Contraception: post-ectopic and baby

Parents' Place
1

I see this question has been asked on the longer thread, but thought I would respond here.

Contraception post-ectopic

This is the age old dilemma I am afraid. And it’s one that affects post-ectopic women.

Coils/IUDs

Whilst coils/IUDs are renowned as being brilliant for preventing pregnancy in the uterus they aren’t so clever at preventing pregnancy elsewhere. In fact they can’t prevent pregnancy elsewhere.

With a coil, sperm and egg can still meet in the fallopian tube, and fertilisation can and often does take place. When things then progress as they should and the egg arrives in the uterus, the coil makes it a hostile place and so conception doesn’t then continue because implantation can’t happen. The egg expires and is passed in normal menstrual blood (you can’t see it, it’s smaller than a pinprick, in fact not visible to the naked eye). The problem with a coil is, if you have a damaged tube(s) and the fertilised egg gets stuck the fallopian tube will temporarily be an environment where implantation can take place (though it shouldn’t) and it can result in a subsequent tubal ectopic pregnancy.

A Mirena Coil is thought to be more suitable than one of the other coils because it releases a small dose of progesterone - progesterone prevents ovulation in a lot of instances (but not all unfortunately it’s not foolproof and women do become pregnant with a Mirena in situ). However a Mirena coil is a progesterone only contraceptive, and these are contra-indicated for women with a history of ectopic pregnancy.

**Progesterone Only Contraceptives** (POCs) are associated with a higher incidence of ectopic pregnancy. The advice of our medical advisers here is as follows:

“delaying conception is advisable because we know one of the actions of synthetic progesterone is to thicken the mucal secretions of the fallopian tubes and we have no definitive information on how long it takes for this action to be reversed and so believe it may contribute to ectopic pregnancy.”

There is no definitive research to refute or verify this hypothesis but the advice is based on the knowledge we do have about the actions of synthetic progesterone and its known link to ectopic pregnancy.

Progesterone Only Contraceptives include contraceptive implants (if used we recommen delaying conception for several months after removal), the mini-pill or progesterone only pill, contraceptive injections (such as depo provera) and the Mirena Coil.

In control groups, women on the combined oral contraceptive were no more likely to suffer ectopic pregnancy, when they stopped taking it, than women who were not on the pill in the first place - thus suggesting that the oral combined contraceptive pill is NOT linked to ectopic pregnancy. There was a noted increase in the rate of women who suffered ectopic pregnancy if they became pregnant whilst taking the progesterone only contraceptive pill however, and it is now listed as one of the precautions in the product data. Likewise, the Morning After emergency contraceptive pill is now available as a progesterone only pill and there is an increased risk of ectopic pregnancy with this form of contraception. Again it is noted in the product data.

Phew. Bet you wished you’d not asked now! For women with a history of ectopic pregnancy, unless the risk outweighs the potential benefits, we stick with barrier methods (cap, condom, diaphragm, femidom), the combined oral contraceptive or Natural Family Planning.

However, when it comes down to it, with all contraception you and your clinician have to ask yourselves the same question - do the benefits of this to me as an individual outweigh the risk?

I hope that helps.

Kind regards

EPT Host 11

2

Hello,

Thank you for this post,the first section about the IUD really helped me understand how this could of happened . That was one of my questions how did this happen when I’ve had the Mirena in me for two years, I currently have a 5 yr. old little girl which I love dearly, but I just wanted to wait until I was married to have another baby. The OB physician explained to me before she performed surgery on me,was that it looked as if my uterus had shifted which had also caused my Mirena to shift as well and that I had Bacterial Vaginosis (not sure if the BV had anything to do with it). Have you ever heard of this type of situation and that maybe due to the uterus becoming out of place that could be the reason the egg did not make it to the uterus? I’m Just so confused and I feel embarrassed and guilty…here it is all these wonderful women on here were trying to have a baby where I was actually trying to prevent it but I am sad that it happened this way, I’ve never been the type of person who would want to abort a baby and that’s why I took precaution (by getting on the Mirena) but with my luck it still happened and not only did it happen, the first time me and my partner found out about it is when he rushed me to the ER room thinking I had kidney stones and being told 1. I was pregnant and 2. The embryo and my right fallopian tube would have to be removed immediately. I just never though this could happen…

3

Dear Townsell

There’s no need to feel guilty or embarrassed - you have been through a very traumatic experience and lost your pregnancy too. That is a horrible thing to happen, whether or not you were trying to conceive .

I have not heard of a uterus shifting, but I am not medically trained. The best people to speak to about your case would be the doctors who have been caring for you - perhaps you could ask for a follow up appointment if you have not been given one or even just to speak to someone on the phone to clear up the confusion about what you have been told. It sounds like they did not fully explain to you what they had seen. It is unfair for you to have been left feeling confused at a time when you have so much to deal with physically and emotionally.

Please do feel free to keep using these forums to ask questions or to express any emotions. Other women going through the experience of an ectopic pregnancy do tend to read the Main Board so you may find you get more replies to posts if you choose to post on there.

Sending you much love

Host 7

x

4

Hi Host 7,

Thanks so much with replying back to me, I didn’t think it would be this difficult to deal with but my wounds are healing still in a little pain though. I think once I go back to work and get back into the routine of things I’ll be much better.

Thanks again!

5

I’m a little confused. I had my Mirena removed a couple months ago so we could try for another baby. Could it have caused the ectopic pregnancy even though it was removed? Was only a couple months ago and they say it can take a little while for fertility to return. Should I have avoided trying due to this risk? Or is it only a risk when you actually have the Mirena in?

6

Dear Littledragon,

The Mirena coil does not cause ectopic pregnancy, in the minimal event of the coil failing and you becoming pregnant, it is more likely to be an ectopic pregnancy.

As you have rightly said, once the coil is removed, this minimal risk is also no longer a worry.

Sending much love,

Karen x

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