Author Topic: New to the board: question about contraception  (Read 2093 times)


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New to the board: question about contraception
« on: February 12, 2016, 09:29:36 AM »
Good morning -- I was diagnosed with Sjogren's in August 2015. I was extremely fatigued and had been suffering from dry eyes, mouth etc. for a while but thought it was just allergies. I have hypothyroidism and take medication for it and have for years as well. During that time I was also on a small dose of sertraline  plus combination birth control pills. I had been on both for a while but my stress levels were down and I started weaning off the sertraline (the doc thought that I may not feel as sleepy without it especially if I didn't need it anymore and was not in the same stressful situations as before) .

After a routine check my doctor found that my thyroid was fine and wondered what the cause of the fatigue was and ran some tests. There were some autoimmune markers and I ended up with a rheumatologist and Sjogren's diagnosis. I also started taking Plaquenil -- 400 mg a day -- soon after.

About a couple of months after I started the Plaquenil I started experiencing extreme anxiety and had trouble sleeping. This was likely because of stress because of one of my adult stepkids plus health issues -- I developed a painful anal abscess which burst and ended up having a lot of attendant issues. After a month or so of dealing with all this, I did a couple of things:
- I went back on the sertraline
- I went off the Plaquenil (after talking to the rheumatologist). I wasn't sure if it was causing the sleep issues.

In the meantime, one of my mother's friends, a gynecologist, learned of my Sjogren's, said I should probably not be on the pill. I went to see my gynie who agreed. I started looking at contraceptive options. I am 43 (44 this May) do not have kids of my own and we absolutely do not want to have kids. My understanding is that the estrogen in the pill is what my body may have an issue with. My options according to my gynecologist were the progestin only pill, the implant and the IUD.

I decided against the pill because one of the things I was also facing at this time was extreme anxiety (also caused by an abscess that occurred at this time) and I couldn't always be certain of taking my pill in a timely way. The IUD insertion freaked me out. So I decided on the implant.

I had the contraceptive implant, Nexplanon, inserted in mid-January. So far I have had no weird side effects and no bleeding. I also talked to my rheumatologist about resuming the Plaquenil. I have been more achey and tired and I don't believe it did cause any of those effects, and he is okay with that.

So, now I take levothyroxine, sertraline and have the Nexplanon and will be resuming the Plaquenil (at 300 mg a day)
But I do have questions:
- Is the implant a good option for contraception with the Plaquenil? There is so little info out there re: contraception options for Sjogren's sufferers.
- Does anybody have the implant and what are your experiences?

Sorry, a very long lead up to some quick questions but I wanted to introduce myself and give you a full picture.

Thanks in advance!



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Re: New to the board: question about contraception
« Reply #1 on: February 15, 2016, 01:39:27 PM »
Welcome to the forum, akylasam.

I don't have experience with Nexplanon. However, when I was exploring contraception options I found one of the major concerns was to determine whether you are antiphospholipid antibody positive as that increases risk of blood clots (thrombosis). If so, it is not good to use a form of conception that also increases risk of blood clots. It is my understanding that estrogen is definitely not recommended as that also increases the risk of blood clots. I'm not sure about progesterone. You might want to check into those two factors.

Also, here's an article about selection of contraception for women with rheumatic diseases. It's from 2007, so there might be more current information available elsewhere by now.
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Re: New to the board: question about contraception
« Reply #2 on: February 16, 2016, 06:45:31 PM »
I concur with Sunshine.  Blood clots are a major concern when using contraception.  I chose something a little more drastic because I didn't want any more children and all the problems I was having it was the best answer for me.  I have never looked back at all.  With all the medical conditions I have to contend with at least I don't have to deal with that.  I got a partial hysterectomy.   
If you are monitored well and tell your doctor everything side effect you feel maybe you will have a good outcome.

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Sjogrens, Arthritis, colonrectal cancer survivor, Diverticulosis, fibromyalgia, chronic sinus, chronic pain, kidney stones,  chronic allergies, digestive tract issues, norco, plaquenil, ativan, ambien, lyrica, claritan, neuron tin, celexa,predinisome,

Joe S.

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Re: New to the board: question about contraception
« Reply #3 on: February 17, 2016, 04:32:44 AM »
Welcome to our forum. I am of the wrong gender to suggest options to you. Having said that I am surprised that you are still able to be sexually active. I gave that up decades ago when it became painful and my wife had problems.

I suggest that you look up the medications and supplements you take for side effects, interactions, and counter indications.
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Re: New to the board: question about contraception
« Reply #4 on: February 17, 2016, 10:07:52 AM »
Welcome Akylasam,

I am not the right one to discuss birth control after having had a hysterectomy many years ago. But because of the Sjogren's dryness and hormonal changes, I ended up needing a
UroGynecologist. I have to have an estrogen patch/creme in order to have a sex life without horrible pain. Otherwise, I would have had to give up that part of my life. Not ready for that.

Hope you get the right answer soon. Welcome to the forum.


Female 55 y/o; SJS Primary; CVID; Autonomic Neuropathy: Chronic Digestive/G.I. issues; Leukopenia;Tachycardia; Bronchiectasis; High Blood Pres; R.A.;Chronic Pain; Sub~Q IVIG infusions~Hizentra; Plaquenil; Restasis; Gapapentin; Breathing/nebulizer meds; Pain meds;


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Re: New to the board: question about contraception
« Reply #5 on: February 25, 2016, 02:47:40 PM »
Hi all and thank you for your input. So sorry I forgot to bookmark this site and haven't come back until now.

I restarted the Plaquenil and per my rheumatologist I am okay with the Nexplanon. I also checked with a pharmacist and got the same thing -- there are no interactions.

My gynecologist knows of the Sjogren's so I assume/hope the Nexplanon is safe.

OTOH, my body is definitely beginning to miss the estrogen. I am experiencing dryness as well and plan to try coconut oil as a lubricant for a bit. Hopefully that works or I will contact my gynie for a cream too.

Longer term I should probably just get a more permanent solution. I don't want to have kids anyway so a hysterectomy is not out of the question.

It occurs to me that we could all use more updated info on contraception, right? I have found so little online.


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Re: New to the board: question about contraception
« Reply #6 on: February 28, 2016, 06:44:38 PM »
I'm a nurse ( I do postpartum visits up to one year following birth for both mom and baby) so I talk birth control options all day!
I'm VERY surprised ANY credible doctor has allowed a woman your age to remain on birth control pills- age alone would put you at high risk for blood clots and stroke.Attendant autoimmune issues also would rule out a hormonal IUD or implants.

If you are in a monogamous relationship the least invasive way to rectify this issue permanently is for your husband to have a vasectomy! If you reside in the US ( we don't have to pay for surgeries here in Canada) it would also be the cheapest option.

If he doesn't have the balls for it( all puns intended) you might consider a tubal ligation - once again a much more invasive surgery than vasectomy but a done deal for fertility. A hysterectomy is a removal of the uterus- a drastic option with a whole host of long term complications that aren't warranted just to ensure no more off spring!
47 female, Sjogrens ,Raynauds,degenerative disc disease.Rheumatoid Arthritis, gastroparesis.

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Re: New to the board: question about contraception
« Reply #7 on: February 29, 2016, 03:45:26 AM »
.Attendant autoimmune issues also would rule out a hormonal IUD or implants.

Thankfully I'm past requiring birth control but my daughter will (she's currently pregnant with no 2 :D ).
So what options are available for women with AI issues ? Why can't we use IUD's or implants?
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