Almost six months ago, I made a choice to go off of my hormonal birth control (HBC).  I wasn’t delighted about ditching this drug; I had been on one form or another of HBC pretty much all of my adult life.  But I was in a spot.  I was five nights sleepless, floridly manic, and the only medication I could take for sleep could not be taken while I was on HBC.  I discovered an interaction between my sleep med (tizanidine) and any form of hormonal birth control that, once my doctor did some research, we found out really should have killed me while I had been taking it.  No exaggeration.  The blackouts I experienced while on the combo were the scariest evidence to back this claim up.

So I had to make a choice, and I chose that I needed to sleep.  And I did, and all was right with the world.  Except. . .

I have always been hypervigilant about unintended pregnancy, but my concerns turned into serious fears when I began treatment for my bipolar disorder.  Me being me, I was all over researching the FDA pregnancy categories of the meds I was taking.  If you don’t know, that’s the way medications are classed to determine their safety for use by pregnant women.  To paraphrase, Cat A meds are  considered safe, Cat B meds are considered probably okay, Cat C meds pose risks but may still be used, Cat D meds are very scary (though occasionally still necessary for the mother’s life), and Cat X meds are horrifying and do terrible things and shouldn’t ever be used in pregnancy.  Like I said, though, that is my paraphrase, please don’t take it as the everything, click the link and do some additional research on your own.

So, most of the meds I had taken during treatment for bipolar, and later on anxiety disorders, were Cat Cs and Cat Ds.  Which is the past for me, but a hint that all of the women reading this who are medicated and of childbearing age should research the drugs they are on.  Whether you ever plan on having children or not, this is information you really should store in your mind somewhere.

Back to me again.  Being denied any use of hormonal birth control methods left me at a bit of a loss.  Yes, there are barrier methods, like condoms and diaphragms.  But I had always used condoms in conjunction with my HBC to be as sure as possible that I was basically eliminating my risk.  And now, using the former alone, I took another look at the information on the box.  And it said, “Condoms are highly effective against pregnancy, less than 2 women in 100 get pregnant during one year of typical correct and consistent use.”

Sounds pretty good, right?  Less than 2 in 100?  Not to me it didn’t.  If we decide to use just a straight 2 (eliminating the “less than”) because it makes this easier to lay out, that means two percent of women get pregnant each year using condoms the right way.  Now that may not seem like a large risk, but I didn’t like to play those odds.

I don’t ever intend to have children.  But, I know that personally, were I to get pregnant, I would not terminate the pregnancy. I would have the baby (and this is not a stance or a judgement or a manifesto on how anyone else should live their lives).  And, I am not comfortable enough with my “no kids ever” policy to just have a tubal ligation.

But the meds that I take now are three Category Cs and one Category D.  And the Category D, Carbatrol (which also goes by the names carbamazepine and tegretol), has such frightening risks associated with pregnancy – like severe neural tube defects in the baby – that it’s enough to scare a woman into a life of celibacy.  Oh, also you cannot do home pregnancy tests while on it.  It can affect the results.  So extra fun there.

I ultimately opted for a copper IUD (non-hormonal), which is highly effective at preventing pregnancy and can be left in place for up to 10 years.  But some tips for all of the women reading this who are in their childbearing years:

• Research the psych medications you take (and of course any others) to see if they interact with hormonal birth control.  Some meds (Carbatrol, for example) render HBC pretty much ineffective.  So that pill or that patch or that ring isn’t really preventing pregnancy.  Talk to you doctors.  Plural.  Your psychiatrist and your OB/GYN, and make a plan that is best for you.
• Find out the pregnancy categories and potential effects on a fetus of the meds you are taking.  Talk to your doctors – again, psychiatrist and OB/GYN, because I have had the former tell me a drug really isn’t as bad as it’s made out to be, while the latter disagreed vehemently – so that you fully understand the risks an unintended pregnancy could pose.
• One last very important tip from Auntie Ruby?  If you aren’t already, begin taking folic acid.  All women in their childbearing years should be taking it anyway, and if you are on any type of high-risk drug (as I am), you need to be taking a whopping 4 mg of the stuff every day.  This dosage was suggested in independent research I did and confirmed by my OB/GYN, a very smart lady who has been in the baby business for years.

Above all, we just need to realize the extra level of responsibility that being a woman on medication – medication of any kind, but especially psych medication – brings.  You never know for sure what you are going to do about a pregnancy until you actually find yourself there (again, not preaching or judging, just sharing life experience), so do everything you can to keep yourself informed and prepared.

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