse with such simple analyses.
    posted by anotherpanacea at 5:56 AM on December 29, 2013 [1 favorite]


    As an aside, the manufacturer, Merck, was also the manufacturer of Vioxx which probably killed 88-140,000 people and may have killed up to half a million Americans. I think it's shocking that the contents of warning labels are negotiable.
    posted by ianso at 6:04 AM on December 29, 2013 [2 favorites]


    I find it absolutely weird and surreal that there are men out there that won't use a condom as the default (ie, unless requested otherwise).

    Learn something new every day. today's something just happens to be deeply disturbing.


    Tell ya what, how about you try to sneak one on me and watch me go into latex anaphylaxis. Maybe people should try talking about these topics before having sexual intercourse ... radical idea, I know.
    posted by crayz at 6:21 AM on December 29, 2013 [1 favorite]


    IUDs also have a much higher up front cost and are not always covered by insurance.

    Also, it's uncommon for women to switch birth control methods unless they have an issue with their current method, and teenagers aren't taught about IUD's (I think technically the mirena is only recommended for women who have already had children).
    posted by dinty_moore at 6:26 AM on December 29, 2013


    That is all for the US -my understanding is that IUDs a lot more common in Asia and Europe, with more variety in size
    posted by dinty_moore at 6:35 AM on December 29, 2013


    I take hormonal birth control for the side effects, which for me include being cured of completely debilitating menstrual symptoms. Seriously: starting the pill was like a revelation. Condoms aren't going to take away my monthly menstrual migraine or save me from spending two days puking, doubled over in pain, and unable to regulate my emotions. I'm willing to tolerate a small amount of risk because the benefits for me are pretty significant.

    Bodies: complicated and varied! The important thing, as other posters have said, is that we have the information we need to make informed decisions.
    posted by ArbitraryAndCapricious at 6:36 AM on December 29, 2013 [18 favorites]


    Even something as simple as moving between the brand name and generic versions of the same birth control pill produce different results. Anecdote: me, fine on Seasonale (brand name). When the pharmacy only had generic Jolessa, I gained 10 pounds and nearly endless constipation. I thought I was going insane until I had a forehead smack moment and realized, OH YEAH, this is the thing that is different.

    Being a sexually active woman who doesn't want to get pregnant is SUCH a pain in the ass. My god. It makes me mad. And that doesn't even cover trying to protect yourself from STDs.
    posted by gsh at 7:04 AM on December 29, 2013 [5 favorites]


    I find it absolutely weird and surreal that there are men out there that won't use a condom as the default (ie, unless requested otherwise).

    Learn something new every day. today's something just happens to be deeply disturbing.

    Tell ya what, how about you try to sneak one on me and watch me go into latex anaphylaxis. Maybe people should try talking about these topics before having sexual intercourse ... radical idea, I know.


    Your tone on this was a little....aggressive/defensive, crayz, but after I did some poking around (heh) to look at non-latex options, it seems that non-latex condoms have much higher breakage rates--and the traditional lambskin ones only protect against pregnancy, not viral STDs. So while you're not playing death-clot roulette, as a man with medical complications, you're also looking at a risk calculus with your own contraceptive choices--which I wasn't aware of before.
    posted by blue suede stockings at 7:13 AM on December 29, 2013 [1 favorite]


    They knew about these side effects and made it available to the public anyway.
    posted by Renoroc at 7:16 AM on December 29, 2013


    Condoms are actually more effective than vasectomies (!)

    Cite? The numbers I can find are that condoms in normal use result in 10-15% pregnancy rate, with a theoretical maximum effectiveness of 2-5% pregnancy for unfailing perfect use, but pregnancy rates for vasectomy are in the 0.1-0.2% range.
    posted by ROU_Xenophobe at 7:17 AM on December 29, 2013 [6 favorites]


    I doubt that most men would tolerate the side effects (increased risk of death, weight gain, sexual side effects/decrease in libido, changes in mate selection, mood swings, etc.) when the consequences of an unintended pregnancy are still pretty minimal for them.

    I agree. The consequences of a pregnancy for me could be purely financial -- as long as I pay my legally mandated child support I would be pretty much free to walk off and go about my life the minute the pregnancy test came back positive. That is not the case for a woman who is much more likely to be stuck with the child for the next 18 years, plus the health consequences of the pregnancy itself, and is exactly why women are willing to accept side effects that most men probably wouldn't be willing to consider at all. I doubt more than a fraction of the men I know would seriously consider taking a male birth control pill.

    Condoms are actually more effective than vasectomies (!)

    As ROU_X says, the usual numbers don't support this.

    I find it absolutely weird and surreal that there are men out there that won't use a condom as the default (ie, unless requested otherwise).

    Uh, how can this possibly be news? Men's (and women's) dislike of condoms is so commonplace as to be almost background noise. People routinely opt to go bareback even (and sometimes especially) in the highest risk situations imaginable.
    posted by Dip Flash at 7:27 AM on December 29, 2013 [3 favorites]


    The United States and New Zealand are the only countries in the world that allow prescription drugs to be advertised on television.

    Huh.
    posted by mediareport at 7:37 AM on December 29, 2013 [3 favorites]


    Unfortunately, that also means it is de facto legal to advertise prescription drugs on TV here in Canada, because we get all the American channels.
    posted by feckless fecal fear mongering at 7:42 AM on December 29, 2013 [5 favorites]


    The focus on the NuvaRing surprises me. I was on . . . five or six hormonal contraceptive devices/pills over 8 years, and the NuvaRing had the fewest side effects for me. I went off it (and on to Yasmin, which was a nasty, nasty drug which made me crazy in exactly the way pregnancy has but also made me pee constantly and gave me nightly charlie horses that were so bad I thought I was dying) largely because of cost but also because the discharge it gave me majorly squicked me out.

    Being on the pill was an interesting experience. I floated from one generic low-dose to another, depending on what my pharmacy in whatever state I was living had available. I finally went off it because of high blood pressure, and my OB/GYN was still pushing me to try other, different pills but I was sick of the mood swings from changing brands. It wasn't until I was off it that I realized it had had the effect, over nearly a decade, of almost completely killing my libido and generally making sex suck (so dry) and just sort of squashing my ability to feel joy. I thought I was too old to like music at 25. Finally, I said "Enough!" and not only did music come back for me, but also I experienced well-lubricated sex for the first time in my life and, like, I wanted it way more. I tried to get an IUD, but even in 2009 I couldn't find a doctor to prescribe one to me unless I was married or "done having my babies." I asked about cervical caps or diaphragms but various doctors told me that they didn't make them anymore. Not sure if this was true, but it's what I was told. So condoms it was.

    The biggest barrier to using condoms was actually the sudden return of my libido paired with the sudden bizarre appearance of my biological clock. I went from wanting to be childfree forever to really really wanting to have unprotected sex and babies every time I ovulated. I have to admit that after TTC last year and now being pregnant, it's going to be hard to go back to condoms but they do seem like the best option until we're done having kids. Plus, I just feel more in tune with my body now. When I went off the pill, I started to remember all these things about my cycle that I'd known in high school but forgotten: the cramps that clue me in to stock up on supplies the day before, the way my blood waxes, then wanes, on days 33-35 of my cycle. It hippie dippie, but I actually like knowing that stuff, far more than I did being able to skip periods on the pill.
    posted by PhoBWanKenobi at 7:59 AM on December 29, 2013 [10 favorites]


    The stuff on page 4 of the Vanity Fair article about 1) the marketing department's tactics to divert doctor questions about blood clots and 2) the revolving door between the FDA and NuvaRing is horrifying:

    For Shkolnik, the paradigm of troubling F.D.A. officials was Dr. Susan Allen, who had been overseeing all birth-control products before leaving the agency to work independently as a consultant. “So, guess who decides to retire? And right in the middle of all of it? And guess who her first client is? NuvaRing!” Allen was then making about $150,000 a year, Shkolnik told me, and now far more, he believes. “She was hired within weeks of leaving the F.D.A. I took her deposition, and in my opinion it was one of the most disgusting displays of everything that is wrong with our regulatory system.”

    The stuff at the bottom of page 5/top of page 6 about the FDA advisory committee's financial conflicts of interest and blocking of voting by members concerned about the drug is also horrifying:

    One member of the panel, Dr. Sidney Wolfe, the head of the Health Research Group at Public Citizen, a powerful consumer-advocate organization, had warned the F.D.A. for years about the possible dangers of third-generation progestins. Two days before the panel convened, he was stripped of his voting rights on the advisory committee. Wolfe had served on the committee for three years, but he was disqualified from voting because of his “intellectual conflict of interest.” Not so with the other members of the panel, doctors representing elite institutions including Harvard’s School of Public Health.
    posted by mediareport at 8:00 AM on December 29, 2013 [1 favorite]


    I am at a loss as to why women do not insist that men use condoms?

    I hate hormones, so I decided to quit using them and just stick to condoms. And then a condom broke! And I had to go get Plan B! Which is... a massive dose of hormones!

    Now I have a copper IUD and I love it, but I never had bad periods to begin with. Not everyone can use them.
    posted by showbiz_liz at 8:33 AM on December 29, 2013 [1 favorite]


    Oh, and also: my first boyfriend and I used only condoms until HE asked that I get on birth control as well, because he was really, really scared of getting me pregnant.
    posted by showbiz_liz at 8:40 AM on December 29, 2013


    (I should note that as someone who doesn't possess a uterus and who doesn't have sex which could possibly result in pregnancy, all I have to worry about is STIs and condoms have basically just been a fact of life for a long time. Point being, if any women here think I'm being prescriptive about female bodies or mansplaining or anything, I'm really sorry if that impression came across.)
    posted by feckless fecal fear mongering at 8:44 AM on December 29, 2013


    Your tone on this was a little....aggressive/defensive, crayz, but after I did some poking around (heh) to look at non-latex options, it seems that non-latex condoms have much higher breakage rates--and the traditional lambskin ones only protect against pregnancy, not viral STDs. So while you're not playing death-clot roulette, as a man with medical complications, you're also looking at a risk calculus with your own contraceptive choices--which I wasn't aware of before.

    Yeah I realize it sounded aggressive, but I have other TMI personal reasons beyond that that the normal polyurethane condoms are really not viable, and for people in this thread to be womansplaining with blanket statements that men must use condoms or they're "disgusting" is just offensive. If women deserve agency and control and respect for the individuality of their bodies, men do too.
    posted by crayz at 8:52 AM on December 29, 2013 [1 favorite]


    I'd read that Vanity Fair article, and as I do every time, I gave a sigh of relief that tying my tubes (because HBC conflicted with other medication) pulled me out of that risk pool. I could still have another 10+ years of HBC under my belt. Too many stories like this, and Vioxx, mean I just don't trust the FDA to do its job of regulating new drugs.
    posted by immlass at 8:59 AM on December 29, 2013 [1 favorite]


    As far as I can tell there are only two people in this thread who were advocating condoms as a default (at least one of whom is a guy) and neither of them said anything about Surprise Condoms! so I feel like the aggressiveness and language about "womensplaining" and the patriarchy are not a great way of paraphrasing the whole thread.
    posted by jetlagaddict at 9:12 AM on December 29, 2013 [17 favorites]


    So if we had a thread wondering why men don't "insist" that women use birth control, the mefi-fave explanation men don't insist is because of what our terrible culture expects of men, and then it was stated that it's "weird and surreal" and "disturbing" that women don't use birth control "unless requested otherwise" ... you really would be unable to find a problem with any of that?
    posted by crayz at 9:48 AM on December 29, 2013


    and for people in this thread to be womansplaining with blanket statements that men must use condoms or they're "disgusting" is just offensive

    I don't actually see the comment you've quoted that calls these hypothetical men disgusting, so maybe it was deleted?
    posted by elizardbits at 9:54 AM on December 29, 2013 [1 favorite]


    crayz, it seems like you have a strangely aggressive axe to grind here. Why is that? We're having a discussion about health effects of the NuvaRing specifically, HBC more generally, and birth control in general after that.

    Yes, okay, you can't wear latex condoms. We've got that. And I get how that circumscribes your options when it comes to safer sex. (The female condom, in case you didn't know, is poly so your latex allergies wouldn't come into play. More expensive, yes, but it might well be an option for you.) But you're being really fighty when I don't see anyone attacking you for anything here.

    What's going on?
    posted by feckless fecal fear mongering at 9:56 AM on December 29, 2013 [2 favorites]


    Sorry "disturbing" was the actual quote, if that changes the meaning significantly
    posted by crayz at 9:57 AM on December 29, 2013


    Uh, note that the whole question is revolving around women being responsible for birth control (it's their responsibility to insist on it), even if it's something penis related. That's pretty much the definition of patriarchal reproductive thinking.

    All of this is ignoring how terrifying it is to get to the hot and heavy point where men would put on a condom and then have to issue an ultimatum.
    posted by dinty_moore at 9:57 AM on December 29, 2013 [1 favorite]


    What's going on?

    Errm, as my comment that was just deleted was trying to say, I find it ironic in a thread about women's problems with birth control that its seen as OK to make demands and judgements about what men should do with their bodies. If the statements were reversed into demands that women use birth control and judgements about those who didn't, MeFi would see it as unacceptable on its face.
    posted by crayz at 9:59 AM on December 29, 2013


    Sorry "disturbing" was the actual quote, if that changes the meaning significantly

    It does change the meaning very significantly. How is it not disturbing that there are lots and lots and lots and lots of men out there who don't take the sexual health (and conception risks/choices, depending on the gender of the other partner involved) of their partners or themselves into consideration often if at all?

    Dude has a one night stand with a girl. Doesn't use a condom, she (for societal reasons alluded to above) doesn't feel comfortable asking for one. She ends up with a disease. Or pregnant. Or both. He blithely walks away.

    (Straight/bi) men who don't take responsibility are buying into the old notion that women are property, disposable fuck-holes for men to use and walk away from. It may not be that overt, but there is an obvious undercurrent of that attitude coursing through western society and that shit needs to change.

    And the simplest way for a man to take responsibility for himself and his partner (while, one hopes, his partner is taking responsibility for both him/herself and their partner) is to wrap that shit up before sticking it in someone.
    posted by feckless fecal fear mongering at 10:00 AM on December 29, 2013 [3 favorites]


    [crayz, you did not have a comment deleted. But maybe we can take it as read that some people have perfectly legit reasons they can't use condoms, and drop the derail about that? Thread is about Nuvaring and HBC.]
    posted by LobsterMitten at 10:02 AM on December 29, 2013 [1 favorite]


    I find it ironic in a thread about women's problems with birth control that its seen as OK to make demands and judgements about what men should do with their bodies. If the statements were reversed into demands that women use birth control and judgements about those who didn't, MeFi would see it as unacceptable on its face.

    Women are already demanded by society to take all the risk and responsibility when it comes to contraception and STI prevention. So no, there's no irony here at all.

    It is perfectly acceptable to demand that people be responsible when it comes to sex. The fact is, men are essentially told that they don't have to be, since it's the woman who takes care of all of that stuff.
    posted by feckless fecal fear mongering at 10:02 AM on December 29, 2013


    How is it not disturbing that there are lots and lots and lots and lots of men out there who don't take the sexual health of their partners or themselves into consideration often if at all?

    No one is advocating that. Again if I said men should insist on women using birth control "unless requested otherwise", and those who don't are "disturbing", that would be easily seen as offensive and it has nothing to do with those offended thinking that women be reckless with their or their partners health.
    posted by crayz at 10:03 AM on December 29, 2013


    And given that there are significant health risks associated with HBC, which there aren't with condoms (barring, as I already mentioned above in my first comment, latex and nonoxynol-9 allergies), it kinda behooves men to insist on condom usage as a matter of basic respect for their partner, her reproductive choices, and her long-term health.
    posted by feckless fecal fear mongering at 10:04 AM on December 29, 2013


    You know, crayz, as far as I can tell, two guys said that they didn't understand why women don't insist that their partners use condoms. A whole raft of women replied with a wide variety of answers about why that's not the right or sufficient decision for us. And then you came along and derailed a thread about women dying to make it about how oppressed you are by two guys who probably just haven't given a ton of thought to the entire thought process that women go through when we make contraceptive decisions. I'm sorry that this has bothered you so much, but can we get back to the whole women dying thing now?
    posted by ArbitraryAndCapricious at 10:07 AM on December 29, 2013 [1 favorite]


    I hope this derail doesn't go on much longer (there's always MeMail or MeTa) but there were just two comments questioning why men don't default to using condoms; after the first, another commenter mentioned the allergy issue; and then after you expressed offense, I actually went in and validated that, as someone latex-sensitive, you were dealing with your own risk calculus.

    You know what would be a great response on your part, crayz? An FPP on male reproductive/contraceptive issues. Not even snarking--that would be plenty interesting. But this isn't what this thread is about by a longshot. Instead of GYOFB, this is definitely GYOFFPP. Because this has otherwise been a really interesting, multi-perspective look at female contraceptive options.
    posted by blue suede stockings at 10:07 AM on December 29, 2013


    [Ok, at this point, please everybody drop it and return to discussion of article? Thanks.]
    posted by LobsterMitten at 10:09 AM on December 29, 2013 [1 favorite]


    How is it not disturbing that there are lots and lots and lots and lots of men out there who don't take the sexual health of their partners or themselves into consideration often if at all?

    No one is advocating that.


    Yes, nobody is advocating that. It is a simple fact of how things are.

    So, again, how is that not disturbing? Try answering the actual question with something relevant this time, please. The non-sequiturs are getting tiresome.

    Again if I said men should insist on women using birth control "unless requested otherwise", and those who don't are "disturbing", that would be easily seen as offensive and it has nothing to do with those offended thinking that women be reckless with their or their partners health.

    This is the same tired kind of thinking that makes people say "Why don't we have a Straight Pride Parade?"

    You know why? Because that parade is every day. It is disturbing that men do not default to using condoms (the only nonpermanent contraception available to us), and it is disturbing because of the patriarchal attitudes that cause that behaviour. It would be offensive to demand that women always use birth control, because women are already demanded to use birth control, often at risk to their own health.
    posted by feckless fecal fear mongering at 10:09 AM on December 29, 2013 [9 favorites]


    I'm tempted to say this is the risk we run of letting clinical level pharmaceutical medical education be conducted by by drug reps parroting press releases

    And those drug reps are often ex-cheerleaders and models chosen for their attractiveness more than their education. Remember that spate of articles a few years back about pharmaceutical companies hiring perky non-scientists to show up in doctors' offices?

    Anyway, the founder of a group that works to provide doctors with "unbiased, non-commercial, evidence-based clinical information" nicely summarized the horrid drug trial and marketing situation at the NYT a couple of weeks ago

    New products are tested by their manufacturers (not the Food and Drug Administration) in studies designed to produce findings just strong enough to meet government standards for approval, and those standards are looser than you'd think.

    Many medications must show only that they produce short-term improvement in a "surrogate measure" such as a lab test; demonstrating better clinical outcomes is often not required. The comparison treatment may be a placebo, so the new product needn't demonstrate that it's better than (or even as good as) existing medications. These pivotal trials sometimes run just 8 to 12 weeks or less, even for drugs designed to be taken for a lifetime...

    The courts are making things worse; a major decision this year stated that drug companies’ First Amendment rights to corporate free speech allow them to market effectiveness claims that the F.D.A. has rejected.

    posted by mediareport at 10:22 AM on December 29, 2013 [2 favorites]


    The courts are making things worse; a major decision this year stated that drug companies’ First Amendment rights to corporate free speech allow them to market effectiveness claims that the F.D.A. has rejected.

    WHAT
    posted by feckless fecal fear mongering at 10:23 AM on December 29, 2013 [2 favorites]


    OMG, that cheerleaders turned drug reps link is amazing (and by amazing I mean simultaneously terrifying and Onion-hilarious), mediareport.
    posted by blue suede stockings at 10:28 AM on December 29, 2013


    drug companies’ First Amendment rights to corporate free speech

    the fact that this is a real thing and not a link to an onion article makes me long for the apocalypse
    posted by elizardbits at 10:29 AM on December 29, 2013 [5 favorites]


    WHAT

    Yeah, that sentence includes a link to a JAMA op-ed that's really chilling, pointing to a 2nd Circuit Court decision that "could be the first step in the judicial dismantling of the US system of drug regulation." The 2nd-to-last paragraph of that article, which describes the court's opinion that it's unconstitutional to ban off-label promotion of drugs to doctors on the grounds that the government could achieve the same results in other ways like educating patients "in differentiating between misleading and false promotions, exaggerations and embellishments" (instead of just banning pretty pharma reps from pushing drugs in unapproved ways), is particularly stunning.

    And for blue suede stockings: there's lots more about pharmaceutical companies seeking out cheerleaders and pretty-boy models to send into doctors' offices.
    posted by mediareport at 10:36 AM on December 29, 2013


    Ridiculous-but-trenchant 2006 Daily Show report on cheerleader drug reps.
    posted by mediareport at 10:51 AM on December 29, 2013


    I'm actually at a loss as to why I'd trust a male contraceptive pill. I mean, I sometimes forget to take mine, and the potential consequence of that is having to cart around a fetus. My partner can't even remember our address; at least I can check if he remembered to put a condom on.

    This, this, this--1000 times. There's a lot of young healthy males (some of them that are called 'fathers') that have a bit of a problem with regard to responsibility--whether it's not driving the speed limit, DWI, paying bills, etc. Not all, but certainly more younger than older males. Other males, no matter what age, have the ingrained idea that it's not their problem. If you can't remember to take your insulin, or where you left your keys, what your anniversary is, or whether or not you paid the phone bill, should a guy be trusted with birth control?

    I repeat: not all men are like this. But I bet everyone knows one or two.
    posted by BlueHorse at 11:32 AM on December 29, 2013 [2 favorites]


    I repeat: not all men are like this. But I bet everyone knows one or two.

    The risk taking part is probably heavily hormonal. I know that at that age I was taking every risk I could find, while everyone around me (family, teachers, relatives, saner friends) was saying "no, don't do it!" Despite all the pressure not to, and all of the negative consequences, many young men seem determined to take those risks.

    But the prevailing attitude of letting guys off the hook for irresponsibility (including the example above of relying on one's female partner to remember one's own address) is totally cultural. If my only risk from an unplanned pregnancy is financial (and even that is often avoidable), I'm going to be ok relying on her to take care of birth control. If, on the other hand, I knew that a pregnancy would result in my having sole custody of that child for the next two decades, you can bet I'd be a lot more interested in my own birth control options. In a society where many men not only don't know how to cook but also rely on women in their lives to buy their clothes, manage their social calendar, and ensure basic hygiene is taken care of, I don't see this kind of change happening any time soon.

    Some of that is pretty much neutral: if people want to live that way, more power to them. But as this FPP demonstrates, this also means that serious health risks are falling exclusively on women instead of being shared more equally. That, to me, seems problematic.
    posted by Dip Flash at 12:36 PM on December 29, 2013 [5 favorites]


    Popping back into the thread after getting sleep to respond to Mitrovarr: I also know men for whom pregnancy would be a big deal. But I also know a lot of men (or rather, the women they left) who just peaced out. You can't be forced to be a father and even considering child support it's pretty easy to leave a pregnancy behind without taking parental responsibility, for men. For women it's culturally a lot more difficult. Pregnancy is a big huge consequence for men if they're planning to stick around, but a lot of men don't.
    posted by c'mon sea legs at 12:38 PM on December 29, 2013 [1 favorite]


    Hormonal contraception (oral, vaginal or topical) is not without side effects. Anyone should be clear about that.
    On a related note, even the use of tampons can be dangerous, as there is risk of TSS.
    posted by travelwithcats at 1:14 PM on December 29, 2013 [1 favorite]


    Hey PhoB! You can totally still get diaphragms. There was a low supply for a while but you can get them now. I love mine, they last forever (so they pay for themselves, which is good because many insurance plans don't even know they exist) and I cannot tolerate hormones or IUDs and I hate condoms, so they are for me. 15 years, no accidental pregnancies yet (knock wood). Memail me if you need details.
    posted by emjaybee at 2:47 PM on December 29, 2013 [1 favorite]


    Thanks, emjaybee! I love that this is a community where women are willing to reach out about contraceptive options. Unfortunately I'm a bit sensitive to nonoxynol-9 and I suspect the prep involved with a diaphragm would be as much a barrier (so to speak) as condom usage, which my husband and I are more accustomed to (we've never had a break or accident in 3+ years of use!) but perhaps we'll give them a try sometime.
    posted by PhoBWanKenobi at 2:52 PM on December 29, 2013


    If you can't remember to take your insulin, or where you left your keys, what your anniversary is, or whether or not you paid the phone bill, should a guy be trusted with birth control?

    You do what my male partner did - buy the forgetful girl/guy a watch that rang everyday so I'd remember to take the damn thing.
    posted by jb at 4:17 PM on December 29, 2013


    If there were a male contraceptive pill I'd be taking it in a damn minute regardless of risk. Just putting that out there. I don't think anyone here particularly means to attack the mutual decision not to use condoms - it's entirely reasonable to insist the woman gets equal/final say and to acknowledge that this doesn't always happen - but one ought also to acknowledge that it often does and many women are quite happy to take a risk for pleasure.
    posted by atoxyl at 4:28 PM on December 29, 2013


    Maybe this is a guy-girl thing, but as a woman, I think that if I was a guy, I'd wear a condom every time (obviously barring a latex allergy) until we were in a position to have a kid. No one is perfect and people make mistakes but that's my perspective. I enjoy sexy times as much as anyone but they're a lot more enjoyable in my opinion when I'm not worried about the possibility of an unplanned pregnancy.

    My husband wore condoms up until I had a brief fling with NuvaRing before I got my IUD. I worried I'd forget pills and I've had depression since puberty so the idea of adding hormones into that mix made me feel uncomfortable. There were a few times where I had to take Plan B but it was not a big deal, fortunately.

    I had never taken HBC before trying NuvaRing. I think immediately after getting the ring, I gained 10 lbs - not the end of the world, but not fun either.

    I thought this article as interesting and compelling but I don't plan on passing it on. I obviously feel badly for the families of the women who died but all drugs have risks. Some have more than others and the article began to explain why 3rd and 4th generation HBCs are more problematic but it didn't give me enough information on that topic. Which is a bummer in my opinion because I think that a lot of people don't know about that.
    posted by kat518 at 4:56 PM on December 29, 2013


    So believe me, married men in your late 30s, all the women in your social group know if you are snipped, which freezer vegetable you used for pain, and if you are not snipped, many theories are offered as to why you've failed to complete your one minor duty w/r/t birth control. They're mostly not flattering, especially if your wife was on bed rest or delivered with no epidural.

    What? Geez, Eyebrows, I remember you as someone who has nerves of fucking steel when it came to dealing with hyperemesis gravidarum during pregnancy, and I respect that you may have strong feelings about birth control and who is responsible for it. At the same time, I can only assume you are being a little loose with your language above because you state something as absolute fact but it has certainly not been my experience, nor that of my friends. No one in my circle knows anything about the status of my husband's penis (except that it is AWESOME). We do not sit around judging one another's SOs over whether or not they've had vasectomies.

    Perhaps more importantly, your assumption that men haven't been taking care of birth control (other than through having vasectomies) throughout the life of the relationship is also strange and absolutely incorrect. Not just for me, but for others in my circle.

    So your statement (and the fact that it has received so many favorites from people I usually respect) is strange and disappointing to me and frankly wrong and insulting to the men in my circle. MetaFilter, you are letting me down!

    It is of course also infuriating that these warnings about the drug were marginalized and so many more women used the product because they didn't receive adequate warning about its risks. And it is awful that women die as a part of managing their birth control. I certainly do have a lot of respect for men who get vasectomies once the kids are born to handle the family birth control needs once and for all. I thought this article about the vasectomy bro experience that Christmas Jammies viral video dad had with his friends when they all went in to get snipped was sort of sweet, for example.
    posted by onlyconnect at 6:54 PM on December 29, 2013 [1 favorite]


    They may work for some couples, but I don't think condoms can generally be regarded as viable contraception in long-term relations. Apart from allergies, a lot of people barely find sex with a condom physically enjoyable. I liked them when I was young because they made me last longer, and that was important back then. Now that I'm past the "Costanza limit" where longevity ceased to be an issue, my feelings about them are different. If condoms were the only contraceptive option in a long-term relation, I'm not sure I'd prefer intercourse over no intercourse many of the times. In a new or casual affair it's a different story - then condoms are necessary and there is a special thrill that makes up for the physical drawbacks.

    I'm not American and some of all this could be cultural, but I've also been surprised at how often I've had to insist on using a condom the first time with a woman. STD protection is at least as important as contraception of course, but me and men around me sometimes seem more worried than our partners about unwanted pregnancy. I guess a woman may put trust in her HBC and also be aware of options down the line if it comes to the worst. For a guy, it's out of his control as soon as the deed is done, and decisions about Plan B and abortions are not for him to make. So if it was possible to go to the surgeon and have a reliable sperm valve installed, I'm sure there would be a great demand for it.
    posted by Herr Zebrurka at 11:16 PM on December 29, 2013


    I am at a loss as to why women do not insist that men use condoms?

    Also, and I'm not quite sure how to say this, part of the joy of not using condoms is being able to have almost-sex or a few-seconds-of-sex without committing to, like, sex-sex. Once a condom is on, it's like, serious. Sometimes its nice to just hey-how-ya-doing for a minute and then stop, and relying on different birth control allows one to not worry about the consequences of pre-ejaculate, or anything else.

    I hate hormonal birth control so, so much but I still think its better than condoms.
    posted by likeatoaster at 7:34 AM on December 31, 2013


    catseye, IUDs do not cause an increased risk of ectopic pregnancies. You have the same risk of an ectopic, and reduced risk for uterine, so you only increase the relative risk (relative to uterine) of ectopic, not the absolute risk. In other words, only the ectopic ones get by -- but you have the same risk of having an ectopic with or with an IUD.

    And they are definitely not just for women who have already given birth. I know women who have them and have never had children, and women who had them before they had children, then had them removed and got (intentionally) pregnant. And if they make your periods more miserable -- just have it removed. (But know that the first 3-4 months will be pretty terrible, then it gets way better, so best to hold out and see.) The copper non-hormonal ones are now rated for 12 years -- so when you look at the upfront costs keep in mind that that will cover you for 12 years of not having to remember to take a pill every day that has side effects.
    posted by antinomia at 9:49 AM on December 31, 2013 [3 favorites]


    onlyconnect: "What? Geez, Eyebrows, I remember you as someone who has nerves of fucking steel when it came to dealing with hyperemesis gravidarum during pregnancy, and I respect that you may have strong feelings about birth control and who is responsible for it. "

    I was joking around. Sorry if I upset you. I do know way too much about my friends' husbands junks and what frozen vegetable they prefer to put on said junk, however. At a certain point it becomes a topic of conversation and, boy howdy, are people delighted to talk really openly about it. And then you see the gentlemen in question the next week at work function and they're talking about budgets and all you can think is, ".... I know you put frozen peas on your junk."

    I personally don't really care what married couples opt to do w/r/t pregnancy, birth, and preventing them, as long as it's in a mutually-decided fashion. But I sure hear a lot about it.
    posted by Eyebrows McGee at 10:34 AM on December 31, 2013


    And they are definitely not just for women who have already given birth. I know women who have them and have never had children, and women who had them before they had children, then had them removed and got (intentionally) pregnant. And if they make your periods more miserable -- just have it removed. (But know that the first 3-4 months will be pretty terrible, then it gets way better, so best to hold out and see.) The copper non-hormonal ones are now rated for 12 years -- so when you look at the upfront costs keep in mind that that will cover you for 12 years of not having to remember to take a pill every day that has side effects.

    Be that as it may, use of the Mirena on nulliparous women is off-label use of a medical device, and some doctors shy away with it for that reason (the doctors are far more liable if there are complications afterwards). Yes, I know that many women who have not had children can use the Mirena comfortably. Take it up with the makers of the Mirena.

    The same was true of the paragard until a few years ago.

    Also, saving money in the future is all well and good, but not very helpful if you don't have half a grand to spend on birth control right now.

    I'm not saying that IUD's are a bad idea - I have one, I haven't had kids, I'm never planning to have children. But there are definitely good reasons why they don't work for everyone.
    posted by dinty_moore at 11:49 AM on December 31, 2013


    catseye, IUDs do not cause an increased risk of ectopic pregnancies. You have the same risk of an ectopic, and reduced risk for uterine, so you only increase the relative risk (relative to uterine) of ectopic, not the absolute risk. In other words, only the ectopic ones get by -- but you have the same risk of having an ectopic with or with an IUD.

    Hmm, that's not the information I got (via the NHS stuff on contraception last time I was looking). It does make more sense, though.

    And if they make your periods more miserable -- just have it removed. (But know that the first 3-4 months will be pretty terrible, then it gets way better, so best to hold out and see.) The copper non-hormonal ones are now rated for 12 years -- so when you look at the upfront costs keep in mind that that will cover you for 12 years of not having to remember to take a pill every day that has side effects.

    And that's great for women who want to use them. I wasn't arguing in any way that copper IUDs are bad - they suit loads of women very, very well indeed.

    But, I wouldn't agree that they are better for everyone than hormonal contraception is, because it's not the case that the pill/hormonal contraception in general inevitably means 12 years of negative side-effects. Plenty of women get no negative side-effects at all (or at worst, negative side-effects that only last for the first few months of taking it), so the cost/benefit calculation is going to vary hugely between individuals. Personally, I would trade 3-4 months of heavy/painful periods in exchange for the daily hassle of the pill, but the implant and injection mean 0 months of heavy/painful periods and no daily hassle, so they win hands down.
    posted by Catseye at 11:59 AM on December 31, 2013


    I was joking around. Sorry if I upset you.

    You didn't "upset" me. My feelings aren't hurt. What you said, in purporting to speak about all women and all men, was actually wrong. That's all.
    posted by onlyconnect at 7:38 PM on December 31, 2013


    Jacqueline: "Non-hormonal IUD for the win."

    Not bulletproof. A friend of mine got pregnant while using one.
    posted by Deathalicious at 1:06 AM on January 8


    Not bulletproof. A friend of mine got pregnant while using one.

    It's still more effective than non-IUD hormonal birth control.
    posted by showbiz_liz at 8:48 AM on January 8


    It's still more effective than non-IUD hormonal birth control.

    More effective than some methods, less effective than others.

    There isn't anything out there which hasn't failed for somebody somewhere though. Nothing is bulletproof.
    posted by Catseye at 9:32 AM on January 8


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