I’ve been on some form of hormonal birth control – either Ortho Evra (the patch) or one or another formulation of the pill – since 2004. Of the two methods I preferred the patch, but it eventually crept back up to being a Tier 3 copay and I just felt that I couldn’t justify the expense. At that point it was $30 for a one-month supply – compare that to the $20 I paid up until now for three months of the pill. So I went back on the pill.
The pill was ok for me, never great. For a long time I was pretty good about taking it on time, every day – mainly I’d mess up if my routine was changed for some reason, and then I’d have all kinds of issues with spotting and breakthrough bleeding. I don’t know if I’m more susceptible to this kind of thing than other women, but let me tell you, it’s annoying. It helped when I was switched to a low-dose formulation. (The conversation with the nurse when I called the office to ask about the problems I was having was hilarious. She cut me off before I could finish trying to make my case and said “Oh my goodness hon, that’s no good at all, we’ll switch you as soon as we possibly can, and in fact your doctor is walking by me right now, hold on and I’ll get her to prescribe something else.” So moral of the story is call your doctor’s office sooner than I did.) And it did have the advantage of enabling me to skip my period a few times a year, which made it shorter and lighter. Yay!
Flash forward to this year, and I’m traveling a lot more (primarily for work) and also having problems remembering to take it on time. I’m taking it at a time that has a natural cue point for me several days a week, and I set alarms for the other days, which I keep up to date if my schedule or routine is changing. But even with an alarm set on my cell phone I’ve been doing things like going out to run errands early in the morning and not taking the pill pack with me . . . only to be far from home when the alarm goes off. So I decided it was probably time to look into an IUD. At one point several years ago a doctor actually suggested Mirena for me, and sent me home with some literature about it. When I called back to say that I’d read the materials and wanted to do it, the nurse said, “Oh, why did she give you that? You don’t want an IUD. . . . I see you’re having trouble with the pill, let’s put you on the patch instead. We’ll call it in today.”
So I read up on my options a bit (this guide at The Hairpin is a great place to start) and a two weeks ago I went in to see my new ob/gyn and said “I’d like to get an IUD.” We had a brief discussion about the two types (short form: Mirena is super low dose hormonal, ParaGard uses copper. Mirena is good for 5 years, ParaGard 10. Mirena will probably keep your period pretty light, maybe it will go away; with ParaGard it’ll eventually revert to whatever it was like before you went on the pill and you’ll have a normal cycle. There’s a bit more to it than that but IMHO, those are the important points. Click the links up top for info.) We talked about the risks – mainly perforation of the uterus during insertion – and she specifically told me she’d put them in successfully many times before and to her knowledge, none of her patients had had an issue. She also told me what I guess is kind of a gruesome story about one that she discovered wasn’t inserted properly, but I found it kind of amusing and interesting once I got over the gross out factor because the woman in question was fine and the device had kept working.
Since this was my first time seeing this doctor and this insurance company (Kaiser Permanente) doesn’t have any of my previous ob/gyn medical records, I expected to at least have to talk with her in depth about my lifestyle and justify my request. She did say that while the typical recommendation is that IUDs are best for women who’ve already had a child, that’s not a hard and fast rule, it’s mainly just that they’re easier to insert after childbirth. This was just part of what I think must be her regular spiel when a patient expresses interest.
So, we talked for a few minutes, I made my decision, she put in the prescriptions and we made an appointment and then went on with the rest of the exam.
A week or so after that appointment, I stopped by the pharmacy to pick up the device. My first surprise (there’s always at least one, right?) was how big the box is. Very long and flat, it reminded me of a carton of cigarettes but I think longer and wider, and a bit thinner. Which makes perfect sense because the wand to insert the device is included in the package. (If you’re concerned about being discreet, you will want to bring a big old tote bag with you. It almost fits in my work bag, when my work bag is full of work day stuff, but was definitely poking out and you can read the name brand on the box.)
My second surprise was the cost. For the IUD and for the one pill I have to take before the insertion – misoprostol, which the doctor said will aid with insertion* – the total copay was $15. The copay listed on my account for the upcoming appointment for the insertion is $20. There will be a follow up, and another appointment to remove it. So assuming those other two are at the same copay level, I will have paid $75 for 5 years worth of hormonal birth control that I don’t even have to think about. (Don’t worry Mom, if you’re still reading this Gentleman Callers will continue to go through a rigorous screening process and be required to use a barrier method. That assumes I get around to trying to identify candidates, but that’s another post for another day.)
That said, these are expensive devices. I wasn’t sure what to expect; naively I just assumed/hoped that since my doctor hadn’t mentioned that there was a big copay, there wouldn’t be a big copay. (I had also decided that the price point for me walking away without it was pretty high.) As a comparison, a friend tells me that even with a fancy plan from her insurance company, Mirena would cost her $750. So for cost alone, this is definitely not for everyone. You’ll need to look at the financials and see what it looks like in the long run, and if you want to/are able to pay the up-front costs. I have the fanciest Kaiser plan offered through my employer, but I don’t know how much that played into my ultimate out of pocket cost, or if this is just their normal charge for Mirena. Part of me thinks it’s the latter, because I had no copay for this initial well visit with my ob/gyn to get my pap and a full STD workup. No copay! Because this is – say it with me now – routine preventive care! Previously I not only had a copay for that visit, but it was a specialist copay.
Edited to Add: Part 2 is here.
* Interestingly, the Common Uses section of the patient information handout I got with this says it’s used to reduce the risk of ulcers in people who take NSAIDs. Some other sections – including the Cautions – include some language that makes me think that the “softening” my doctor said this would cause is a side effect.