Copper IUD & PCOS: Pain, Hormones, Alternatives

Polycystic Ovary Syndrome, identified by the acronym PCOS, is a common endocrine disorder affecting women of reproductive age, with hormonal imbalances and metabolic disturbances as key attributes. Copper IUDs, a form of non-hormonal contraception, are often considered by women seeking alternatives to hormonal birth control methods due to concerns about hormonal side effects or contraindications. Pain management is a significant consideration for women with PCOS, as the condition can exacerbate pelvic pain; this is where the utilization of tools like pain scales is essential in assessing the impact of interventions such as copper IUDs. The American College of Obstetricians and Gynecologists (ACOG) provides guidelines and recommendations for managing PCOS and advising on appropriate contraceptive methods, making its guidance crucial for understanding the complexities of using copper IUDs in individuals with polycystic ovaries.

Navigating Contraception with PCOS: Understanding the Copper IUD

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting approximately 6-12% of women of reproductive age worldwide.

It is characterized by hormonal imbalances, irregular periods, and/or the presence of multiple cysts on the ovaries.

These symptoms can lead to a variety of health challenges, including infertility, metabolic syndrome, and an increased risk of certain cancers.

The Challenge of Contraception in PCOS

For women with PCOS, managing contraception can be particularly complex. Many traditional hormonal birth control methods, while effective for contraception, may also impact the hormonal imbalances inherent in PCOS.

This can lead to a difficult balancing act, weighing the benefits of contraception against potential side effects and impacts on underlying PCOS symptoms.

Introducing the Copper IUD: A Non-Hormonal Alternative

The Copper Intrauterine Device (IUD) presents a compelling alternative. Unlike hormonal IUDs or oral contraceptives, the Copper IUD is a non-hormonal contraceptive option.

It works by releasing copper ions into the uterus, creating an environment that is toxic to sperm and preventing fertilization.

This mechanism of action offers effective contraception without directly affecting the body's hormonal balance.

Scope of the Discussion: Complexities and Considerations

This article delves into the specific considerations for using the Copper IUD in women with PCOS.

It is crucial to understand that the interaction between PCOS and the Copper IUD is not always straightforward.

While the Copper IUD offers a hormone-free alternative, it may still influence menstrual patterns and exacerbate certain PCOS-related symptoms in some individuals.

Objective: A Comprehensive Analysis

The primary objective of this analysis is to provide a comprehensive overview of the benefits, risks, and management strategies associated with Copper IUD use in women with PCOS.

By exploring these factors in detail, we aim to equip both healthcare providers and patients with the knowledge necessary to make informed decisions about contraception and PCOS management.

This includes considering the potential impacts on menstrual cycles, pain management, and overall quality of life.

Understanding Polycystic Ovary Syndrome (PCOS): A Comprehensive Overview

Before delving into the intricacies of contraception and PCOS, it's crucial to establish a solid understanding of the syndrome itself. PCOS is a complex condition with diverse manifestations, and a clear grasp of its diagnostic criteria, symptoms, and underlying mechanisms is essential for effective management.

Defining PCOS and the Rotterdam Criteria

PCOS is not a singular disease, but rather a syndrome characterized by a constellation of signs and symptoms related to hormonal imbalances and metabolic dysfunction.

The most widely accepted diagnostic criteria are the Rotterdam criteria, which require the presence of at least two of the following three features:

• Oligo- or Anovulation: Infrequent, irregular, or absent menstrual periods.
• Clinical and/or Biochemical Signs of Hyperandrogenism: This includes physical signs like hirsutism (excessive hair growth), acne, and androgenic alopecia (male-pattern baldness), as well as elevated levels of androgens (such as testosterone) in the blood.
• Polycystic Ovaries on Ultrasound: The presence of 12 or more follicles in each ovary measuring 2-9 mm in diameter, and/or increased ovarian volume (>10 mL).

It’s important to note that other conditions that can mimic PCOS must be excluded before making a diagnosis.

The Role of Ultrasound in PCOS Diagnosis

Transvaginal ultrasound plays a vital role in identifying the characteristic polycystic ovarian morphology in women with PCOS. While the presence of multiple small follicles is a key feature, it's crucial to understand that polycystic ovaries alone do not confirm a PCOS diagnosis.

Many women with polycystic ovaries on ultrasound do not have PCOS, and conversely, some women with PCOS may not exhibit polycystic ovaries.

Ultrasound is also used to rule out other potential causes of menstrual irregularities or pelvic pain, such as ovarian tumors or structural abnormalities of the uterus.

Common Symptoms and Manifestations

PCOS presents with a wide range of symptoms, and not every woman experiences the same manifestations. Irregular menstrual cycles are one of the most common indicators, ranging from infrequent periods (oligomenorrhea) to the complete absence of menstruation (amenorrhea).

Hyperandrogenism can manifest as hirsutism (excess hair growth on the face, chest, or back), acne, and androgenic alopecia.

Many women with PCOS experience infertility or difficulty conceiving due to irregular ovulation or the absence of ovulation altogether.

Other associated symptoms include weight gain, insulin resistance, skin tags, and acanthosis nigricans (dark, velvety patches of skin).

Underlying Pathophysiology: Insulin Resistance and Elevated Androgens

The precise cause of PCOS is not fully understood, but two key factors play a central role in its development: insulin resistance and elevated androgens.

Insulin resistance occurs when the body's cells become less responsive to insulin, leading to increased insulin levels in the blood. Elevated insulin levels can stimulate the ovaries to produce excess androgens.

Elevated androgens, such as testosterone, contribute to many of the characteristic symptoms of PCOS, including hirsutism, acne, and irregular periods. Androgens also disrupt the normal development of follicles in the ovaries, leading to the formation of cysts.

These hormonal imbalances can further contribute to metabolic dysfunction, increasing the risk of type 2 diabetes, cardiovascular disease, and other long-term health complications.

Key Diagnostic Tools for Assessing PCOS

Diagnosing PCOS involves a combination of a thorough medical history, physical examination, and laboratory testing.

Blood tests are essential for measuring hormone levels, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, DHEA-S (dehydroepiandrosterone sulfate), and prolactin. These tests help to assess androgen levels and rule out other hormonal disorders.

Glucose and lipid levels are also typically measured to assess for insulin resistance and metabolic dysfunction.

A pelvic exam is performed to assess the reproductive organs and rule out other potential causes of the patient’s symptoms.

The Copper IUD: How It Works, Benefits, and Important Considerations

Having established a foundational understanding of PCOS, it's imperative to examine the intricacies of the Copper IUD as a contraceptive option for women managing this syndrome. This section delves into the IUD's mechanism of action, its unique advantages, potential drawbacks, and critical contraindications, providing a comprehensive overview for informed decision-making.

Mechanism of Action: A Non-Hormonal Approach to Contraception

The Copper IUD stands apart from hormonal contraceptives through its unique mechanism of action. Unlike hormonal IUDs or birth control pills, it does not rely on synthetic hormones to prevent pregnancy. Instead, it leverages the spermicidal properties of copper.

The IUD, once inserted into the uterus, continuously releases copper ions. These ions create a toxic environment for sperm, impairing their motility and viability.

This prevents fertilization by hindering the sperm's ability to reach and penetrate the egg.

Additionally, the presence of the IUD can induce a localized inflammatory response within the uterus, further inhibiting implantation should fertilization occur. This dual action makes the Copper IUD a highly effective contraceptive method.

Contrasting with Hormonal IUDs

The key distinction between the Copper IUD and hormonal IUDs, such as those containing levonorgestrel, lies in their hormonal composition. Hormonal IUDs release progestin, a synthetic form of progesterone, which thickens cervical mucus, thins the uterine lining, and can suppress ovulation.

While hormonal IUDs can offer benefits such as lighter periods, the Copper IUD provides a hormone-free alternative for women who prefer to avoid hormonal contraception due to personal preference, medical contraindications, or concerns about side effects.

Benefits of the Copper IUD

The Copper IUD offers several compelling benefits, making it a suitable choice for many women:

• Long-Term Contraception: The Copper IUD provides effective contraception for up to 10 years, eliminating the need for daily or monthly intervention.

• Non-Hormonal: As mentioned, the absence of hormones makes it a suitable option for women who cannot or prefer not to use hormonal methods. This is particularly relevant for those with hormone-sensitive conditions or concerns about hormonal side effects.

• Immediate Reversibility: Upon removal, fertility returns quickly, allowing women to conceive without delay.

• Cost-Effectiveness: While the initial cost may be higher than some other methods, the long lifespan of the Copper IUD can make it a cost-effective option over time.

Potential Side Effects and Risks

While the Copper IUD offers numerous advantages, it is crucial to be aware of potential side effects and risks:

• Increased Dysmenorrhea (Painful Periods): Many women experience heavier and more painful periods, particularly in the initial months after insertion. This can be managed with over-the-counter pain relievers like ibuprofen or naproxen.

• Menorrhagia (Heavy Bleeding): Similar to dysmenorrhea, increased menstrual bleeding is a common side effect. In some cases, this may lead to anemia.

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• Risk of Pelvic Inflammatory Disease (PID): There is a slightly increased risk of PID, particularly in the first 20 days after insertion. This risk is primarily associated with pre-existing sexually transmitted infections (STIs). Screening for STIs before insertion is crucial to minimize this risk.

• Uterine Perforation: Although rare, uterine perforation can occur during insertion. This is when the IUD passes through the wall of the uterus. It's critical that insertions are only performed by a qualified healthcare provider.

• Expulsion: The IUD can be expelled from the uterus, especially in the first few months after insertion. Women should be taught how to check for IUD strings to ensure it remains in place.

Contraindications: When the Copper IUD is Not Recommended

The Copper IUD is not suitable for all women. Contraindications include:

• Pregnancy: The Copper IUD cannot be inserted during pregnancy.

• Active Pelvic Infection: An existing pelvic infection must be treated before IUD insertion.

• Known or Suspected Uterine Abnormalities: Conditions such as uterine fibroids or distortions of the uterine cavity can make insertion difficult or increase the risk of complications.

• Wilson's Disease: This genetic disorder, which causes copper to accumulate in the body, is a contraindication.

• Copper Allergy: A known allergy to copper is a clear contraindication.

• Unexplained Vaginal Bleeding: Abnormal vaginal bleeding should be evaluated before considering IUD insertion.

In conclusion, while the Copper IUD represents a valuable non-hormonal contraceptive option with long-term efficacy, a thorough understanding of its mechanism, benefits, potential side effects, and contraindications is essential for informed decision-making. Careful evaluation and counseling by a healthcare provider are crucial to determine if the Copper IUD is the right choice for each individual.

Copper IUD and PCOS: Navigating Potential Interactions

Having established a foundational understanding of PCOS, it's imperative to examine the intricacies of the Copper IUD as a contraceptive option for women managing this syndrome. This section delves into the IUD's mechanism of action, its unique advantages, potential drawbacks, and how these factors might intersect with the complexities of PCOS. A thorough understanding of these interactions is crucial for informed decision-making and effective management.

Menstrual Pattern Disruptions: A Common Concern

One of the primary concerns for women with PCOS considering the Copper IUD is its potential impact on menstrual patterns. PCOS is often characterized by irregular periods, heavy bleeding (menorrhagia), or prolonged cycles. The Copper IUD, while offering non-hormonal contraception, can sometimes exacerbate these pre-existing menstrual irregularities.

The mechanism behind this lies in the IUD's local inflammatory effect within the uterus. The copper ions released induce a sterile inflammatory response that is toxic to sperm and prevents fertilization. This same inflammatory process, however, can also lead to increased uterine contractions and blood vessel dilation, contributing to heavier and more painful periods.

While some women with PCOS might experience a worsening of their already irregular cycles or increased bleeding, others might, paradoxically, experience amenorrhea (absence of menstruation). This is less common, but can occur due to various factors, including the suppression of ovulation in some PCOS patients even without hormonal intervention. It's important to note that amenorrhea should always be investigated to rule out other potential causes like pregnancy.

Therefore, women with pre-existing heavy or irregular bleeding due to PCOS should be thoroughly counseled about the potential for these symptoms to worsen after Copper IUD insertion. Close monitoring and appropriate management strategies are essential.

Strategies for Managing Dysmenorrhea

Dysmenorrhea, or painful periods, is another common symptom reported by Copper IUD users, including those with PCOS. The IUD-induced inflammation can increase uterine contractions, leading to more intense menstrual cramps. Managing this increased pain is crucial for ensuring patient comfort and adherence to this contraceptive method.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are often the first-line treatment for dysmenorrhea. These medications work by inhibiting prostaglandin production, which reduces uterine contractions and pain. They are most effective when taken preventatively, starting a day or two before the expected period.

In cases where NSAIDs are insufficient, other pain management strategies may be considered. These could include:

• Heat therapy: Applying heat to the lower abdomen can help relax uterine muscles and reduce pain.
• Transcutaneous electrical nerve stimulation (TENS): TENS units deliver mild electrical pulses that can block pain signals.
• Acupuncture: Some studies suggest that acupuncture may be effective in reducing menstrual pain.
• Prescription pain relievers: In severe cases, a physician may prescribe stronger pain medications.

It's imperative to discuss pain management options with a healthcare provider to develop a personalized plan that addresses individual needs and pain levels. Women with PCOS may already have heightened sensitivity to pain, so a proactive approach to pain management is essential.

Hormonal Profile: Minimal Direct Impact

Unlike hormonal IUDs or other hormonal contraceptive methods, the Copper IUD does not directly alter the body's hormonal profile. This is a significant advantage for women with PCOS, as it avoids the potential side effects associated with exogenous hormones. PCOS is characterized by hormonal imbalances, including elevated androgens (like testosterone and DHEA-S), and often, insulin resistance.

The Copper IUD does not affect estrogen, progesterone (or progestins if using other hormonal therapies), or androgen levels. This means that it will not directly improve or worsen the hormonal imbalances associated with PCOS. Therefore, it will not directly address symptoms like hirsutism (excess hair growth) or acne, which are driven by excess androgens.

However, it's crucial to remember that the Copper IUD also does not interfere with other treatments that are aimed at addressing the hormonal aspects of PCOS. Women can safely use the Copper IUD in conjunction with medications like metformin (for insulin resistance), spironolactone (for androgen excess), or combined oral contraceptives (for cycle regulation and androgen suppression).

The primary benefit of the Copper IUD in the context of PCOS is providing effective, long-term contraception without introducing additional hormonal factors. This can be particularly appealing for women who are sensitive to hormonal side effects or who prefer a non-hormonal approach to contraception.

Medical Management and Treatment Strategies: A Multidisciplinary Approach

Having established a foundational understanding of PCOS, it's imperative to examine the intricacies of the Copper IUD as a contraceptive option for women managing this syndrome. This section delves into the IUD's mechanism of action, its unique advantages, potential drawbacks, and how these factors intersect with the complexities of PCOS. We will further explore the crucial roles of various medical specialists in providing holistic care.

The Gynecologist/Obstetrician: The Primary Caregiver

The Gynecologist/Obstetrician often serves as the primary point of contact for women with PCOS who are considering or using the Copper IUD. Their role extends far beyond simply prescribing, inserting, and removing the IUD. It encompasses a comprehensive approach to managing PCOS itself.

This includes accurate diagnosis utilizing criteria such as the Rotterdam criteria, symptom management, and ongoing monitoring. They assess a patient's suitability for the Copper IUD, considering potential contraindications and individual risk factors.

They are also equipped to address common concerns such as irregular bleeding, pelvic pain, and vaginal discharge. Furthermore, they can manage potential complications arising from IUD insertion, such as infection or expulsion.

When to Consult an Endocrinologist: Addressing Hormonal Imbalances

While the Copper IUD is a non-hormonal contraceptive, PCOS itself is fundamentally a hormonal disorder. This means that an Endocrinologist's expertise is often invaluable. An endocrinologist can provide specialized care for the intricate hormonal imbalances that define PCOS.

Situations that warrant an endocrinological consultation include: persistent or worsening symptoms of hyperandrogenism (hirsutism, acne), uncontrolled menstrual irregularities despite IUD insertion, or suspicion of underlying endocrine disorders contributing to PCOS.

Moreover, endocrinologists can guide treatment strategies aimed at optimizing hormone levels, improving metabolic health, and reducing long-term health risks associated with PCOS. This includes careful monitoring of testosterone, DHEA-S, and insulin levels.

Pain Management: A Holistic Approach

Both PCOS and the Copper IUD can contribute to pelvic pain, necessitating a comprehensive and individualized pain management strategy. This often requires a multidisciplinary approach.

While gynecologists can prescribe initial pain relief measures, such as NSAIDs, a Pain Management Specialist may be consulted for chronic or severe pain. A pain management specialist can offer advanced interventions such as nerve blocks, trigger point injections, or other therapies to alleviate discomfort and improve quality of life.

Psychological therapies such as cognitive behavioral therapy (CBT) may also be considered to manage the emotional and psychological impact of chronic pain. Furthermore, alternative medicine approaches like acupuncture can be used.

Fertility Considerations and the Reproductive Endocrinologist

Many women with PCOS experience infertility due to irregular ovulation or other reproductive challenges. When pregnancy is desired after Copper IUD removal, consulting a Reproductive Endocrinologist becomes essential.

These specialists possess in-depth knowledge of assisted reproductive technologies (ART) and can develop personalized treatment plans to optimize fertility. Such plans may involve ovulation induction medications, intrauterine insemination (IUI), or in vitro fertilization (IVF).

The Reproductive Endocrinologist will also assess and manage other factors that may impact fertility, such as insulin resistance, obesity, and hormonal imbalances. A collaborative approach between the gynecologist, endocrinologist, and reproductive endocrinologist ensures comprehensive care for women with PCOS seeking to conceive.

Exploring Alternative Contraceptive Methods for Women with PCOS

Having established a foundational understanding of PCOS and the multifaceted roles of the healthcare team in its management, it’s equally important to consider the spectrum of contraceptive options available to women with PCOS. The choice of contraception is a deeply personal one, influenced by factors ranging from individual health profiles and lifestyle preferences to long-term family planning goals. This section delves into alternative contraceptive approaches, comparing their benefits and drawbacks, specifically within the context of managing PCOS symptoms.

Hormonal Birth Control (Pills, Patch, Ring) vs. the Copper IUD for PCOS Management

When considering contraceptive methods for women with PCOS, a key point of comparison lies in their ability to address the syndrome's underlying hormonal imbalances. Hormonal birth control, including pills, patches, and vaginal rings, often contains synthetic estrogen and progestin. These hormones can help regulate menstrual cycles, reduce androgen levels, and alleviate symptoms like acne and hirsutism.

Specifically, the combination oral contraceptive pill is a mainstay in PCOS management. By providing a consistent dose of hormones, the pill can reduce the production of ovarian androgens, decreasing unwanted symptoms. This is a significant advantage over the Copper IUD, which offers no direct hormonal benefit and may not alleviate PCOS-related symptoms.

However, hormonal birth control isn't without its drawbacks. Potential side effects can include mood changes, weight gain, and an increased risk of blood clots, particularly in women with other risk factors. Additionally, hormonal methods do not address the underlying insulin resistance that is often a core component of PCOS.

In contrast, the Copper IUD offers a hormone-free alternative. It prevents pregnancy by creating a toxic environment for sperm, thus not interfering with a woman's natural hormonal cycle. While this is appealing for those seeking non-hormonal contraception, it's crucial to acknowledge that the Copper IUD does not directly improve PCOS symptoms and may even exacerbate heavy bleeding.

Hormonal IUDs (Levonorgestrel IUD) Compared to the Copper IUD

The levonorgestrel-releasing IUD (hormonal IUD) presents another important alternative to the Copper IUD. This type of IUD releases a synthetic progestin, levonorgestrel, locally into the uterus. This often leads to lighter periods and can even result in amenorrhea (absence of menstruation) in some women.

For women with PCOS who experience heavy or prolonged bleeding, the hormonal IUD can be a highly effective option. The localized progestin can thin the uterine lining, reducing menstrual flow and alleviating associated discomfort.

However, it's important to note that while the hormonal IUD is generally well-tolerated, it is not without potential side effects. Some women may experience hormonal side effects such as mood changes, breast tenderness, or acne.

Furthermore, the hormonal impact is less systemic compared to oral contraceptives, therefore it is unlikely to substantially alter the circulating androgen levels. The hormonal IUD's impact on androgen-related symptoms in PCOS is less pronounced compared to the combined oral contraceptive pill.

Choosing between a hormonal IUD and a Copper IUD requires careful consideration of individual needs and priorities. If symptom management, particularly reducing heavy bleeding, is a primary goal, the hormonal IUD may be a more suitable option. If the primary goal is non-hormonal contraception, then the Copper IUD is a suitable option.

Considerations for Using Birth Control Pills (Oral Contraceptives) to Manage PCOS Symptoms

Birth control pills, specifically combined oral contraceptives containing both estrogen and progestin, are frequently prescribed to manage a range of PCOS symptoms. They help regulate menstrual cycles, reduce androgen levels, and can improve acne and hirsutism. The estrogen component increases sex hormone-binding globulin (SHBG), which binds to free testosterone, reducing its impact.

However, it's important to consider the specific type of progestin used in the pill. Some progestins have androgenic properties, which can potentially worsen acne or hirsutism in sensitive individuals. Therefore, healthcare providers should carefully select pills with lower androgenic activity.

Another important consideration is the increased risk of blood clots associated with estrogen-containing birth control pills, particularly in women who are overweight or have other risk factors. The benefits and risks must be carefully weighed.

In conclusion, when managing PCOS symptoms, hormonal birth control pills offer a multifaceted approach by addressing menstrual irregularities and reducing androgen levels. Careful consideration of the progestin type and potential risks is essential for optimal management. Ultimately, the choice of contraceptive method should be a shared decision between the healthcare provider and the patient, tailored to the individual's unique needs and circumstances.

Patient Education and Counseling: Empowering Informed Decisions

Having established a foundational understanding of PCOS and the multifaceted roles of the healthcare team in its management, it’s equally important to consider the spectrum of contraceptive options available to women with PCOS. The choice of contraception is a deeply personal one, influenced by individual health considerations, lifestyle factors, and reproductive goals. Effective patient education and counseling are paramount in ensuring that women with PCOS can make informed decisions about their contraceptive options and overall health management.

The Cornerstone of Care: Informed Consent

Informed consent transcends being a mere formality; it is the ethical and legal bedrock of patient-centered care. It requires healthcare providers to furnish patients with comprehensive information regarding the risks, benefits, alternatives, and potential complications associated with a proposed treatment or intervention. In the context of Copper IUD use for women with PCOS, this necessitates a thorough discussion of the IUD's mechanism of action, potential side effects, and its suitability given the patient's specific PCOS presentation.

This process must also encompass a frank discussion of alternative contraceptive methods, including hormonal options, barrier methods, and sterilization, enabling patients to weigh the pros and cons of each in light of their individual circumstances.

Furthermore, the limitations of the Copper IUD must be clearly articulated, especially regarding its inability to directly address the underlying hormonal imbalances characteristic of PCOS.

Transparency and Open Communication

Transparency is not just about disclosing information; it's about fostering trust. Providers should actively encourage patients to ask questions, express concerns, and seek clarification on any aspect of their care. This necessitates a patient-centered communication style, devoid of medical jargon and tailored to the individual's level of understanding.

Shared Decision-Making: A Collaborative Approach

Shared decision-making embodies a paradigm shift from the traditional paternalistic model of healthcare, where the provider dictates the course of treatment. Instead, it advocates for a collaborative partnership between the healthcare provider and the patient, where both parties contribute their expertise and preferences to arrive at a mutually agreeable decision.

For women with PCOS, this entails a comprehensive assessment of their individual needs, values, and priorities, alongside a thorough evaluation of their medical history, lifestyle, and reproductive goals. The provider's role is to present the available options, elucidate the potential benefits and risks of each, and answer any questions the patient may have.

Patient Preferences and Quality of Life

One of the crucial elements of shared decision-making is the explicit consideration of the patient's preferences and values. This involves exploring the patient's views on various contraceptive methods, their tolerance for potential side effects, and their overall goals for managing their PCOS symptoms.

Quality of life considerations should also be central to the discussion, recognizing that the impact of a contraceptive method on a woman's physical, emotional, and social well-being can significantly influence her adherence and satisfaction.

By engaging in shared decision-making, healthcare providers empower women with PCOS to take an active role in their healthcare, fostering a sense of ownership and control over their bodies and reproductive health. This approach not only enhances patient satisfaction but also promotes better health outcomes and improved quality of life.

So, there you have it! Navigating the world of the copper IUD with polycystic ovaries can feel a little overwhelming, but hopefully, this gave you some clarity. Remember, everyone's experience is unique, so chat with your doctor to figure out what's best for you. Good luck on your journey!