The IUD and Perimenopause
I am 40, married, NP, perimenopausal, and considering an IUD. My first choice would be sterilization, which I started asking for when I was 16, but now that I'm finally "old enough to make that decision," (thank you, medical profession, for infantalizing me all these years!) I have lousy insurance (catastrophic care only, $20,000 deductible, sterilization explicitly excluded) and can't afford it ($5000 for Essure and $8-10,000 for a tubal are the best self-pay prices I've gotten where I live)...so, next best thing, right? Or not...I have a few concerns and hesitations.
.1.) I have hormone issues, and wasn't great on the pill when younger, mostly mood-related (the "uni-mood" and depression) and mild immune system issues (got sick easily). Never had any acne, hair problems (growing or losing), or BTB. Lately, I've been having what I consider to be more perimenopausal symptoms: insane anxiety, a bit of weight gain/redistribution, occasional yeast infections, more PMS, no sex drive, and slightly erratic periods...natural progesterone and supplements help somewhat. So, I decided maybe Mirena wasn't the best bet...synthetic hormones scare me, always have. I dig that the Mirena hormones are mostly confined to the uterus, and even went so far as to compare published blood serum concentrations of LNG between Mirena and LevLite (which I've taken, and was probably the worst of the low-dose pills for me, the best being LoEstrin 1/20), and it's a dramatic difference, as far as I trust serum hormone measurements. I am just a bit nervous about Levonorgestrel.
2.) When younger, I had heavy, very crampy, clotty periods, mostly 8 days or more. In my 30's, they really backed off to 1-2 heavy, crampy days and 3-4 moderate days, then a spotty couple of days. But lately, the old patterns have been making an occasional reappearance...every few months, I'll have one of those periods where the cramps are so bad you're looking around on the floor for your uterus (magnesium is my best friend). So, I decided maybe Paragard might not be the best bet, either...they say to look at your mother and your early menstrual patterns to see what menopause might look like...my mother suddenly (and for the first time) had killer periods, much like my early ones (she actually apologized to me for not being more sympathetic when I was a teenager). So if that's the way things might trend for me in the future, I might not do well with increased bleeding and cramps. I spend a lot of time working on construction sites with only crappy porta-sans and big, burly guys who are totally not interested in "lady problems," so utterly gushing periods would not be great for me.
3.) I am a gynecological wimp, I think. Intellectually, I know it's nuts, but I am severely squicked out by the idea of jamming something inside my uterus. I don't even like tampons because they somehow block me emotionally...as bad as my periods have been in the past, it's always been a stress-release for me, and tampons just stuff a sock in it (so to speak). On the other hand...I don't even understand the idea of a "painful" Pap smear...honestly, I don't even feel it, so maybe I'm not as much of a wimp as I thought. But knowing that I can't take NSAID's (one aleve or ibuprofen and I am puking my guts out) makes me apprehensive about insertion...the NP I talked to at PP said "Oh, we'll give you whatever you need," but I am skeptical. I've had my cervix dilated before (with percocet and valium for my mental state) and it kinda sucked, but wasn't excrutiating or anything, if that gives you any ideas of how I respond to cervical manipulation. At my last exam, the NP said my cervix looked nice and soft and like it would not pose huge problems at insertion. My biggest fear is that I will never be able to forget the IUD is there, and will be intensely aware of it ALL THE TIME...anyone have that fear going in, and did it resolve or go away?
Sooo...my main questions are: any perimenopausal women using an IUD of either kind? The NP was really pushing the Mirena at me like a cure for all my menopause problems...I remain unconvinced, and there are not a lot of NP 40+ year olds with IUD's running around to give advice. Would the Mirena help or exacerbate this hormonal process I'm in? I've read all the horror stories, but there aren't a lot of older women saying much. Also, I do a fair amoung of very awkward heavy lifting at work...will that be an issue, expulsion-wise? And finally, I am completely and utterly paranoid about pregnancy...I know that's just my twonky brain at work, but any advice on how you dealt with that issue? Is it just a gradual process of getting used to the idea of IUD protection? I'm just afaid I'd be checking the strings 327 times a day, and using condoms and spermicide "just to be sure."
Sorry to be so long-winded, but when you're poor and on the hook for all your medical expenses, you tend to be a little paranoid about making the wrong choice. So if I do this, I want to make sure I do it right, because I definitely can't afford a mistake. Y'all got a great little community here; I've been reading online forums for years, and can tell quality at a glance...you ladies are quality!