Infertility/Fertility/birth control

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QUESTION: Hello,

I am writing from Honolulu, HI.  I was dx with PCOS for about a year.  I am 29 and do not want to get pregnant now; probably another 2-4 years will be ready.  I am currently on Mirena (for about 1 year), but my naturopath told me I should get off of it and switch for Paragard.  I would rather not be on any birth control, but I know due to the 1. not getting pregnant, and 2. my ovarian dysfunction, I should be on something.  What is your recommendation for the best birth control to be on.  I am not insulin sensitive and am not on any other medication beside birth control.

Thank you in advance,
Lindsey

ANSWER: Hello Lindsey from the U.S. (Hawaii),

Your naturopath is incorrect.  Since you have PCO, which is an ovarian dysfunction with other potential side effects, you should be on some type of hormonal supplementation.  Although Mirena is not the optimal treatment, because it does not have estrogen, and PCO tends to cause an estrogen deficiency, it will be adequate to suppress the ovaries to prevent the side effects.

The optimal treatment for PCO is to suppress the ovaries with oral contraceptves and then replace the hormones since BCP's have estrogen and progesterone.  The ideal contraceptive for this purpose is Yaz or Yasmin.

There is more to discuss regarding the treatment of PCO but it would be too long to discuss in this forum.  I have written extensively about it in my Blog and would recommend that you read it there.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate


---------- FOLLOW-UP ----------

QUESTION: Thank you so much for you quick response!

I'm reading your blog now and one question focused on natural progesterone cream, which led me to a follow up question.

Since I already have the Mirena in, is there something I can take/apply/eat/do to get the estrogen that I need?  Or is there something I should look out for (symptoms/signs) that would indicate that I'm low on estrogen?

Thanks again,
Lindsey

Answer
Hello Again,

There is not a "natural" form of estrogen that you can add, although you can find such products in natural food stores and/or read about replacing estrogen with yams and soy (they don't work).

On the other hand, you can take estrogen via tablets, patches, injections or vaginally in order to get estrogen, in addition to the Mirena.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate

Infertility/Fertility

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Edward Joseph Ramirez, MD, FACOG

Expertise

I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.

Experience

I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

Organizations
American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

Publications
American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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