Don't be a hatah

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andrea@altsexcolumn.com

Dear Andrea:

I hate my contraceptive! Hate hate hate hatedy hate! I'm on the mini-pill because the other ones made me sick, and this one is giving me headaches, zits, bloating, crying jags ... you name it. Planned Parenthood says the Mirena IUD has fewer side effects, but isn't that just the same hormone? So I'll be just as sick, but out more money? I think I'd just as soon get my tubes tied. Do you have any better suggestions or is it all the same bullshit?

Love,

I Hate Everything

Dear Thing:

I get it! You're miserable. It's bound to happen sometimes when the system you're messing with is inextricably bound up with metabolism, mood, libido, and even whether you're going to have zits or not. Perhaps hormonal birth control is not for you?

Usual caveats (I'm not a doctor, etc.), but I have two suggestions for you — beyond the Mirena, which is greatly beloved by most of its many users and really does have fewer side effects, mostly just break-through bleeding. The subject of permanent birth control, especially for women, always raises these interesting issues of self-determination and even self-knowledge. At the risk of sounding either paternalistic in the old-time doctory mode or, I guess, maternalistic (as a smugly parental parent addressing the childless), people change their minds. People change their lives, or their lives are changed for them, and there you go. If you are absolutely sure this could not possibly ever apply to you, I think this new thing, Essure, is a great option. It's a pair of tiny coils inserted in a quickie outpatient procedure. The company claims that it's covered by most insurance plans, and I believe it's covered by Medicaid in 46 states. If you can find a way to get it, I'd say it has you written all over it (albeit in very small writing).

My second suggestion is hormonal, but bear with me. Although the arsenal of useful hormones is limited, making it appear at first glance as though there's no real difference between this method and that, delivery style matters. Pills must survive a trip through your inhospitable digestive system before getting filtered and altered, often in unfortunate ways, by your liver, while topical methods follow a less torturous path and can be administered in much lower doses. Many women who can't tolerate pills love the NuvaRing so much they'd marry it if they weren't already seeing somebody. It's very low dose, easy to use, and easy to quit if you don't like it (remove offending ring, throw away). You should be able to get it for cheap at a clinic. If you hate it, feel free to write back and bitch me out, but seriously, you may be feeling so much better you won't want to.

Love,

Andrea

Dear Andrea:

At a recent routine checkup, my doctor asked what methods of contraception I'm currently using, and she strongly advised me to use something to fortify my old mainstay of a condom. Her suggestion, spermicide, sounded plenty reasonable. She's been my doctor for most of my life and always trustworthy, so I felt good about going the extra mile to protect myself when I used spermicidal film the next time I had sex.

Next thing I know, I'm in the throes of a particularly grim yeast infection, which I'm not prone to, so I suspected the spermicide. Sure enough, a bit of Web-poking turned up a long-established link between nonoxynol-9 and yeast and bladder infections. Maybe it wouldn't happen every time I used the stuff, but the connection is there, and this infection has been miserable enough that I assure you I'll be avoiding nonoxynol-9 like the plague.

So what's a girl to do?

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