Mechanical valve + Coumadin + Birth Control

[Jailene777]

Hi! This question is geared towards women who have had valve replacement, that are taking coumadin, and are of child-bearing age.

I am 25 years old and its been more than a year since my valve replacement, and I am on coumadin. I can't take any birth control for risks of blood clots and interaction with my anticoagulation regime. I "can't" get pregnant because of coumadin andthis risk of have a deformed child and a thrombosed valve according to medical guidelines. But what am I supposed to do to avoid getting pregnant?

I have tried the mirena iud and I had severe side effects. Severe headaches that had me in tears, I was taken to the ER by ambulance thinking I was having a stroke, they did a CT scan to make sure I wasn't hemorrhaging. I had nausea, visual side effects, heat flashes in my leg and foot. And my midwife was saying none of it was related to the iud. I even experienced a chaotic heart palpitation which felt like my heart was flip flopping like a fish in my chest. After two months of fighting to get it outhey took it out.

I was given the iud because they felt like it was the safest birth control for me. Yeah... Sure.... I made them do a transvaginal ultrasound to make sure of the placement of the iud, turned out it was off axis! Which is a sure way to get pregnant. Smh... My hands are tied. I feel stuck in a corner. I never knew how complicated it would be to have a mechanical valve and avoid pregnancy. Truth be told, I wish I could have another one, but I'm still waiting on the fence for some medical breakthrough to happen for childbearing women like me. :/

I could use any advice or experiences! Please! Thanks!

 

[Mom2izzy]

Generally, the side effects from birth control are caused by hormones. Isn't the Mirena IUD the one with hormones? My body doesn't like the hormones (terrible headaches and crankiness), so I got the plain old copper IUD. I don't even notice it's there.

 

[njean]

When I had my first OHS, I was married then, but shortly after the surgery, my wonderful husband asked me for a divorce so consquently didn't have to worry about that anymore. However, several years later, when I met my 2nd husband, and our relationship got serious, I elected to have a tubal ligation. He already had two children from a previous marriage so his children became my children. And I am proud to say, that I'm even a great grandma already!!!

I feel for you because I know the "corner" you're describing.....I was in that corner decades ago, so I know the feeling. But I also wanted to live and I had to listen to my doctors and what they recommended. There's always adoption you know. And too, if you are married or find the right man, perhaps he would be willing to have a vasectomy.....that would be the easiest and safest way of birth control for you.

Wishing you a long and good life ahead!

 

[Jailene777]

I considered the copper iud, but supposedly its not right for me. My midwife said I would bleed heavier. A lot of women complain about their menses and I would not benefitfrom it cuz I'm on coumadin.

I have spoken to my husband about a vasectomy, he's only 26. We both have resolved on the fact of playing it safe and not trying to have another one. But we would love to have another one if things were different. He feels he is too young to get snipped. He will think about it when he is 30. I respect it. It's his body. I can't do my tubal ligation cuz doctors say its too risky. But do u have a mechanical valve?

 

[njean]

I have two mechanical valves. And keep in mind, my surgery was done way back in '75....the dark ages!

When I had the tubal ligation, my cardiologist was right in the operating room with the gynecologist who performed the surgery. In fact, my cardio was the one that recommended him. He became my gyno from then on, up until 10 years ago when he retired. The doctors expressed some concern of course, but they thought that was my best and safest alternative.

I think you need to have a serious talk with your doctors to see if this is a possibility. I mean, if the surgery (tubal) could be done 32 years, surely it can be done now and probably with less risks involved. I was content with my decision and accepted things for what they were, and I was not about to play russian roulette with my life! I had been through too much already!

Like I said, talk to your doctors! Good luck!


Note: I want to add that I have undergone three OHS, a Hysterectomy, Knee surgery, Appendectomy and have been on coumadin for 37 years!

 

[Lynette]

My OB/Gyn also was concerned about giving me any birth control with estrogen, due to the increased risk of blood clots. As I've read posts in the past, this seems to be a point where doctors have different opinions, since some women have indicated their doctor felt that if they were on warfarin they were protected against clots, and so were willing to use estrogen based birth control. However, if you want to avoid estrogen another option is depo-provera. It is given as an injection every 3 months. You could discuss this with your OB/Gyn to see if it would fit your circumstances.

 

[AgilityDog]

There's a cute little procedure where you get little scarring plugs in the fallopian tubes. I forget what it's called.
Also intrauterine ablation seems to cause permanent sterility in most women, and since it is cautery, there's little to no blood loss risk.

You can TOO have your tubes tied. Just like any other surgery you'd have to bridge with lovenox, and yes, there's a risk, but not nearly so great as the risk of pregnancy.

 

[Jkm7]

People on coumadin have surgeries every day of the week. They have just about every surgery you can name and their health care providers manage the coumadin by various methods including stopping it for given number of days prior to surgery, bridging. lowering INR.

It might be a good idea for you to seek other opinions.
You have not necessarily been given all available choices and perhaps a second or third opinion from gynecologists might be helpful for you.

Most women on coumadin can have tubal ligation if that is their wish. Competent cardiologist, surgeon and coumadin management make it possible.

Best Wishes.

 

[Jailene777]

When I first mentioned tying my tubes to my midwife, she freaked.out and said "oh no, we dont wanna do that!" As if she was concerned of me wanting more children. She said medicine is always advancing and that God f rbid I tie my tubes and some beautiful anticoagulation sent from heaven safe for me and baby comes out and I won't be able to take advantage and regret it. That's how I felt her response. This was before my OHS. After my OHS, that's when I walked into the elephant in the middle of the room. It has been no easy way around it.

I got two consultations for maternal fetal medicine doctors and they said that I can definitely get pregnant and deliver my baby. I just have to plan my pregnancy. They explained the risks. But they have dealt with women with mechanical valves whose babies have been born perfectly healthy. So I'm stuck on the hope of having a baby someday, which is why scarring my tubes or tying them are not my options right now.

The depo shot, my midwife turned it down for me, for the simple fact of the classic weight gain experienced with a lot of women, and also that it stays in my system for 3 months, if I have any adverse effects from it as I did with the iud, I'm preety much hit. And I am not gonna take the chance.

So its been a non hormonal type of scenario for now. I'm considering going to see an ob/gyn to answer all my pregnancy and birth control methods.

 

[Jailene777]

I do have one child right now, and I'm happy to adopt if I had to. I'm just torn between the whole risk involved in having another.pregnancy that it does turn my off and hits me back to reality.

 

[njean]

I do have one child right now, and I'm happy to adopt if I had to. I'm just torn between the whole risk involved in having another.pregnancy that it does turn my off and hits me back to reality.

You're in a tough place, I know, however you are so lucky to have at least that one child.

I only wish that I could have been that lucky and had been able to have the one child I had to give up in order to live.
I was just one year younger than you when I had my first OHS. A few months before my surgery was to take place, I found out I was pregnant. But my pregnancy was terminated because the doctors said I would not survive or see it to term. That was devastating.

As I said before, you have a very tough decision to make and all we can do is support whatever you decide. And you are right.....medical technology is always advancing and there's nothing wrong in praying for the "wonder" drug. I keep praying for the drug that will dissolve scar tissue so doctors can go back in there and change out my mechanical mitral valve so I don't have to depend on so many drugs to keep me alive.

We'll pray together. Take care!

 

[sarahsunshine]

I'm sorry, I'm no help for you, but I have read that lovenox (daily injectable "blood thinner" usually used for bridging) is sometimes an option for women who wish to become pregnant but have a clotting disorder. Lovenox does not cross the placental barrier and therefore is not thought to cause birth defects (at least in the first trimester.) Using enoxiparin for the whole pregnancy seems to have higher risks, however. Warfarin, on the other hand, usually seems to have it's effects mostly in the first trimester. This must be the "being careful" that your midwife has described.

I can understand your dilemma, and it is a very serious thing to consider. I feel for anyone having to make those decisions.

Have you considered a surrogate prior to doing anything permanent?

 

[Protimenow]

I have to wonder -- why is birth control YOUR responsibility? Is your husband too good to wear a condom? Should he put your health at risk just to avoid that minor inconvenence?

I read through these posts and didn't see something saying that he's contemplated anything other than a vasectomy - which he feels too young to get.

It seems that the only safe, rational thing is for your husband to take on some of the responsibility. If he doesn't like the feel of the condom -- there are probably other activities that he'll enjoy that don't require a condom.

(I'm trying to put this as delicately as I can -- but I'm sure you all get the point). (You might just say - no condom, no sex. This may be all that he needs to hear)

 

[drivetopless]

Are you home testing your INR yet? WHen you hav access to that, it makes it a lot easier to monitor your INRs so I think the clotting issue is less troubling. You can even test yourself more often to make sure you are staying in range vs the less frequent intervals the clinics follow.

I asked those same questions about bcp right before my surgery. I was told that if I wanted to stay on them I would be fine and would probably be at less risk for blood clots than a woman not on anticoagulation. If blood clots or DVT doesn't run in your family, you might want to get another opinion on the bcps. Maybe avoid the brands like Yaz. Just a thought.

It's old fashioned but has no side effects--you could try the diaphram with contraceptive gel.

 

[Luana]

It's old fashioned but has no side effects--you could try the diaphram with contraceptive gel.

It has about a 5% failure rate.

 

[Protimenow]

I repeat -- what about a condom? Why shouldn't the person without concerns for anticoagulation-related issues take some responsibility?

 

[mom2angel]

I am 32. I had my mechanical valve put in in 1982 at the age of 2, so I have had mine my entire child bearing age. I have a 4 year old and am pregnant with my second. I have always taking oral birth control when wanted. My Dr. has always put me on a low dose birth control- ortho tri-cyclen. My Dr. has never had an issue with prescribing me that one. The risk of birth defects is low, and that is why I am not afraid to have children. however, having lived on coumadin for as long as i can remember, it's a normal part of life for me, so I don't tend to think about it too much.
I would definitely do your research, and check into all your options before deciding that there is nothing you can do. Good luck!

 

[bdryer]

mom2angel

I'm sorry to deviate from the topic of this thread, but I could not help but read that you have the same valve for 30 years implanted at the age of 2. You are an inspiration to parents whose children are facing OHS for valve replacement.

 

[Jailene777]

LOL @ PROTIMENOW!

For a moment you sounded like my midwife, who said she wanted to meet my husband and sit on him a little bit and have a long and serious conversation about the risks of me getting pregnant. Condoms are the only thing we ARE using. And its very depressing to go to a doctor and leave empty handed with no other birth control solution. None of my doctors want me to get pregnant but I have found no assistance in finding an option that would suit me without the risks of blood clots. It's been a lose lose situation. I'm still looking for answers.

 

[Jailene777]

Wow, you are the woman I need to speak to! How did you manage!!!!!! Please tell me how!!! mom2angel