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Ask Dr. D. Love Your Own Question

Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18213
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I'm a 43 year old woman just had my forth baby four and a

Customer Question

I'm a 43 year old woman just had my forth baby four and a half moths ago. I don't want anymore children but really don't want my husband to have. A vecetomy. The problem I have is I'm a smoker, have severe migraines with and without aura. I'm on prophylactic medication for this. Propanalol 40mg BD and Gabapentin 100mg BD. My migraines are usually hormonal before a period and lasting at lest 3 days, sometimes very debilitating. I have also have quite bad Chloalasma with the pill and pregnancy. I have tried the coil but ended up with three week periods and no sex life anyway. I'm not sure what's my best option for contraception? I have tried the mini pill years ago, can't really remember what it was like think it stopes my periods. I know pill wise I'm high risk of stroke with my history, ( I'm a registered nurse myself), I just wondered if you have any suggestions that are lower risk and would not inflame my problems with migraine, Chloalasma etc. Thank you
Serena
Submitted: 11 months ago.
Category: Medical
Customer: replied 11 months ago.
Sorry for the typos, dam auto correct!!��
Expert:  Dr. D. Love replied 11 months ago.

Hello from JustAnswer.

Is there a particular reason that you do not want your husband to have a vasectomy?

Does that also extend to not wanting to undergo a tubal ligation yourself?

Customer: replied 11 months ago.
Not really I suppose, although I don't want anymore children myself I do t want to make that permanent at the moment
Customer: replied 11 months ago.
Sorry typo again should say don't
Customer: replied 11 months ago.
I didn't think I want to have this last baby but I'm so glad I have him. I have my first at 20, he's now 22 going on 23. I love them all. The only thing that put me off more it the amount oftentimes they did this time because of my age. I would think it irresponsible of us to have a child with Downs for example at our age. Depending on their problems because of our age the could well end up in a care home. I would hate that, I have worked in many, some not nice at all.
Customer: replied 11 months ago.
Sorry that was so incoherent, auto correct I think. I meant to say the amount of tests they did because of my age etc. Not sure I could go through that worry again. They treated my like a first time mum and was very oppossed to me having a home both etc, despite 3 normal births before.
Customer: replied 11 months ago.
Just need to know what your opinion is for safe contraception for me in view of my medication and history please, thank you
Expert:  Dr. D. Love replied 11 months ago.

If you are not ready to make a decision that you are certain that you do not want a permanent decision, then sterilization is not really an option. However, the most common approach for a woman that is certain that she does not want any further children is sterilization. Sterilization can be done of either member of the couple, but it is easier and less risky to perform a vasectomy than a tubal ligation. Sterilization is even more desirable in a woman that smokes or has other risk factor for blood clots or cardiovascular disease.

It is important to note that the majority of men that are afraid of having a vasectomy are actually afraid of complications that are not really a concern. Since you are a nurse, you have a better understanding of surgical risk than most women, but the risks of a vasectomy are quite low.

There also is a newer technology to perform non-surgical sterilization, such as Essure. This is a device that is inserted into the opening of the tubes and can be done as an office procedure. Since it is a relatively new procedure, we are still learning about the long-term effects, but when you get to the point that you are wanting to consider a permanent intervention, then you can also consider this as an alternative to a traditional surgical sterilization.

In terms of reversible contraception, as you get older, the risk associated with smoking and migraines will only get greater. The level of concern in using hormonal contraceptives become greater with each year. The most effective form of non-hormonal reversible contraception would be a copper IUD. Any IUD can be associated with abnormal bleeding patterns, and it appears that you experienced this previously. Another option for reversible contraception would be a diaphragm. When used correctly, diaphragms can be very effective. They are not as effective as IUD or hormonal methods, but is far more effective than condoms. If you do not want to repeat the risk of potential side effects of IUDs, then it would be appropriate to consider a diaphragm.

However, once you are certain that a permanent solution would be appropriate for you, it would be most effective and lowest risk to consider vasectomy or tubal ligation.

If I can provide any additional information, please let me know.

Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18213
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
Dr. D. Love and 3 other Medical Specialists are ready to help you
Customer: replied 11 months ago.
please call me it's easier than texting, thank you
Expert:  Dr. D. Love replied 11 months ago.

It was a pleasure to talk to you today.

Thank you for using JustAnswer.

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