Roaccutane and contraception

[OverHereBitches]

This will be long so bear with me...

For those who don't know, roaccutane is an acne medication which is very strong and can have horrible side effects, including depression and birth defects but there are plenty more. It is so strong and the side effects can be so bad that there are even many people who think it should be banned and are trying to do exactly that.

Understandably because of the birth defects you must not get pregnant while on it. The manufacturers highly recommend using contraception while on it and for one month afterwards and insist on pregnancy tests whilst on it.

Even though contraception isn't compulsory (I will get to that bit later), at least not in the UK or US, there are still a great number of dermatologists who insist it is and simply will not prescribe to anyone who isn't on contraception. It doesn't matter if you're not sexually active and have no intention to be because they "can't take your word for it" that you won't have sex (yet they have no problem taking your word for it and believing you when you say "yup, doc, I'm on the pill" ). Nope, you must take contraception.

I can understand why. Really I do. You really do not want to get pregnant while on it, the birth defects are really horrible. But somehow I just can't help but think that it is fucking offensive that women have to have their hand held and be treated like children when it comes to pregnancy and babies. All medications involve an element of trust between doctor and patient but when it comes to women and their reproductive organs and their sex lives then they are too fucking stupid to be trusted and have to be guided and have their hand held all the way.

Also roaccutane obviously has side effects. Contraception can also have really bad side effects for some women too. I have known women who have suffered depression, mood swings, non stop bleeding, bad headaches to the point of being sick, etc whilst on the pill/injection/imlplant/whatever. So you then have to basically put up with the side effects of the roaccutane and the contraception. If you're not even sexually active them it just seems insane to me to do that and take unnecessary medication and put up with even more side effects.

Also I mentioned depression is a possible side effect of roaccutane and hormonal contraception. So in other words women would have to put up with double the risk of depression.

I'm aware that contraception isn't actually mandatory while on it (although the number of dermatologists who insist it is is just astounding) but it is so heavily reccomended that it might as well be.

In case anyone thinks I'm cracking up with that last point, it is certainly not compulsory in the UK or the US. I have no idea about other countries.

"Do all women have to enter the Pregnancy Prevention Programme?
Women who are not sexually active, or who are unable to become pregnant due to medical reasons, or who have been sterilised, may be excluded from the Pregnancy Prevention Programme."
-- The British Association of Dermatologists

And in the US where they have the ipledge program you're actually meant to choose two forms of contraception, a hormone method and a barrier method. However you are allowed to select abstinence as your first method of contraception and "nothing" as your second (and I have known people who have done exactly that).

"iPLEDGE guidelines suggest that abstinence is not advised, but is an acceptable option when chosen for religious, lifestyle, or medical reasons."
-- here

Yet of course there are some people who have been brainwashed to think that contraception is compulsory that anyone who has chosen to opt out of it and not taken it with the agreement of their doctor is "breaking the rules" .

I have heard the whole "you should take contraception just in case you are raped" but I don't even want to go into how fucking offensive that argument is. I have been raped before and it just smacks of victim blaming to me and I do find it fucking offensive. I guess these people just think all women should be on contraception all of the time "just in case" they are raped. Unless of course they're trying for a baby in which case they should be locked in a tower with access to their husband only .

.

[Thistledew]

I think it is more to do with not getting sued than any notions about women's sexuality. It's about demonstrating that the doctors have done all they can to make sure that the likelihood of conception is kept as low as possible. Insisting that the woman takes contraception is a box that can be ticked in a far easier way than lecturing about abstinence, as people do get carried away, think they can rely on withdrawal/natural family planning etc.

[lougle]

How depressed do you think a woman might be if their child is born with (preventable) disability because they feel pregnant while on the drug?

[HeyheyheyGoodbye]

I wasn't pressured to go on contraception when I was on Roaccutane. Maybe because I was already on anti-depressants so they didn't think it was worth the risk of messing with my hormones. But I know my consultant didn't force any female patients to take the pill so long as they signed something saying they understood they must rigorously avoid pregnancy.

I'm a bit torn on this issue. On the one hand I agree that it is annoying for female patients to face this pressure, but on the other hand, the doctors need to do everything they can to avoid further complications. Hmm.

Side note: Roaccutance completely changed my life and I would suffer the (admittedly awful) side-effects all over again if I had to. For me it was a miracle drug.

[PuffinsAreFicticious]

Yup, because trusting women is just too ridiculous, isn't it.

What with us all being lying snakes with tits and all.

If a doctor has informed a woman of the consequences of becoming pregnant while using roaccutane and the woman signs to say that she understands, then that is all that needs to happen.

If the woman becomes pregnant, there is the option of termination.

All sorted, no one is forced to take hormonal contraception against their wishes or inclination.

[AuntieStella]

I've always thought that it is because doctors are the people who do see PGs arising from contraception failure, hence for the duration of treatment with a highly teratogenic drug they want to see that risk (no matter how small) removed.

It's not solely about trusting women. It's about trust in contraceptive technology, and all bar abstinence or surgery (eg hysterectomy) have a failure rate (even sterilisations can fail).

[TonightTonight]

I know my experience is merely anecdotal but I wasn't pressured about contraception at all when I was prescribed roaccutane in 2007. I was given the advice about pregnancy risks obviously, as you would expect. Are your concerns based on a survey or a study? Can you link?

[RabbitOfNegativeEuphoria]

DD1 was on Roaccutane for - well, it seemed like a lifetime but it was about 10 months in all I think, she had to take breaks and a low dose because it affected her physically , her body couldn't tolerate the maximum dose, which people usually work up to and then maintain, she had to switch between the beginner's dose and the medium dose throughout the course. This really dragged it out. The hospital were great with her, actually, took her side effects (which were considerable) very seriously and provided a very high standard of care. She had to do a pregnancy test once a month but she was not pressured at all to go on hormonal contraception (there are some quite strong contra-indicators for her for this anyway).

Fingers crossed, the treatment worked, so she is glad she took it - the side effects were brutal though. But, she feels (and felt right the way through) on balance worth it.

[lougle]

I know that it seems ridiculous that women aren't 'trusted' but I can count 4 women that I know personally, who have conceived unintentionally, who all thought they were 'safe'. Reasons such as 'we thought DP had dodgy sperm because when we forgot to use a condom once I didn't get pregnant.'

Lots of women are not knowledgeable about safe sex. It stands to reason that of a doctor is going to prescribe a treatment that can do good and harm, it is their duty to either insist on precautions being taken, or insist that a disclaimer is signed.

[YonicScrewdriver]

Lougle, I think stating and practicing "abstinence" is a bit different to your example.

[PuffinsAreFicticious]

I understand that contraception fails. Been there, done that. It is solely about not trusting women.

A doctor stating exactly what will happen in the woman becomes pregnant while taking this medication, advising her on what kinds of contraception are recommended and then asking her if she has any questions before she signs a disclaimer is all that's needed. This belief that women are too untrustworthy or too stupid to make informed decisions about their bodies really annoys me.

[scallopsrgreat]

"Women who are not sexually active, or who are unable to become pregnant due to medical reasons, or who have been sterilised, may be excluded from the Pregnancy Prevention Programme."

And lesbians? Perhaps? Maybe? If the wind is blowing in the right direction? Incredibly heteronormative assumptions there.

"iPLEDGE guidelines suggest that abstinence is not advised" YY. Wouldn't do for the men to do without

[carlsonrichards]

It does niggle that homosexuality is not exempted. A lesbian is not going to become pregnant without assisted conception.

[Amethyst24]

What bothers me most about this is the squeamishness around abortion. If we were honest about that, then doctors could say to women, "Look, if you find yourself pregnant while taking this drug it would be a terrible idea. So you'll use all sensible contraceptive measures, and if the worst happens, you'll terminate the pregnancy, is that okay?" And the woman says, "Yes, of course, just get rid of this fucking acne." And then everyone knows the score.

But I can see how medical practitioners are ultra-wary of finding themselves in a position where a woman (or her family) has a change of heart in the event of an unplanned pregnancy, and the baby is born terribly damaged, and then they get sued and there's such a fuss in the press that the drug gets withdrawn.

It's just excessive wariness of lawsuits, as far as I can tell, with women getting the sharp end of it.

[MyNameIsNotReallyAlexa]

And lesbians? Perhaps? Maybe? If the wind is blowing in the right direction? Incredibly heteronormative assumptions there.

Speaking of lesbians there was a thread here a couple of months ago where the OP was a lesbian in a long term relationship with a woman. The poster in question was going to try roaccutane as a last resort for her acne but she was wary about taking contraception while on it and didn't really want to. IIRC this was because she had never taken hormonal contraception before and was worried about any side effects she might have to deal with along with any side effects of the roaccutane she may have (a perfectly valid worry imo). Also she couldn't take the pill so it would have to be a longer method of contraception like the implant or injection. Also IIRC again she had never actually had sex with a man before.

However she did say that if contraception was really necessary she would grit her teeth, take it and get on with it but understandably she would prefer to opt out if that was an option.

Most people who replied were nice and understanding however there were a certain two regular posters who were just downright nasty to the OP (okay only one of them was really overly harsh, the other one I think was at least trying to be helpful and understanding but still come across as harsh imo). The OP of that thread really came in for a beating and was told constantly how "disgusting" she was for even daring to consider taking roacutane without contraception, how it would be her fault if the drug gets withdrawn, etc. She was also told constantly that she would be raped because she was a lesbian () so she just take it for that "just in case" (disgusting attitude to have imo). Even when the OP repeatedly said that she was going to use contraception if necessary she was immeditley shot down and called a "liar".

The thing is though in that thread it was pointed out by several posters and even a doctor that contraception wasn't actually compulsory while on it and you can opt out of it. They backed this up with their own experiences and also with sources online. But these two posters either ignored them or again resorted to bashing those posters instead.

It was a very strange thread to say the least.

[tywysogesgymraeg]

Roaccutane is a great drug when taken properly. It changed my life in my 40s, after a lifetime of acne.

I think that contraception whilst on the drug cannot be emphasised enough, and should even be compulsory. Even people who are not sexually active when being presecribed the drug can have unplanned sex whilst on the drug. My DH had had a vasectomy. I was still advised to take contraception in case I went elsewhere! Fine by me - I wasn't planning to, but I can understand that the medics need to protect themselves from litigation.

[MyNameIsNotReallyAlexa]

The only reason I brought that up was because I have actually spoken to the OP of that thread since then and she was very upset by that particular poster as she was sexually abused and raped as a child. She said that reading that she has a good chance of getting raped again was like being kicked in the stomach and brought up a lot of bad memories. She also thought that she was being blamed somehow and should be held responsible.

I haven't spoke to her for about a month now but she did tell me that her dermatologist had allowed her to opt out of taking contraception so she didn't have to take it. She also told me that her doctor had actually told her that nope contraception is not compulsory, just very strongly advised.

[MyNameIsNotReallyAlexa]

tywysogesgymraeg the thing is though how exactly would you make taking contraception compulsory? From what I understand and from speaking to people who prescribe it, one of the main reasons it's not actually compulsory is because it can't actually be enforced.

People may well lie (and they do) about being on the pill or whatever. And as nobody actually checks you're using contraception they just take your word for it that you are. Unless the doctor actually comes to your house and physically shoves the pill down your throat how exactly can it possibly be made compulsory?

Also as mentioned above contraception can have terrible side effects too. If you're not sexually active then why would you want to take unnecessary medication and have to deal with the side effects of both the contraception and roaccutane?

[RabbitOfNegativeEuphoria]

tywy I would be very at anyone who suggested that my 15/16 yo DD was disgusting for not taking contraception while she was on roaccutane. I would also be more than at anyone who suggested she should be made to take it (in the light of her other medical issues which mean it would not be a good idea at all).

[PenguinsandtheTantrumofDoom]

I think for me there are two categories.

If you are a woman who reports that she is sexually active in a hetrosexual relationship, I don't have an issue with the doctor wanting to talk through your contraceptive choices. We all know that contraception can fail. We all know people who have had 'interesting' ideas about contraception. I think a straightforward conversation and a discussion about the merits of using two forms makes sense. Not policing women, but giving a full picture and, for example, advising that condoms alone may not be the best choice if a secondary option is viable.

For anyone who reports that they are not, and do not plan to be sexually active (with a man), a frank discussion about the risks of pregnancy on the drug should be plenty.

[MyNameIsNotReallyAlexa]

Ironically the dermatologists who I know report that those who do end up pregnant on roaccutane tend to be the ones who insist they are using contraception. Their pregnancy is either the result of contraceptive failure or obviously not being truthful about it.

The women who opt out of taking contraception because they insist they aren't sexually active actually tend to be the ones who are fine and don't end up pregnant on it anyways.

A dermatologist told me that out of the hundreds of women he's prescribed roaccutane to who have decided not to use contraception only about half a dozen have become pregnant.

Compared to those who have used contraception (or have said they are) out of around the same number, there were actually a hell of a lot more pregnancies. He does know that a lot of them were contraception failures as there were several who clearly had the impant or coil still in place. Obviously he wouldn't be able to monitor injection use or pill use in more depth as that is user controlled but obviously there will simply be contraceptive failure from this method too.

[MyNameIsNotReallyAlexa]

To be fair RabbitOfNegativeEuphoria that poster didn't say that, it was the other poster in the thread I was talking about who called the OP "disgusting" (and other nasty things) because she wasn't keen on using it. Anyone who posted to say it wasn't actually compulsory to take contraception and also backed it up with evidence was shot down too.

I found that posters attitude to women and rape the only disgusting thing about that thread tbh.

[tywysogesgymraeg]

I never mentioned the word "disgusting"?????

[SweetDreamsSusie]

I wasn't pressurised to take contraception while on roaccutane. I was made aware of the risks about what would happen if I did get pregnant and I was told that it was highly recommended that I be on the pill but I could opt out of it if I wanted to. So in the end I didn't take contraception but I did have to be counselled a bit more on that decision and I had to sign an opt out form.

The main reason I didn't want to take contraception was because I was a virgin with no intention of becoming sexually active and because of this had never used hormonal contrception before. So I didn't really want to have to put up with side effects from both of them (like has already been mentioned).

Good thing too as I discovered later when I started using hormonal contraception that it all pretty much sends me loopy and give me other several bad side effects. Considering that roaccutane also sent me slightly loopy and I had quite a fair few side effects on that too so I really dread to think what I would have been like if I had taken both together and had to deal with all of those side effects at once.

IME HCP's tend to be more strict with contraception when it comes to teenagers taking it. With adults they tend to be more "you're an adult, you're responsible for yourself".

[SweetDreamsSusie]

Alexa I remember that thread and I was a bit at some of the responses. The OP's concerns about possible side effects of contraception and the roaccutane together were merely brushed aside by that one poster and she was basically told she was making excuses and of course it doesn't have side effects . I beg to differ - hormonal contraception is exactly that - hormonal! So of course it's going to cause side effects, some of which can be really bad for some women. The OP's concerns were valid imo.