Monday, June 8, 2009

Ultrasound Tomorrow

I am more anxious about this ultrasound tomorrow than I had thought I would be. More accurately, I am worried about what will need to happen after the ultrasound.

In March, at my annual exam, the Mirena IUD was recommended to me for two reasons: one, because it greatly reduces bleeding for most women, while the progesterone it releases is localized, rather than systemic, so it is not as likely to interfere with the antidepressant meds as the low-estrogen birth control pills I'd tried a few years ago. Those pills are also usually the newer versions, and expensive on my insurance (the monthly copay was $50). Two, now that I am divorcing, there is always the possibility that at some point I will want to know I have reliable birth control. Otherwise, experience so far suggests that I have a fertility level that is almost a stereotype for someone of Irish and Pennsylvania Dutch descent.

The nurse practitioner had the Mirena herself, for over two years, and loved it. While the placement of the IUD was, well, not without discomfort as medical people use the word, it was very brief and certainly less difficult than pregnancy or childbirth. It also did its job right from the start. Some women bleed straight through the first month or two, or possibly more, but I didn't. Periods came on schedule and were much, much improved (what I imagine most women experience as a normal period), with just a little more cramping.

So, I was being proactive and responsible for my life; a goal for this year. Happily, I went to my scheduled followup last week. This is the norm, to ensure that the has not fallen out (I was pretty sure this wasn't a problem, having just had the second, improved period) or caused any negative symptoms. Problem: it couldn't be found. The strings, which have a texture like fishing wire, are left trailing from the cervix at placement, both to be able to confirm that the IUD is still there and for removal at a later date (it stays for 5 years unless you want it removed sooner). I had, in fact, not been able to find the strings myself, but was not greatly concerned because I had also had a hard time reaching them the month before (a monthly check is recommended).

The practitioner apologized as she readjusted the speculum a couple of times, using what she described as a sort of mascara-brush implement in an attempt to draw the strings down if they were there. Nothing. So now what? I asked. The ultrasound. Either the IUD is in place and everything is fine, only the strings somehow retracted all the way up into the uterus, or it's gone or it is still in the uterus but in some skewed position and will have to be removed. Given the uncomfortable attempts simply to locate it, I am not looking forward to that possibility, and it is possible that it would have to be removed in surgery.

To add to the physical concerns, this is my Open Enrollment period, and I have elected to switch from my HMO to a Health Savings Account, a decision I will quickly rescind if this whole issue isn't resolved, with or without the removal of the IUD, by the end of June. Also, I don't know whether insurance covers a replacement IUD if the first one needs to be removed. If surgery is needed, I have decided that while the doctor's in there, she can perform a tubal ligation, and whatever procedure (ablation, possibly) will help with the heavy bleeding issues.

The possibility of the thing being expelled on its own was something I'd read in the warnings. I don't know if I never saw a warning that the IUD might shift and be undetectable at an exam, or if I simply read it that the same way we breeze through the legal disclaimers on so many products these days; sure, there is always a slight chance of a bizarre reaction, just like there is a slight chance that I'll be hit by a car, but you can't function under that kind of fear. Now, of course, I have looked up the Mirena and potential side effects, to find things I don't want to contemplate.

Well, if all goes well tomorrow, there will be no need for further intervention. If the IUD is where it should be, I don't need any more followup now (I am willing to postpone thinking about how the eventual removal will happen; without the strings that will still be difficult). If not, there's the removal ahead, with the additional copays. Worrying won't help, I know that. I was simply not expecting so much difficulty. Still, I am hoping for the best.

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