When writing this post I am making the assumption that everyone reading it is a consenting adult and is fully aware of the principles of safe sex. If you are in a relationship I am assuming that you trust your partner and have both been given the all clear in terms of STDs. I am not in any way advising you of any course of action and accept no responsibility for anything you do after reading this post. I’m not giving you the statistics – I’m just letting you know some of my experience and a little bit of knowledge about the available options. Fair warning.
In the early days of trying to manage my PCOS symptoms, contraception was a difficult subject. While I wasn’t sexually active as a teenager, many of my doctors tried to treat my PCOS with contraceptive pills and it led to many long years of misery. I know that I’m not alone in having experienced that and the long and short of it is that, sometimes, trying to mask a problem of “bad” hormones by throwing “good” hormones at it is just not a good course of action. Some are better than others and if it’s a course of treatment your doctor wants to explore then there are a lot of options out there. Dianette initially managed my symptoms and then later on I had some less bad years on Yasmin, but neither were ideal. I’ve been pretty persistent in my attempts to find a decent method of contraception that has minimal impact on me as a PCOS warrior and also on the man I love. We’ve done a lot of research and it occurred to me that perhaps it might be worth sharing with others who are in a committed relationship and wondering where to go if the pill is not an option.
It’s worth mentioning here that I am aware of the implants and also the injections. I have not tried either. Some of the pills made me so sick that it just wasn’t worth risking having something put in me that I couldn’t take out for a period of time, especially in the case of the injections which don’t wear off for 3 months minimum. It may be something you want to explore with your doctor. Just because I didn’t want to risk it doesn’t mean it’s not a viable option for you.
The obvious option is condoms but I am aware that these aren’t always ideal. They’re expensive and if you have an active sex life that’s something to bear in mind. They also occasionally break up the mood and perhaps you just want that extra piece of skin to skin intimacy with a trusted partner. The good news is that there are other things you can try, including the female condom which, full disclosure, I simply cannot look at without breaking down into uncontrollable laughter. They look like wind socks and honestly, the diagrams for how to use them that they put on the packet are just horrifying and deeply unsexy. But it’s an option.
If you’re considering some kind of implant that doesn’t have systemic hormones, I was advised by a family planning nurse that she generally prescribes a Mirena coil for women who have PCOS. Having asked around the community (because guess what – no scientific articles available…what a surprise) reviews were mixed. An awful lot of women swear by it, claiming that the low level hormones in the Mirena IUD made their periods much easier to deal with, lighter in terms of bleeding and a lot less painful. A handful of women said that they’d had an increase in large ovarian cysts and some noticed that their acne got worse. So it’s win some and lose some on that front. I would say that my overall impression of it from the community was positive though, so again it’s maybe something to discuss with your doctor. The other “implant” I have heard good things about is the Nuvaring. Again, it’s a low oestrogen option so it can perhaps provide some alleviation of PCOS symptoms without having the full scale higher dose systemic hormones. The only complaint I heard about it was that depending on where you get it from it’s maybe a slightly more expensive option for those of you that would have to pay and may or may not be covered by health insurance.
When I first asked my doctor about a diaphragm he flat out laughed at me. When he realised I was serious, he told me that he didn’t think the NHS prescribed them any more and wasn’t even sure if anyone still made them. Not to be deterred, I took myself off to the family planning and sexual health clinic and they were able to provide me with one. The standard prescription one given here is the Caya, which is a one size fits most option, and they gave me a test one to wear for a few days and then once I had a follow up appointment to check that everything was fine with size and placement etc, I was given a real one. We honestly love it. The accompanying gel provided by the clinic is not recommended for daily use but there are less aggressive spermicidal options out there, including the one manufactured by Caya themselves. You can purchase these online but when I researched online about diaphragms, they strongly advise that you get fitted for one by a professional because we are all different shapes and sizes and “one size fits most” doesn’t mean that size can fit all.
The final note I wanted to make on this topic is that I’ve been seeing a lot in the news lately about fertility apps that can track your periods and tell you when you’re in your fertile window, so you can use them to determine either when to get pregnant or when to take extra precautions. I don’t object to these in principle, however I do have grave concerns about the massive scope for human error in using said apps. Oversleeping and taking your temperature in a different time or a different place might be an issue. I also have concerns about how these are primarily based on and used for an “average” cycle of 28 days and we all know that the irregularities in the menstrual cycles of women with PCOS means that it’s almost impossible to predict when or where Aunt Flo will make her grand appearance. If you are bound and determined to use an app, then I would strongly recommend that you use it for several full cycles with another means of contraception and wait until it has accurately predicted at least a few before you begin to trust it.
So that’s a general round up of contraception. I hope it was helpful and informative. There are a lot of options out there, so have some fun and find the one that suits you!