Working off that large insurance deductible? Only have a set budgeted amount for your contraception? There is no reason you and your gyno cannot strategize about what is going to be the most cost-effective contraceptive alternative for you out there.

The factors that weigh into those treatments vary from woman to woman. If your periods are heavy, maybe you need to factor in the cost of tampons and pads as well! And maybe if you are going to try for a baby in 6 months to a year, that will be a factor as well; what is cost effective for a few months may not quite be the same as what is cost effective for the long haul.

And what about method switching? It turns out this may be the most cost effective strategy of all! Who would have thought that! For instance, what about the woman with those terrible cramps and clots. If you are just going to treat your heavy periods for only one year, it’s the most cost effective strategy to just pop on to a low dose generic birth control pill; your gyno can help you pick one out. But then when the bleeding is better, get an IUD in the second year.

As Paul Bluementhal reported in "Contraception" in 2006 when he looked at this subject in depth, effectiveness of the therapy definitely has to be looked at, as well as pure cost. So generic low-dose progesterone given at the beginning of a cycle is a low-cost alternative for heavy periods, but maybe not always effective at curing the problem, and therefore not the most cost effective, either. Studies for heavy bleeding have backed this up.

The Mirena IUD, compared to taking monthly a small dose of progesterone for heavy menstrual bleeding (HMB), is more effective, according to the 2005 Cochrane review, but compared to just being given monthly progesterone, these women had more spotting and breast tenderness. If breast tenderness is already an issue with you, well, there goes the formula, it may not apply to you.

And what about getting an IUD vs getting a NovaSure ablation? In one study, if you got a Mirena IUD vs getting a NovaSure ablation, you might have similar reduction in menstrual blood loss for two years, but the progesterone side effects are greater with the IUD, although as a group, NovaSure women had more surgical side effects. Although some of this information quoted is almost thirty years old now, Nilsson reported in clinical endocrinology that the tissue levels of levonorgesterel with the Mirena are hundreds of times higher than what can be given orally. So that potent progesterone effect on the uterine lining may be just what your gyno wants for you!

New things to make sense of? This gyno thinks so, what do you think?