Before bowel surgery, there are tons of things swirling around your mind. Will I be OK? How much will it hurt? Will I feel better afterward? Will my insurance cover this?
For women, something that should be on that list, but is often missed, is this: What should I do for birth control before and after my surgery?
Discussions about how bowel surgery affects the female body are frequently missed or forgotten, often because colorectal surgeons are male and their priority is repairing your bowel. Female bodies are often drastically changed by bowel surgery, and discussions about this prior to surgery are key — including whether you plan to have children and how you will work that around your surgery.
If you’re having bowel surgery, it is likely that you’re already experiencing some absorption issues, and if you’re on any type of pill form of birth control, it may be time to consider changing. After my colectomy, I noticed I was passing whole birth control pills into my ostomy. I was facing at least two more surgeries, and an unplanned pregnancy would have been disastrous for my health and the future of my bowels.
Here are a few birth control options that may be worth considering in place of a pill.
Birth control implant
The implant is a type of “set it and forget it” birth control. It’s a small rod that is implanted under the skin in your arm, releasing a form of the hormone progestin in the body, and it lasts up to four years. If you can get over the fact that you can see it and feel it under your skin, it’s a good long-term option that doesn’t rely on your digestive tract to absorb the medication.
An IUD is another excellent option for someone who is looking for long-term, set-it-and-forget-it birth control that doesn’t rely on your digestive tract to absorb hormones. If you’re looking at having an IUD placed after surgery, you may need to wait a few weeks because your uterus may shift/tilt due to swelling after bowel surgery. There are hormonal and nonhormonal versions of the IUD.
Birth control shot
The birth control shot is another potential contraception option for a bowel surgery patient because, again, it doesn’t rely on your digestive tract to absorb it. The shot is injected once every three months into muscle tissues by your health care provider. The added bonus to the shot is that it may also lighten or stop your period, which is something that may be highly appealing when you’re in and out of surgery. There is also a version of the shot that you can inject yourself at home; ask your health care provider if you are a candidate for this more convenient option.
Birth control patch
The patch is another birth control option that doesn’t rely on digestive tract absorption. The patch is replaced every week and can be placed on your abdomen, buttocks, or upper body (but not the breasts). The downside to the patch is you have to remember it weekly. In my experience, pre- and post-surgery, I had a lot of things on my mind, and forgetting birth control was likely one of them. If you’re good at remembering medication, this may be a good option for you.
The contraceptive ring (NuvaRing) is a silicone ring that is inserted into your vagina for three weeks at a time, with a week off in between rings to allow for a period. You can remove it for short periods of time and still be protected against pregnancy.
A word of caution: I was on the NuvaRing during one of my surgeries, and my surgeon removed it without telling me. I started my period almost immediately after, and was in a panic when I saw that I was bleeding in the hospital directly after surgery. Once I realized my ring had been removed, and that I was having my period, I was far less worried, but it made recovery much harder, my entire cycle was offset, and I didn’t have another NuvaRing with me because I didn’t anticipate being without it. Make sure to discuss whether the ring needs to come out for surgery with your doctor.
We’re lucky to live in a time where there are so many birth control options aside from the pill, and while none of them are perfect, there should be something that can work for everyone’s unique situation. Before you select a birth control method, there are a few things to consider:
The type of hormone your selected method uses
If/when you’re planning to have a family
If/when you plan to be done with surgery
If you want to stop your period
Recommendations from your surgeon and gynecologist
The method that you will have the best success at remembering
Your comfort level
While your bowel surgery should be your top priority right now, it’s best to take smart precautions before and after regarding birth control to give your body its best chance at healing properly. A healthy body is key for your future and for any potential children you may wish to have.
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Jackie Zimmerman is a multiple sclerosis and ulcerative colitis patient and the founder of Girls With Guts. Since diagnosis, she has blogged her IBD journey at Blood, Poop, and Tears. Jackie has worked hard to become a strong voice in the patient advocacy community. In her free time (what free time?!) she spends time with her two rescue pups and plays roller derby. She’s online @JackieZimm.