They're great! I forgot that they haven't been officially approved for longer, but keep an eye out because the data is there. :)
For most people, the amount of levonorgestrel in the Mirena (hormones, 6 years) is minimal and stays pretty local and acts on the uterine lining. 80% of Mirena users stop bleeding completely within a year. The Paraguard (copper, 10+ years) can increase bleeding intensity and duration along with worsening cramps, but for some people it gets better over time. Another option lots of people forget about is the Nexplanon, the rod that goes in your arm and lasts 4 years. It can cause irregular spotting, though overall less bleeding than most people had before.
A patient of mine had Fox News on in an exam room this morning, and Fox and Friends were explaining how the protesters were entirely either "illegals" or "paid protesters from billionaires making $15/hour," not "real Americans." A true test of my professionalism after a night shift. (Also, hi! former lurker enticed out by the other thread here.)
I'm delurking for the second time! Longtime reader of Jezebel, found this site through comments after it started, made an account long ago that lapsed. I still check in now and again.
As far as me, I'm an Ob/Gyn resident in the NYC area, married to another resident, planning a career in medicine and advocacy. I love cats, history, and talking about birth control. Grew up in the Seattle area, lived in Minnesota for 4 years. User name inspired by an epithet from a Planned Parenthood protestor :) So, hi!
No worries! I saw a few patients in clinic with what it sounds like this could be and it sounds crazy terrifying.
Ok, I tried the comment/delete method. Let me know if it worked! Should I see a "comment deleted" thing?
Actually the drug you'd want is called carbamazipine... Too many flash cards and I'm dropping syllables. How do you edit a comment?
Sure, but I am only a 4th year med student. How can I send you an email address without posting it? (Since I'm weeks from applying to residency, I have to be super careful about what is public.) Your story is pretty classic for this condition, so you can totally try the ENT you're seeing anyway or even an urgent care clinic. Any decent GP should be able to prescribe the right treatment for it. Neurosurgery is a distant and unlikely possibility, and this is a reasonably common condition.
If it hadn't lasted so long, another thing to think about would be shingles, but it doesn't sound like there's a rash over the area. If there was one when or right before it started and shingles is a possibility, you could have postherpetic neuralgia and gabapentin would be better. /nerd
There's a drug called carmezapine (has a relative that sounds similar and starts with an o, same drug class) that helps something like 80% of people with trigeminal neuralgia, but they'll want you to come in for blood tests periodically to make sure it isn't causing side effects. Other options are more traditional nerve pain drugs like baclofen, lamotrigine, and gabapentin, but they sometimes don't work quite work as well. Other options if meds don't work are gamma knife surgery or surgical decompression of the 5th cranial nerve. Go in soon and don't try to tough it out, though - they seem to think that the longer you let the nerve be irritated, the harder the over activity is to cure. (Source: just finished studying the neurology material for the USMLE boards.)
Recommendations vary and are in flux right now. Everyone agrees you need one every year after 50. In practice, most of the time it depended on patients' family and medical history between 40 and 50, and lots of people who had no risk factors did them about every other year during their 40s.
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