Note: for the purposes of this series, I will be using the terms prescription birth control and contraception interchangeably to refer to birth control options that can't be bought over the counter like condoms and emergency contraception like Plan B. Here is an amazing resource and birth control overview, complete with historical information!

"Are you sure you're not interested in anything else?"

A phrase normally reserved for pushy servers at restaurants came out my gynecologist's mouth half skeptical and half concerned. It had that kind of tone moms use when they want you to reconsider your decision because they think it's a terrible mistake but won't say that directly. 

It was late April 2017. I was less than a month away from college graduation and the terror of the unknown that would follow. We were discussing birth control, and I can understand why she wanted me to take a second look at the metaphorical menu before handing it back. She had just removed the Nexplanon arm implant I'd had for a little over a year. Nexplanon (also known as Implanon) is a type of LARC, Long Acting Reversible Contraceptive. IUDs, the shot, and the ring fall into this category even though the latter two options aren't as long term as IUDs or the implant. LARCs are any kind of birth control that don't require daily maintenance like the pill but aren't permanent like tubal ligation (getting your tubes tied). The Nexplanon is supposed to be replaced every 3 years, but there are some IUDs that can last up to 10 or more. 

In my doctor's eyes, it was fine that I didn't want the Nexplanon anymore, but my refusal to start another kind of hormonal birth control gave her pause. Given my age, in her eyes I should want to take advantage of all my options to prevent pregnancy. But before we get to why I didn't want hormonal birth control anymore, I have to explain how I got here in the first place. 

I first got the Nexplanon in February 2016, after the most stressful college semester I'd experienced up to that point. I had been on the pill since I was 16, first recommended to me after an ovarian cyst ruptured and I learned I had PCOS, polycystic ovarian syndrome. PCOS is an endocrine system disorder that results from too many androgens, or "male" hormones. These excess androgens can cause symptoms like excess hair growth and acne. For people with PCOS the egg that is supposed to release every month during ovulation just doesn't, creating a fluid filled cyst on the ovary. This happens so frequently there will be multiple cysts on each ovary (hence the poly in polycystic). 

Sometimes, these cysts continue to grow until they rupture or require surgery to remove. For me, I thought I was just having really bad period cramps but they didn't stop. The doctor originally thought it was appendicitis until I got an ultrasound. I was in so much pain that I felt it on the strongest dose of Percocet I could be prescribed. It's one of the top causes of infertility because people with PCOS don't ovulate frequently and hormone imbalances can cause miscarriages. Unfortunately, there is no cure because the cause isn't known. It's linked to genetics and environment, but nothing definite.

Because I was so afraid of another cyst rupture, I took the pill every day for almost 5 years straight. It wasn't until the end of the first semester of my Junior year in 2015 that my schedule got so out of whack I started missing pills for days on end. By this point IUDs had exploded in popularity in my friend group, and I was willing to give something more long term a shot. My rationale was that my schedule wasn't suddenly going to lighten up so I should be proactive.

The idea of an IUD still freaks me out because of the potential for uterine perforation (literally the IUD poking through your uterus), so I researched other options. That's when I came across the Nexplanon arm implant. It's a matchstick sized device that your doctor puts into your inner upper arm just underneath the skin and releases hormones that prevent ovulation, thicken cervical mucus to make it harder for sperm to travel, and change the lining of the uterus so it's harder for a fertilized egg to stick. With my health insurance, it was free (#ThanksObama) so I made the appointment.

The actual insertion process was easy and relatively painless. My gyno gave me a shot of lidocaine to numb the area on my left bicep, put the implant into a little tube, slid it into my arm, pulled the tube out, and that was it. It took about 2 minutes from numbing to getting the bandage put on. I was so happy I wouldn't have to worry about remembering to get my pills or taking them anymore. Things were good, until they weren't. If I'm being honest, I think I remember my time with the Nexplanon as more hassle-free than it actually was. There's a prevailing unspoken attitude among people invested in protecting access to contraceptives that the benefits outweigh potential negatives so we should just sweep those under the rug. I'm being only slightly hyperbolic.

Read more about my Nexplanon experience and what led me away from hormonal birth control in part 2. 

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